Simplify HRT, pregnancy, breastfeeding questions into "Breast density factors"

app/assets/javascript/main.js

@@ -95,6 +95,9 @@ document.addEventListener('DOMContentLoaded', () => {
   // Handle reset data in background
   setupResetSessionLink()
 
+  // Auto-save breast density factors when changed
+  setupBreastDensityFactorsAutosave()
+
   // Reading workflow: auto-dismiss the opinion banner after a delay
   const opinionBanner = document.querySelector('[data-reading-opinion-banner]')
   if (opinionBanner) {
@@ -185,6 +188,105 @@ document.addEventListener('DOMContentLoaded', () => {
   }
 })
 
+function setupBreastDensityFactorsAutosave() {
+  const saveTarget = document.querySelector('[data-breast-density-factors-save-url]')
+  if (!saveTarget) {
+    return
+  }
+
+  const saveUrl = saveTarget.dataset.breastDensityFactorsSaveUrl
+  if (!saveUrl) {
+    return
+  }
+
+  const checkboxSelector =
+    'input[name="appointment[medicalInformation][breastDensityFactors]"]'
+  const hrtRadioSelector =
+    'input[name="appointment[medicalInformation][breastDensityFactorsHrt]"]'
+  const checkboxes = document.querySelectorAll(checkboxSelector)
+  const hrtRadios = document.querySelectorAll(hrtRadioSelector)
+
+  if (checkboxes.length === 0 && hrtRadios.length === 0) {
+    return
+  }
+
+  const updateBreastDensityFactorsSummary = () => {
+    // Find the breast-density-factors section and update its contents summary
+    const section = document.getElementById('breast-density-factors')
+    if (!section) {
+      return
+    }
+
+    // Count selected factors
+    const selectedCheckboxes = document.querySelectorAll(`${checkboxSelector}:checked`)
+    const selectedHrtRadio = document.querySelector(`${hrtRadioSelector}:checked`)
+    let count = selectedCheckboxes.length
+    if (selectedHrtRadio && selectedHrtRadio.value === 'yes') {
+      count += 1
+    }
+
+    // Find and update the contents summary span
+    const summarySpan = section.querySelector('.app-details__contents-summary')
+    if (summarySpan) {
+      if (count === 0) {
+        summarySpan.textContent = 'No breast density factors added'
+      } else if (count === 1) {
+        summarySpan.textContent = '1 breast density factor added'
+      } else {
+        summarySpan.textContent = count + ' breast density factors added'
+      }
+    }
+  }
+
+  const saveFactors = async () => {
+    const formData = new URLSearchParams()
+    const selectedCheckboxes = document.querySelectorAll(`${checkboxSelector}:checked`)
+    const selectedHrtRadio = document.querySelector(`${hrtRadioSelector}:checked`)
+
+    selectedCheckboxes.forEach((checkbox) => {
+      formData.append(
+        'appointment[medicalInformation][breastDensityFactors]',
+        checkbox.value
+      )
+    })
+
+    if (selectedHrtRadio) {
+      formData.append(
+        'appointment[medicalInformation][breastDensityFactorsHrt]',
+        selectedHrtRadio.value
+      )
+    }
+
+    try {
+      const response = await fetch(saveUrl, {
+        method: 'POST',
+        headers: {
+          'Content-Type': 'application/x-www-form-urlencoded',
+          'X-Requested-With': 'XMLHttpRequest'
+        },
+        body: formData.toString()
+      })
+
+      if (!response.ok) {
+        throw new Error('Breast density factors auto-save failed')
+      }
+
+      // Update the summary text in the section after successful save
+      updateBreastDensityFactorsSummary()
+    } catch (error) {
+      console.error(error)
+    }
+  }
+
+  checkboxes.forEach((checkbox) => {
+    checkbox.addEventListener('change', saveFactors)
+  })
+
+  hrtRadios.forEach((radio) => {
+    radio.addEventListener('change', saveFactors)
+  })
+}
+
 // Quick settings modal — press backtick (`) to open settings in a modal overlay.
 // On close, the page reloads to pick up any changes.
 document.addEventListener('keydown', (e) => {

app/lib/utils/medical-information.js

@@ -429,59 +429,28 @@ const summariseOtherRelevantInformation = (medicalInformation) => {
 
   const summaries = []
 
