Chronologic vs Narrative: Oncology Clinicians Have a Preferred Patient History Format

A group of researchers sought to determine which format — chronologic or narrative — was preferred among oncology clinicians. For this study, the National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group was asked to distribute a survey on oncology history documentation style preferences to their member institutions. The findings were published in JCO Oncology Practice.

The team collected responses over the course of 6 weeks. By the end of the data collection period, they had received responses from a total of 562 clinicians from 19 institutions.

The survey contained 2 examples of oncology patient histories: The first was an edited narrative history of a patient with colon cancer that included key clinical events, first-person comments, and other details. The second was a list of bullet points with dates in chronological order based on the narrative summary, but it omitted clinical and personal details except the ones determined to be necessary for understanding the decision making. It then asked participants 2 questions:

• Which summary better prepares you for your first encounter with this established patient?
• Which summary would serve as a better foundation for documentation of your own clinic visit?

The majority of the respondents (66%) replied that they preferred a chronologic history when preparing for a visit with an unknown patient. Seventy-seven percent replied that they preferred a chronologic history when preparing their own notes.

The researchers noted that this is the first large study of documentation style preferences for oncology histories. But it does have some limitations. The survey relied upon a convenience sampling strategy and just 1 consensus-derived example of each oncology history format. The respondents represented large multidisciplinary academic centers that might include a different mix of providers than one would find at a community oncology center, which may affect the generalizability of these findings.

“Our results should be regarded as informative and hypothesis-generating,” the researchers noted.

Although these findings suggest that a chronologic history format has some advantages over a narrative history, it may also have some weaknesses.

“Providers using or considering this format should be encouraged that it’s well-received, but note the potential for loss of a patient story and nuances of [social determinants of health],” they concluded. “Further research is required to understand how to effectively use this format in clinical practice to satisfy the needs of both note authors and readers.”

Disclosures: Some study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Martin DB, Stetson PD, Gilcrease GW, et al. Preferences in oncology history documentation styles among clinical practitioners. JCO Oncol Pract. Published online July 6, 2021. doi:10.1200/OP.20.00756