Add pain as a symptom / support significant symptoms (#180)

Author: edwardhorsford

app/data/session-data-defaults.js

@@ -11,6 +11,7 @@ const fs = require('fs')
 const { needsRegeneration } = require('../lib/utils/regenerate-data')
 const config = require('../config')
 const repeatReasons = require('./repeat-reasons')
+const symptomTypes = require('./symptom-types')
 
 // Check if generated data folder exists and create if needed
 const generatedDataPath = path.join(__dirname, 'generated')
@@ -87,5 +88,6 @@ module.exports = {
   settings: defaultSettings,
   defaultSettings,
   medicalHistoryTypes,
-  repeatReasons
+  repeatReasons,
+  symptomTypes
 }

app/data/symptom-types.js

@@ -0,0 +1,32 @@
+module.exports = [
+  {
+    name: 'lump',
+    slug: 'lump',
+    isSignificantByDefault: true
+  },
+  {
+    name: 'swelling or shape change',
+    slug: 'swelling-or-shape-change',
+    isSignificantByDefault: true
+  },
+  {
+    name: 'skin change',
+    slug: 'skin-change',
+    isSignificantByDefault: true
+  },
+  {
+    name: 'nipple change',
+    slug: 'nipple-change',
+    isSignificantByDefault: true
+  },
+  {
+    name: 'breast pain',
+    slug: 'breast-pain',
+    isSignificantByDefault: false
+  },
+  {
+    name: 'other',
+    slug: 'other',
+    isSignificantByDefault: false
+  }
+]

app/lib/generators/symptoms-generator.js

@@ -3,11 +3,16 @@
 const { faker } = require('@faker-js/faker')
 const weighted = require('weighted')
 const generateId = require('../utils/id-generator')
+const symptomTypesData = require('../../data/symptom-types.js')
 
-// Updated symptom types to match the form
-const SYMPTOM_TYPES = {
-  'Lump': {
-    weight: 0.4,
+// Helper to convert lowercase to sentence case
+const toSentenceCase = (str) => str.charAt(0).toUpperCase() + str.slice(1)
+
+// Generator-specific configuration (weights, descriptions, etc.)
+// Keys match lowercase names from symptom-types.js
+const GENERATOR_CONFIG = {
+  'lump': {
+    weight: 0.25,
     requiresLocation: true,
     descriptions: [
       "Hard lump that doesn't move",
@@ -17,8 +22,21 @@ const SYMPTOM_TYPES = {
       'Tender lump that varies with menstrual cycle'
     ]
   },
-  'Swelling or shape change': {
-    weight: 0.2,
+  'breast pain': {
+    weight: 0.35, // Most common symptom
+    requiresLocation: true,
+    descriptions: [
+      'Sharp pain in breast',
+      'Dull ache that comes and goes',
+      'Burning or stabbing sensation',
+      'Tenderness that varies with menstrual cycle',
+      'Constant throbbing pain',
+      'Pain when pressure applied',
+      'Shooting pain through breast'
+    ]
+  },
+  'swelling or shape change': {
+    weight: 0.15,
     requiresLocation: true,
     descriptions: [
       'Change in size or shape of breast',
@@ -28,14 +46,15 @@ const SYMPTOM_TYPES = {
       'Visible dent or dimpling'
     ]
   },
-  'Nipple change': {
-    weight: 0.15,
+  'nipple change': {
+    weight: 0.1,
     requiresLocation: false, // Uses nippleChangeLocation instead
     nippleChangeTypes: [
       'bloody discharge',
       'other discharge',
-      'inversion or shape change',
-      'rash',
+      'inversion',
+      'rash or eczema',
+      'shape change',
       'colour change'
     ],
     nippleChangeDescriptions: {
@@ -46,10 +65,15 @@ const SYMPTOM_TYPES = {
       ]
     }
   },
-  'Skin change': {
-    weight: 0.15,
+  'skin change': {
+    weight: 0.13,
     requiresLocation: true,
-    skinChangeTypes: ['dimples or indentation', 'rash', 'colour change'],
+    skinChangeTypes: [
+      'sores or cysts',
+      'dimples or indentation',
+      'rash',
+      'colour change'
+    ],
     skinChangeDescriptions: {
       other: [
         'Orange peel texture',
@@ -58,30 +82,34 @@ const SYMPTOM_TYPES = {
       ]
     }
   },
-  'Other': {
+  'other': {
     weight: 0.02,
     requiresLocation: true,
     descriptions: [
       'Unusual sensation or tenderness',
       'Heaviness in breast',
       'Tingling sensation',
-      'Unusual firmness',
-      'Persistent pain'
+      'Unusual firmness'
     ]
   }
 }
 