-  // HRT summary
-  const hrt = medicalInformation.hrt
-  if (hrt) {
-    if (hrt.hrtQuestion === 'yes') {
-      summaries.push(
-        `Taking HRT (started ${hrt.hrtDateStarted || 'date not specified'})`
-      )
-    } else if (hrt.hrtQuestion === 'no-recently-stopped') {
-      if (hrt.hrtDateStopped) {
-        summaries.push(`Recently stopped HRT (stopped ${hrt.hrtDateStopped})`)
-      } else {
-        summaries.push('Recently stopped HRT')
-      }
-    }
-    // Don't add anything for 'no' - that's the default/negative state
+  const breastDensityFactorsRaw = medicalInformation.breastDensityFactors
+  const breastDensityFactors = Array.isArray(breastDensityFactorsRaw)
+    ? breastDensityFactorsRaw
+    : breastDensityFactorsRaw
+      ? [breastDensityFactorsRaw]
+      : []
+  const breastDensityFactorsHrt =
+    medicalInformation.breastDensityFactorsHrt ||
+    (breastDensityFactors.includes('hrt') ? 'yes' : undefined)
+
+  if (breastDensityFactors.includes('pregnant')) {
+    summaries.push('Pregnant')
   }
 
-  // Pregnancy and breastfeeding summary
-  const pregBf = medicalInformation.pregnancyAndBreastfeeding
-  if (pregBf) {
-    // Pregnancy
-    if (pregBf.pregnancyStatus === 'yes') {
-      if (pregBf.pregnancyDueDate) {
-        summaries.push(`Pregnant (due ${pregBf.pregnancyDueDate})`)
-      } else {
-        summaries.push('Pregnant')
-      }
-    } else if (pregBf.pregnancyStatus === 'noButRecently') {
-      if (pregBf.pregnancyEndDate) {
-        summaries.push(`Recently pregnant (ended ${pregBf.pregnancyEndDate})`)
-      } else {
-        summaries.push('Recently pregnant')
-      }
-    }
+  if (breastDensityFactors.includes('breastfeeding')) {
+    summaries.push('Breastfeeding')
+  }
 
-    // Breastfeeding
-    if (pregBf.breastfeedingStatus === 'yes') {
-      if (pregBf.breastfeedingStartDate) {
-        summaries.push(
-          `Breastfeeding (started ${pregBf.breastfeedingStartDate})`
-        )
-      } else {
-        summaries.push('Breastfeeding')
-      }
-    } else if (pregBf.breastfeedingStatus === 'recentlyStopped') {
-      if (pregBf.breastfeedingStopDate) {
-        summaries.push(
-          `Recently breastfeeding (stopped ${pregBf.breastfeedingStopDate})`
-        )
-      } else {
-        summaries.push('Recently breastfeeding')
-      }
-    }
+  if (breastDensityFactorsHrt === 'yes') {
+    summaries.push('Taking HRT')
+  } else if (breastDensityFactorsHrt === 'no') {
+    summaries.push('Not taking HRT')
   }
 
   // Other medical information (free text)

app/routes/appointments/medical-information.js

@@ -7,8 +7,143 @@ const {
   getReturnUrl,
   modalBreakout
 } = require('../../lib/utils/referrers')
+const { getAppointmentData } = require('../../lib/utils/appointment-data')
 
 module.exports = (router) => {
+  // Auto-save breast density factors when checkboxes are changed
+  router.post(
+    '/clinics/:clinicId/appointments/:appointmentId/medical-information/breast-density-factors-save',
+    (req, res) => {
+      const data = req.session.data
+      const postedFactors = req.body?.appointment?.medicalInformation?.breastDensityFactors
+      const postedHrt = req.body?.appointment?.medicalInformation?.breastDensityFactorsHrt
+
+      // No posted factors means all options are currently unchecked
+      const factors = Array.isArray(postedFactors)
+        ? postedFactors
+        : postedFactors
+          ? [postedFactors]
+          : []
+      const nonHrtFactors = factors.filter((factor) => factor && factor !== 'hrt')
+
+      if (!data.appointment) {
+        data.appointment = {}
+      }
+
+      if (!data.appointment.medicalInformation) {
+        data.appointment.medicalInformation = {}
+      }
+
+      data.appointment.medicalInformation.breastDensityFactors = nonHrtFactors
+
+      if (postedHrt === 'yes' || postedHrt === 'no') {
+        data.appointment.medicalInformation.breastDensityFactorsHrt = postedHrt
+      }
+
+      // Keep a draft cache outside auto-stored form keys so later form posts
+      // cannot accidentally clear the latest autosaved checkbox state.
+      if (!data._medicalInformationDraft) {
+        data._medicalInformationDraft = {}
+      }
+      data._medicalInformationDraft.breastDensityFactors = nonHrtFactors
+
+      if (postedHrt === 'yes' || postedHrt === 'no') {
+        data._medicalInformationDraft.breastDensityFactorsHrt = postedHrt
+      }
+
+      res.status(204).send()
+    }
+  )
+
+  // Save other medical information while preserving breast density factors
+  router.post(
+    '/clinics/:clinicId/appointments/:appointmentId/medical-information/other-medical-information-save',
+    (req, res) => {
+      const { clinicId, appointmentId } = req.params
+      const data = req.session.data
+      const referrerChain = req.query.referrerChain
+      const scrollTo = req.query.scrollTo
+
+      const appointmentMedicalInformation = data?.appointment?.medicalInformation
+      const postedBreastDensityFactors =
+        appointmentMedicalInformation?.breastDensityFactors
+      const postedBreastDensityFactorsHrt =
+        appointmentMedicalInformation?.breastDensityFactorsHrt
+      const cachedBreastDensityFactors =
+        data?._medicalInformationDraft?.breastDensityFactors
+      const cachedBreastDensityFactorsHrt =
+        data?._medicalInformationDraft?.breastDensityFactorsHrt
+
+      const normalisedPostedBreastDensityFactors =
+        Array.isArray(postedBreastDensityFactors)
+          ? postedBreastDensityFactors
+          : postedBreastDensityFactors
+            ? [postedBreastDensityFactors]
+            : undefined
+
+      if (normalisedPostedBreastDensityFactors) {
+        if (!data._medicalInformationDraft) {
+          data._medicalInformationDraft = {}
+        }
+        data._medicalInformationDraft.breastDensityFactors =
+          normalisedPostedBreastDensityFactors.filter((factor) => factor && factor !== 'hrt')
+      }
+
+      if (postedBreastDensityFactorsHrt === 'yes' || postedBreastDensityFactorsHrt === 'no') {
+        if (!data._medicalInformationDraft) {
+          data._medicalInformationDraft = {}
+        }
+        data._medicalInformationDraft.breastDensityFactorsHrt =
+          postedBreastDensityFactorsHrt
+      }
+
+      // If this submission did not include factors, keep the last saved values
+      if (!normalisedPostedBreastDensityFactors)
+      {
+        const savedAppointmentData = getAppointmentData(data, clinicId, appointmentId)
+        const savedBreastDensityFactors =
+          savedAppointmentData?.appointment?.medicalInformation?.breastDensityFactors
+
+        if (cachedBreastDensityFactors)
+        {
+          data.appointment.medicalInformation.breastDensityFactors =
+            cachedBreastDensityFactors
+        }
+        else if (savedBreastDensityFactors)
+        {
+          data.appointment.medicalInformation.breastDensityFactors =
+            savedBreastDensityFactors
+        }
+      }
+
+      if (!postedBreastDensityFactorsHrt)
+      {
+        const savedAppointmentData = getAppointmentData(data, clinicId, appointmentId)
+        const savedBreastDensityFactorsHrt =
+          savedAppointmentData?.appointment?.medicalInformation?.breastDensityFactorsHrt
+
+        if (cachedBreastDensityFactorsHrt)
+        {
+          data.appointment.medicalInformation.breastDensityFactorsHrt =
+            cachedBreastDensityFactorsHrt
+        }
+        else if (savedBreastDensityFactorsHrt)
+        {
+          data.appointment.medicalInformation.breastDensityFactorsHrt =
+            savedBreastDensityFactorsHrt
+        }
+      }
+
+      const returnUrl = getReturnUrl(
+        `/clinics/${clinicId}/appointments/${appointmentId}/review-medical-information`,
+        referrerChain,
+        scrollTo
+      )
+
+      res.redirect(modalBreakout(returnUrl))
+    }
+  )
+
   // Save breast features (includes converting JSON string to structured data)
   router.post(
     '/clinics/:clinicId/appointments/:appointmentId/medical-information/record-breast-features/save',