The use of electronic narratives records to support the decision-making process in oncology care at private hospitals in Cape Town

Abstract

Electronic narratives are recognised for their significant contribution to healthcare – emphasising that the patient’s narrative should not only be included, but valued. The survival rate of cancer patients in the UK, USA, Italy and Australia are improving, making it necessary to investigate the use of electronic narratives in private oncology centres. This research, conducted in Cape Town, South Africa, started off by critically analysing available scientific information. Subsequently, a gap was identified regarding the use of electronic narratives as a way of acquiring important data from patients – something that is crucial in the treatment process (from the pre-diagnosis to the follow-up), and in decision-making. The lack of narratives in electronic health records (EHRs) could affect the quality of the decision-making process, particularly for chronic non-communicable diseases (NCD); which could result in administering incorrect dosages of medication leading to deterioration of the patient’s health, and in some cases, even death. The purpose of this research was to explore the use of narratives in electronic health records to support the decision-making process by healthcare professionals in private oncology care. The study was qualitative; hence interviews were used for data collection. A purposive sample of eighteen healthcare professionals (oncologists, psychiatrists and general practitioners) was used in this study. The data was then analysed thematically, and the interpretation thereof done subjectively. The key findings of this study indicate that electronic health records are used considerably in private oncology care due to benefits such as real-time access to information and easy back-up. Healthcare professionals acknowledge that narratives are present in oncology care, and mainly used in the diagnosis phase. These narratives are mostly in note format (hand-written on paper). These written notes are then later recorded into the patient’s electronic health record which, in many cases, results in the omission of important information, because not everything the patient said is transcribed into medical jargon. The current system in private oncology care does not support electronic narratives even though healthcare professionals express an interest in using this. The findings further suggest that to successfully implement electronic narratives, there are basic prerequisites such as a computer or tablet, recording devices and software. Furthermore, the findings show that electronic narratives are often not used due to limited knowledge, lack of interest, specific cultural practices, and the fear of change. To alter and positively transform healthcare professionals’ and patients’ views of electronic narratives, the researcher recommends educating healthcare professionals about the value of patients’ narratives. In other words, providing training is crucial as narratives contain values that aid constructive decision-making. Furthermore, since narratives involve patients, extending training to the patients will be beneficial. The findings of this study contribute to the current literature on electronic health records and narratives in private oncology care of South Africa.