JMIR Publications

ABSTRACT

Background:

A crucial tenet of person-centered care (PCC) and concordance during the cancer patient treatment trajectory, is shared decision making (SDM). This is enhanced when patient information is well documented in Electronic Health Records (EHRs). Patients may access clinical narratives or summaries to read about their condition and treatment. In oncology this has been shown to stimulate patient engagement. However, the unstructured information in EHRs is often incomplete, delayed, or noted in negative tones that may obscure patient preferences and priorities. Suboptimal oncologist communication and treatment discordance may result from missing documentation - or narrative content that is not person-centered.

Objective:

This scoping review explores oncologist narratives in EHRs in relation to treatment concordance and PCC. The aim is to explore documentation patterns and themes in a secondary analysis of oncology EHR related studies that can influence PCC concepts and person centred communication.

Methods:

Following PRISMA-ScR guidelines, we conducted a scoping review of studies published between 2015 and early 2026 that use Natural Language Processing - primarily Text Mining - of oncologist narratives in EHRs. Qualitative reports and conventional surveys into the oncologist EHR experience are included. Data were charted by topics such as adverse effects, note style, stigma, time barriers and workflow burden. A discourse analysis with narrative synthesis was conducted.

Results:

Forty (40) studies met the inclusion criteria. Four clinician side themes emerged: (1) Compliance-orientated EHR design factors may hinder PCC and treatment concordance (2); Incomplete or delayed documentation that fails to report patient priorities such as, adverse effects, social determinants of health or prognostic conversations; (3) Formal language styles in notes that may suggest bias or stigma; (4) An excessive time and cognitive burden for oncologists to source information and input EHR data.

Conclusions:

EHRs may not be aligned with PCC that promote shared decision making (SDM). A medication compliance focused design may produce a mechanistic approach to care that impacts patient narratives. Conversely, person-centered design can stimulate patient engagement to enhance shared decision making (SDM) and treatment adherence. EHRs may lack features to support treatment concordance and fully operationalize PCC.