The pathology report is a key document that contains critical information for the proper diagnosis and prognosis of a patient. It is used to communicate key pathologic findings to users of the pathology report: oncologists who will use this document to base treatment options and cancer registries that use key attributes of cancer cases for surveillance and research purposes. The synoptic report can provide a standard format that contains key information consistency for users of the report. The Vancouver Island Health Authority (VIHA) was the first to adopt this innovative method of pathology reporting within British Columbia. A mixed methods research study design using both qualitative and quantitative techniques to evaluate a synoptic reporting system’s impact on pathology reporting was used in this study. The impact of synoptic reporting was evaluated based on the utilization of the synoptic summaries and the perceived effect on the quality and processes of pathology reporting from the perspectives of pathology reporting stakeholders. Pathology reports obtained from VIHA and British Columbia Cancer Agency (BCCA) databases were audited to obtain information on the amount of synoptic summaries included in pathology reports and whether this inclusion was associated with any pre-defined variables. Pathology reporting stakeholders’ perceptions data was obtained by a self-administered web survey distributed to VIHA pathologists, Victoria location British Columbia Cancer Agency (BCCA-VICC) oncologists and BCCA Cancer Registry management. Out of the reports generated by VIHA pathologists, only 3.5% (593/17430) of them contained a synoptic summary, 5.4% (590/10990) when only considering the pathology reports that were associated to a CAP checklist and activated within the system. According to the VIHA database, it was determined that 16.2% (2819/17430) cases were malignant suggesting that inclusion of synoptic summaries is not being done for the vast majority of malignant cases contrary to expectations. This was further confirmed by the BCCA audit, which contained primarily malignant cases but also had additional non-malignant (benign) cases requested by the BCCA. The BCCA audit revealed that 18.6% (58/312) reports included a synoptic summary, 19.7% (58/294) when only considering the pathology reports that were associated to a CAP checklist and were activated within the system. Differences with the synoptic summary inclusion were found in: individual pathologists, procedures performed, sites of report generation, tumor groups, tumor types, and malignancy status of the specimens. Variation was observed in the perceptions surrounding the quality of the pathology report. Pathologists’ responses were highly variable to the majority of questions in all categories, demonstrating the polarizing views within the community. Pathologists overall had a more favorable opinion of the current pathology report (including synoptic summary) generated, where users (oncologists and registry) had a more favorable opinion of the perceived impact of synoptic summaries on pathology reports and a more favorable opinion regarding improvements that could be made in pathology reporting. While VIHA has taken a significant step forward, being the first health authority in British Columbia to implement synoptic reporting (synoptic summaries), further improvements can be made to better enhance the adoption. / Graduate / 0571 / 0769 / bornfurtado@gmail.com

The healthcare today is experiening a greater burden since diseases suchas cancer are more common. The diagnostic parts of the healthcare, suchas radiology and pathology, are aected with increased workload. Duringthe past several decades, systems for structured reporting in radiology havebecome available in a try to facilitate their work ow. The introduction ofdigital pathology has enabled the possibility to introduce structured reportingin pathology as well. The question is whether it can facilitate their work ow.Today's aids for structured reporting in radiology are more or less perceivedas distracting, and the challenge in this thesis is to create an aid for structuredreporting that is not distracting the pathologist's diagnostic work ow.To achieve this, a prototype with a template for invasive breast cancer andprostate cancer was implemented in Sectra's viewer for pathology images. Thetemplate for invasive breast cancer was tested by two pathologists in a userstudy with the main objective to determine the dierences in the diagnosticwork ow using the prototype and using only paper and pen. The pathologistcould see a use of the prototype both for breast assessment and assessmentsin other areas of pathology. Both pathologists also think that the prototypewill save time in their overall work ow, help them organize the informationretrieved during the assessment, and create an overall better diagnostic work- ow.