-// const DATE_RANGE_OPTIONS = [
-//   "Less than a week",
-//   "1 week to a month",
-//   "1 to 3 months",
-//   "3 months to a year",
-//   "1 to 3 years",
-//   "Over 3 years"
-// ]
+// Build SYMPTOM_TYPES by merging data file with generator config
+// Use sentence case keys to match stored data format
+const SYMPTOM_TYPES = {}
+for (const symptomType of symptomTypesData) {
+  const config = GENERATOR_CONFIG[symptomType.name]
+  if (config) {
+    const sentenceCaseName = toSentenceCase(symptomType.name)
+    SYMPTOM_TYPES[sentenceCaseName] = {
+      ...config,
+      isSignificantByDefault: symptomType.isSignificantByDefault
+    }
+  }
+}
 
 const DATE_RANGE_OPTIONS = [
-  'Less than  3 months',
+  'Less than 3 months',
   '3 months to a year',
   '1 to 3 years',
   'Over 3 years'
@@ -175,7 +203,7 @@ const generateSymptom = (options = {}) => {
 
   // Generate dateType matching the form structure
   const dateTypeWeights = {
-    ...Object.fromEntries(DATE_RANGE_OPTIONS.map((range) => [range, 0.1])), // 60% total for ranges
+    ...Object.fromEntries(DATE_RANGE_OPTIONS.map((range) => [range, 0.1])),
     dateKnown: 0.3,
     notSure: 0.1
   }
@@ -190,6 +218,14 @@ const generateSymptom = (options = {}) => {
     dateAdded: new Date().toISOString()
   }
 
+  // Set significance based on type
+  if (typeData.isSignificantByDefault) {
+    symptom.isSignificant = true
+  } else {
+    // For non-significant-by-default types, randomly mark 10% as significant
+    symptom.isSignificant = Math.random() < 0.1
+  }
+
   // Add user who added the symptom
   if (options.addedByUserId) {
     symptom.addedByUserId = options.addedByUserId
@@ -213,7 +249,6 @@ const generateSymptom = (options = {}) => {
     // For range options, store the same value in approximateDuration
     symptom.approximateDuration = symptom.dateType
   }
-  // For range options and 'notSure', no additional date fields needed
 
   // 30% chance the symptom has recently stopped
   symptom.hasStopped = Math.random() < 0.3
@@ -227,10 +262,15 @@ const generateSymptom = (options = {}) => {
   symptom.isIntermittent = Math.random() < 0.25
 
   // Handle type-specific fields
-  if (type === 'Other') {
-    symptom.otherLocationDescription = faker.helpers.arrayElement(
-      typeData.descriptions
-    )
+  if (type === 'Other' || type === 'Breast pain') {
+    // Both Other and Breast pain use simple descriptions
+    if (type === 'Breast pain') {
+      // Breast pain doesn't need otherDescription, but we can add to additionalInfo later
+    } else {
+      symptom.otherDescription = faker.helpers.arrayElement(
+        typeData.descriptions
+      )
+    }
   } else if (type === 'Nipple change') {
     const changeType = faker.helpers.arrayElement(typeData.nippleChangeTypes)
     symptom.nippleChangeType = changeType

app/lib/utils/status.js

@@ -197,6 +197,8 @@ const getStatusTagColour = (status) => {
     // Metadata
     'has_symptoms': 'yellow',
     'has_repeat': 'yellow',
+    'significant_symptom': 'yellow',
+    'highlight_to_image_readers': 'yellow',
 
     // Reading statuses
     'waiting_for_1st_read': 'grey',
@@ -291,6 +293,20 @@ const hasAppointmentNote = (event) => {
   return event?.appointmentNote && event.appointmentNote.trim().length > 0
 }
 
+/**
+ * Check if an event has an appointment note
+ *
+ * @param {object} event - Event object to check
+ * @returns {boolean} Whether the event has an appointment note
+ */
+const hasSymptoms = (event) => {
+  // symptoms stored at event.medicalInformation.symptoms[]
+  return (
+    event?.medicalInformation?.symptoms &&
+    event.medicalInformation.symptoms.length > 0
+  )
+}
+
 module.exports = {
   hasNotStarted,
   isCompleted,
@@ -304,6 +320,7 @@ module.exports = {
   filterEventsByStatus,
   isSpecialAppointment,
   hasAppointmentNote,
+  hasSymptoms,
   // Export groups for testing/reference
   STATUS_GROUPS
 }

app/routes/events.js

@@ -24,6 +24,9 @@ const {
 } = require('../lib/utils/referrers')
 const { createDynamicTemplateRoute } = require('../lib/utils/dynamic-routing')
 const { isAppointmentWorkflow } = require('../lib/utils/status')
+const { sentenceCase } = require('../lib/utils/strings')
+// Load symptom types data
+const symptomTypes = require('../data/symptom-types')
 
