Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample (Preprint)

Abstract

Studies exploring the workload in health care focus on the doctors’ perspectives. The ecology of the health care environment is critical and different for doctors and patients.

In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient’s perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use).

We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors’ use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41%). A majority (n=81, 60%) of them were White, and only (n=16, 11.85%) went to graduate schools.

The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients’ satisfaction during the visit. A total of 80% (n=108) of patients experienced an overall high level of workload. Despite almost 55% (n=75) of them experiencing a high mental load, 71.1% (n=96) reported low levels of effort, 89% (n=120) experienced low time pressure, 85.2% (n=115) experienced low frustration levels, and 69.6% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95% CI 0.001-2.34; <i>P</i>=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95% CI 0.002-2.64; <i>P</i>&lt;.001), the physical load (OR 0.194, 95% CI 0.004-4.23; <i>P</i>&lt;.001), the time load (OR 0.183, 95% CI 0.02-2.35; <i>P=</i>.046) the effort needed to cope with the environment (OR 0.163, 95% CI 0.05-1.69; <i>P</i>&lt;.001), and the frustration levels (OR 0.323, 95% CI 0.04-2.55; <i>P</i>=.03). The patients’ perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95% CI 0.08-6.35; <i>P</i>=.01) and the high frustration level experienced (OR 0.111, 95% CI 0.015-3.75; <i>P</i>&lt;.001).

The study’s findings established pathways for future research and have implications for cancer patients’ workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors.