Leon Wreyford

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.

Background: Documentation in oncologist Electronic Health Records (EHRs) plays a critical role in communication, shared decision-making, and the detection of adverse effects all of which influence treatment concordance and adherence. However, narrative content is often incomplete, delayed, or written in formal styles that obscure patient priorities. Methods: Following PRISMA-ScR guidelines, we conducted a scoping review of studies published between 2013 and early 2024 that used natural language processing (NLP) or text mining on oncologist notes, or qualitatively examined EHR use in oncology. Data were charted by topic (e.g., adverse effects, note style, stigma, workflow burden) and synthesized using discourse analysis. Results: Twenty-three studies met inclusion criteria. Four clinician-side themes emerged: (1) compliance-oriented EHR design; (2) incomplete or delayed documentation of adverse effects, pain, and social determinants of health (SDOH); (3) formal or stigmatizing language; and (4) time and cognitive burden limiting person-centred narratives. These factors hinder concordance documentation and communication transparency. Conclusions: Improvements in EHR design, including person-centred prompts, plain-language templates, and audit-log-informed workflow changes, may enhance adherence by supporting better documentation and communication. Nursing and service leaders can implement these changes to promote trust, engagement, and continuity of care. Registration: Not registered.

Background: Treatment nonadherence in oncology is common. Surveys often miss why patients do not follow recommendations. We synthesised Natural Language Processing (NLP) studies, mainly sentiment analysis, of patient-generated content (social media, forums, blogs, review sites, and survey free text) to identify communication and relationship factors linked to nonadherence and concordance. Methods: We conducted a scoping review (PRISMA-ScR). Searches of PubMed, CINAHL, and Scopus from 2013 to 15 June 2024 identified eligible studies. We included 25 studies. Data were charted by source, cancer type, NLP technique, and adherence/concordance indicators, then synthesised via discourse analysis and narrative synthesis. Results: Four themes emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear concordance within person-centred care; and (4) misinformation dynamics and perceived clinician bias. Sentiment analysis helped identify emotions and information gaps that surveys often miss. Conclusions: Patient-voice data suggest practical actions for nursing, including routine distress screening, teach-back, misinformation countermeasures, and explicit concordance checks to improve adherence and shared decision making. Registration: Not registered.

Background: Treatment nonadherence in oncology is prevalent and often assessed by surveys that miss the qualitative reasons underpinning nonadherence or treatment discordance. We aimed to synthesize evidence from Natural Language Processing (NLP) studies, primarily sentiment analysis of patient generated content (social media, forums, blogs, review platforms, and survey free text), to identify communication-related and relational factors linked to nonadherence/concordance. Methods: We conducted a scoping review following PRISMA-ScR. Searches of PubMed, CINAHL, and Scopus (2013 early 2024) targeted NLP studies of the cancer patient experience; conventional reports were included where they clarified communication/adherence constructs. Data were charted against source, cancer type, NLP technique, and inferred adherence/concordance factors, then synthesized using discourse analysis and narrative synthesis. Results: Four patient side themes consistently emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear treatment concordance within patient/person-centred care; and (4) online misinformation dynamics (and perceptions of clinician bias). Sentiment analysis detected fine grained emotions (fear, disgust, sadness, surprise), informational gaps and trust issues that are often less visible in structured surveys. Conclusions: Patient voice data offer actionable insights for nursing practice: routine distress screening, teach back strategies, misinformation countermeasures, and explicit concordance checks. Integrating these into person-centred workflows may improve adherence and shared decision making. Registration: Not registered.

Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients—published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: ‘Physician factors can influence patient factors in treatment nonadherence’. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors—with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of ‘treatment adherence’ receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.