|The following article features coverage from the Oncology Nursing Society (ONS) 2019 Annual Congress. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
ANAHEIM, CA — Clinical photography provides detailed documentation of tumors, infection sites, and visible signs of disease over time. Including the images in electronic medical records (EMRs) also enables all clinicians to follow patient assessments in real time, according to a poster presentation at the Oncology Nursing Society (ONS) 44th Annual Congress.
The radiation oncologists included in the study often work at another distant facility or in a laboratory outside the cancer center, which left care decisions in their absence to covering physicians. In addition, the multidisciplinary team, including medical oncologists, surgeons, radiation oncologists, wound management nurse practitioners, and others, work in different locations throughout the health system.
A review of tumor or wound care issues by numerous clinical team members could require the patient to endure multiple dressing changes and has the possibility of being traumatic. For this reason, communicating tumor or wound status to all members of the patient’s care team, while essential, was challenging, explained John Hillson, RN, BSN, BA, OCN®, of Duke Cancer Institute in Durham, North Carolina, during a poster presentation. Patients’ ability to monitor their own treatment site was also a challenge. For example, a study of patients referred for Mohs surgery found that few patients were able to identify their surgical site or to see their biopsy sites. Furthermore, less than half had chart notes and few of them included photographs or high-quality diagrams.
Clinical photography is an objective measure of the appearance of visible lesions over time and provides detailed documentation of a treatment field. In addition, the center’s electronic medical record (EMR) has the capability to accept uploaded clinical photographs and to allow clinicians to route notes to relevant members of the multidisciplinary team. Mr Hillson and colleagues sought to improve continuity of care through expanding the use of clinical photography to nursing notes in the EMR.
As a radiation oncology department, the researchers were already using clinical photography for the purpose of quality control. The department owned several digital cameras, and the institution’s informed consent documents included language that allowed clinical photographs of treatment areas. Despite this, the researchers found that many nurses were unfamiliar with how to use the camera, so an in-service and handout materials were created.
In the 2 years clinical photography has been in place, all stakeholders have had a positive response, reported Mr Hillson. Clinical photography has been used to communicate surgical infections, potential new or treatment-resistant disease, and toxicities from treatment. Use of clinical photography has become common for easily visualized tumors such as sarcomas and anal cancers, and has been incorporated into weekly treatment visits for patients undergoing radiation therapy for skin cancer and head and neck cancer.
The value of clinical photography is fully realized when clinicians who may not have been present at a patient’s consult are called on to make an assessment during a treatment visit. This allows clinicians to be better informed and provide appropriate feedback and guidance to patients, Mr Hillson explained.
Despite how effective clinical photography can be, he warned of a few caveats. Accurate and thorough documentation is still important. Critical elements such as pain, functional deficits, drainage, odor, and presence of a fever cannot be captured in a photograph. Composition is also important. For example, anatomical landmarks need to be captured when possible, close-ups should be paired with more distant images to adequately reflect location, images from several angles may be needed, and including a piece of disposal measuring tape to assist size comparisons.
The researchers also noted feedback that was received regarding future process improvements. Nurses noted that the upload process could be simplified and that doing so may result in more pictures being taken. Physicians asked that the photographs be added to the Imaging tab in the EMR instead of nursing notes to improve visibility and comparison of photos across time.
Hillson J, Mowery Y, Allen D. Use of clinical photography in radiation oncology. Poster presentation at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA.