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Peer-reviewedCC BY 4.0JAMA Network Open

Development and Validation of a Tool to Measure Documented Health Care Encounter Time

  • Ronald Chow1,2,3,4
  • Sarah Bayrakdarian1
  • Olivera Gojsevic1
  • Emily MacMillan1
  • Tracy Balboni5
  • Joanne Bowen6
  • Eduardo Bruera7
  • Raymond J. Chan8
  • Arjun Gupta9
  • Nicolas H. Hart8,10
  • Peter Hoskin11,12
  • David Hui7
14 more authors
  • Hirotoshi Iihara13
  • Michael Jefford14,15
  • Shing Fung Lee16,17
  • Rachel Riechelmann18
  • Hope S. Rugo19
  • Christina H. Ruhlmann20
  • Charles B. Simone21
  • Henry C. Y. Wong21
  • Camilla Zimmermann2,3
  • Hans Chung1,3
  • Georgia C. Richards22
  • Carl Heneghan4
  • Jennifer Leigh1,3
  • MASCC Emerging Toxicities Study Group
22 affiliations
  1. 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
  3. 3Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
  5. 5Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  6. 6School of Pharmacy and Biomedical Science, Adelaide University, Adelaide, South Australia, Australia
  7. 7The University of Texas MD Anderson Cancer Center, Houston
  8. 8Caring Futures Institute, College of Health and Enablement, Flinders University, Adelaide, South Australia, Australia
  9. 9City of Hope Cancer Center Phoenix, Phoenix, Arizona
  10. 10Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  11. 11Mount Vernon Cancer Centre, Northwood, United Kingdom
  12. 12Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
  13. 13Department of Pharmacy, Gifu University Hospital, Gifu, Japan
  14. 14Centre for Health Services Research in Cancer, Australia Cancer Survivorship Centre, and Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  15. 15Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Parkville, Victoria, Australia
  16. 16Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
  17. 17Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  18. 18Clinical Oncology Department, AC Camargo Cancer Center, Sao Paulo, Brazil
  19. 19Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
  20. 20Department of Oncology, Odense University Hospital, Odense, Denmark
  21. 21New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, New York
  22. 22Department of Toxicology and Forensic Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
Open at sourceDOICite

Abstract

Importance: Time toxicity, defined as the time patients spend receiving cancer treatment and interacting with health care systems, is an emerging treatment-related burden. Existing studies typically quantify time toxicity using health care contact days, which may inadequately capture patient burden because encounters of different durations are weighted equally.

Objective: To develop and internally validate the Multinational Association of Supportive Care in Cancer (MASCC) Time Intensity and Measurement of Encounters (TIME) tool, a standardized medical record abstraction instrument for measuring documented health care encounter time.

Design, Setting, and Participants: This multiphase mixed-methods prognostic study, including tool development, was conducted from March to May 2026, through a 3-round international consensus process involving 16 oncology trialists from 9 countries and internal validation using electronic medical records from a cohort of patients with prostate cancer treated at a tertiary cancer center in Toronto, Ontario, Canada. Validation compared standardized abstraction using the MASCC TIME tool with prior unstructured medical record abstraction across 367 health care encounters.

Main Outcomes and Measures: Content validity, extraction accuracy compared with investigator consensus review, interrater reliability assessed using the Gwet agreement coefficient 1 (AC1) and percentage agreement, and abstraction feasibility.

Results: Sixteen oncology trialists participated in tool development. The final tool included 8 variables: encounter start date, start time, end date, end time, purpose, planned or unplanned status, mode of contact, and primary clinician. All variables achieved a content validity ratio of 1.0. Accuracy of medical record extraction increased from 31% (95% CI, 28%-35%) to 90% (95% CI, 87%-93%) without the tool to 66% (95% CI, 62%-69%) to 99% (95% CI, 99%-100%) with the tool, with absolute differences of 2 percentage points (95% CI, −1 to 5 percentage points) to 35 percentage points (95% CI, 30 to 40 percentage points); 7 of 8 variables demonstrated statistically significant increases with the tool. Percentage agreement between abstractors increased from 31% to 82% without the tool to 42% to 99% with the tool, while the Gwet AC1 increased from −0.24 to 0.87 without the tool to 0.14 to 0.99 with the tool. Mean abstraction time decreased from 10 to 5 minutes per encounter.

Conclusions and Relevance: In this prognostic study of the MASCC TIME tool, it was found to be associated with excellent content validity, improved accuracy, high interrater reliability, and acceptable feasibility for standardized measurement of documented health care encounter time. Standardized assessment of time toxicity may improve comparability across oncology studies and support more rigorous evaluation of health care–related burden in cancer research.

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Cite

BibTeXRIS
BibTeX
@article{chow2026development,
  title = {{Development and Validation of a Tool to Measure Documented Health Care Encounter Time}},
  author = {Ronald Chow and Sarah Bayrakdarian and Olivera Gojsevic and Emily MacMillan and Tracy Balboni and Joanne Bowen and Eduardo Bruera and Raymond J. Chan and Arjun Gupta and Nicolas H. Hart and Peter Hoskin and David Hui and Hirotoshi Iihara and Michael Jefford and Shing Fung Lee and Rachel Riechelmann and Hope S. Rugo and Christina H. Ruhlmann and Charles B. Simone and Henry C. Y. Wong and Camilla Zimmermann and Hans Chung and Georgia C. Richards and Carl Heneghan and Jennifer Leigh and MASCC Emerging Toxicities Study Group},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.38034},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854970},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Development and Validation of a Tool to Measure Documented Health Care Encounter Time
AU  - Ronald Chow
AU  - Sarah Bayrakdarian
AU  - Olivera Gojsevic
AU  - Emily MacMillan
AU  - Tracy Balboni
AU  - Joanne Bowen
AU  - Eduardo Bruera
AU  - Raymond J. Chan
AU  - Arjun Gupta
AU  - Nicolas H. Hart
AU  - Peter Hoskin
AU  - David Hui
AU  - Hirotoshi Iihara
AU  - Michael Jefford
AU  - Shing Fung Lee
AU  - Rachel Riechelmann
AU  - Hope S. Rugo
AU  - Christina H. Ruhlmann
AU  - Charles B. Simone
AU  - Henry C. Y. Wong
AU  - Camilla Zimmermann
AU  - Hans Chung
AU  - Georgia C. Richards
AU  - Carl Heneghan
AU  - Jennifer Leigh
AU  - MASCC Emerging Toxicities Study Group
PY  - 2026
DA  - 2026/10/08
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.38034
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854970
AB  - Importance: Time toxicity, defined as the time patients spend receiving cancer treatment and interacting with health care systems, is an emerging treatment-related burden. Existing studies typically quantify time toxicity using health care contact days, which may inadequately capture patient burden because encounters of different durations are weighted equally.  Objective: To develop and internally validate the Multinational Association of Supportive Care in Cancer (MASCC) Time Intensity and Measurement of Encounters (TIME) tool, a standardized medical record abstraction instrument for measuring documented health care encounter time.  Design, Setting, and Participants: This multiphase mixed-methods prognostic study, including tool development, was conducted from March to May 2026, through a 3-round international consensus process involving 16 oncology trialists from 9 countries and internal validation using electronic medical records from a cohort of patients with prostate cancer treated at a tertiary cancer center in Toronto, Ontario, Canada. Validation compared standardized abstraction using the MASCC TIME tool with prior unstructured medical record abstraction across 367 health care encounters.  Main Outcomes and Measures: Content validity, extraction accuracy compared with investigator consensus review, interrater reliability assessed using the Gwet agreement coefficient 1 (AC1) and percentage agreement, and abstraction feasibility.  Results: Sixteen oncology trialists participated in tool development. The final tool included 8 variables: encounter start date, start time, end date, end time, purpose, planned or unplanned status, mode of contact, and primary clinician. All variables achieved a content validity ratio of 1.0. Accuracy of medical record extraction increased from 31% (95% CI, 28%-35%) to 90% (95% CI, 87%-93%) without the tool to 66% (95% CI, 62%-69%) to 99% (95% CI, 99%-100%) with the tool, with absolute differences of 2 percentage points (95% CI, −1 to 5 percentage points) to 35 percentage points (95% CI, 30 to 40 percentage points); 7 of 8 variables demonstrated statistically significant increases with the tool. Percentage agreement between abstractors increased from 31% to 82% without the tool to 42% to 99% with the tool, while the Gwet AC1 increased from −0.24 to 0.87 without the tool to 0.14 to 0.99 with the tool. Mean abstraction time decreased from 10 to 5 minutes per encounter.  Conclusions and Relevance: In this prognostic study of the MASCC TIME tool, it was found to be associated with excellent content validity, improved accuracy, high interrater reliability, and acceptable feasibility for standardized measurement of documented health care encounter time. Standardized assessment of time toxicity may improve comparability across oncology studies and support more rigorous evaluation of health care–related burden in cancer research.
SN  - 2574-3805
ER  -