 /**
  * Get single event and its related data
@@ -590,6 +593,10 @@ module.exports = (router) => {
         const symptomType = symptomTemp.type
         const isNewSymptom = !symptomTemp.id
 
+        const symptomTypeConfig = symptomTypes.find(
+          (st) => st.name === symptomType.toLowerCase()
+        )
+
         // Start with base symptom data
         const symptom = {
           id: symptomTemp.id || generateId(),
@@ -604,6 +611,16 @@ module.exports = (router) => {
           symptom.dateAdded = new Date().toISOString()
         }
 
+        if (symptomTypeConfig) {
+          if (symptomTypeConfig.isSignificantByDefault) {
+            // Always significant for default significant types
+            symptom.isSignificant = true
+          } else {
+            // Use string value for non-default types
+            symptom.isSignificant = symptomTemp.isSignificant === 'yes'
+          }
+        }
+
         // Add investigation details if investigated
         if (symptomTemp.hasBeenInvestigated === 'yes') {
           symptom.investigatedDescription = symptomTemp.investigatedDescription
@@ -638,7 +655,7 @@ module.exports = (router) => {
             ? true
             : false
 
-        if (symptom.hasStopped) {
+        if (symptom.hasStopped && symptom) {
           symptom.approximateDateStopped = symptomTemp.approximateDateStopped
         }
 
@@ -805,21 +822,15 @@ module.exports = (router) => {
 
       // If symptomType is provided, pre-populate and go to details
       if (symptomType) {
-        // Map camelCase symptom types to display names
-        const symptomTypeMap = {
-          lump: 'Lump',
-          swellingOrShapeChange: 'Swelling or shape change',
-          skinChange: 'Skin change',
-          nippleChange: 'Nipple change',
-          other: 'Other'
-        }
-
-        const fullSymptomType = symptomTypeMap[symptomType]
+        // Find symptom type by slug
+        const symptomTypeConfig = symptomTypes.find(
+          (st) => st.slug === symptomType
+        )
 
-        if (fullSymptomType) {
+        if (symptomTypeConfig) {
           // Pre-populate symptomTemp with the selected type
           data.event.symptomTemp = {
-            type: fullSymptomType
+            type: sentenceCase(symptomTypeConfig.name)
           }
 
           // Redirect to details page

app/views/_includes/add-symptom-button-menu.njk

@@ -8,20 +8,12 @@
   {% set methodUrl = methodUrl ~ "/add?symptomType=" %}
 {% endif %}
 
-{% set symptoms = [
-  "Lump",
-  "Swelling or shape change",
-  "Skin change",
-  "Nipple change",
-  "Other"
-] %}
-
 {% set buttonMenuItems = [] %}
 
-{% for symptom in symptoms %}
+{% for symptomType in data.symptomTypes %}
   {% set buttonMenuItems = buttonMenuItems | push({
-    text: symptom,
-    href: (methodUrl ~ (symptom | camelCase) ) | urlWithReferrer(referrerChain, scrollTo),
+    text: symptomType.name | sentenceCase,
+    href: (methodUrl ~ symptomType.slug) | urlWithReferrer(referrerChain, scrollTo),
     classes: "nhsuk-button--secondary js-expand-parent-section"
   }) %}
 {% endfor %}
@@ -37,6 +29,4 @@
       alignMenu: "left"
     }) }}
   </div>
-{% endif %}
-
-
+{% endif %}

app/views/_includes/medical-information/index.njk

@@ -99,17 +99,10 @@
   <h4>Add symptoms</h4>
 
   <div class="nhsuk-button-group app-button-group--small">
-    {% set symptoms = {
-      lump: 'Lump',
-      swellingOrShapeChange: 'Swelling or shape change',
-      skinChange: 'Skin change',
-      nippleChange: 'Nipple change',
-      other: 'Other'
-    } %}
-    {% for symptomType, symptomName in symptoms %}
+    {% for symptomType in data.symptomTypes %}
       {{ button({
-        text: symptomName,
-        href: ("./medical-information/symptoms/add?symptomType=" + symptomType) | urlWithReferrer(currentUrl, scrollTo),
+        text: symptomType.name | sentenceCase,
+        href: ("./medical-information/symptoms/add?symptomType=" + symptomType.slug) | urlWithReferrer(currentUrl, scrollTo),
         classes: "nhsuk-button--secondary app-button--small"
       }) }}
     {% endfor %}