"""Tier 4: Real-World Clinical Workflows & End-to-End Scenarios. Replicates complete oncology journeys in Hospitalisation à Domicile (HAD): - Scenario 1: Acute Febrile Neutropenia Emergency Journey - Scenario 2: Routine Home Nurse Clinical Observation & Summary Export - Scenario 3: Multi-Patient Home Hospitalization Cycle (AC-T vs FOLFOX6) - Scenario 4: Clinician Observation vs Patient Self-Report Differentiation """ import pytest @pytest.mark.tier4 class TestClinicalWorkflows: """End-to-end clinical oncology journeys.""" def test_scenario_febrile_neutropenia_emergency( self, patient_client, oncologist_client, nurse_client, session_server ): """Clinical Scenario 1: Acute Febrile Neutropenia Emergency. Context: Jeanne Durand (Patient 1, on AC-T protocol) experiences chills and fever (38.7°C) on Day 8 of Cycle 4. """ # Step 1: Patient logs in and submits constitutional symptom report report_payload = { "patient_id": 1, "symptom_id": "febrile_neutropenia", "symptom_category": "constitutional", "severity_score": 3, "lab_values": {"anc_mm3": 800, "temp_celsius": 38.7}, "notes": "Température 38.7°C mesurée à 14h, frissons intenses, neutropénie connue", } rep_resp = patient_client.post("/api/reports", json=report_payload) assert rep_resp.status_code == 201 rep_data = rep_resp.json() report_id = rep_data["report_id"] grading = rep_data["grading"] alert = rep_data["alert"] # Step 2: Verify CTCAE Grade 3/4 and Emergency Alert assert grading["grade"] in (3, 4) assert alert is not None assert alert["alert_type"] == "emergency" assert alert["patient_id"] == 1 # Step 3: Verify French patient emergency guidance is accessible guidance_resp = patient_client.get("/api/guidance?symptom_id=fever&grade=3") assert guidance_resp.status_code == 200 guidance_data = guidance_resp.json() assert guidance_data["symptom_id"] == "fever" assert "guidance" in guidance_data # Step 4: Oncologist Dr. Martin reviews alerts and timeline onco_alerts_resp = oncologist_client.get("/api/alerts?patient_id=1") assert onco_alerts_resp.status_code == 200 emergency_alerts = [ a for a in onco_alerts_resp.json().get("alerts", []) if a["alert_type"] == "emergency" and a["report_id"] == report_id ] assert len(emergency_alerts) == 1 emergency_alert_id = emergency_alerts[0]["id"] # Step 5: Oncologist acknowledges emergency alert ack_resp = oncologist_client.post(f"/api/alerts/{emergency_alert_id}/acknowledge") assert ack_resp.status_code == 200 # Step 6: Oncologist dispatches urgent message to HAD nurse msg_payload = { "recipient_id": nurse_client.current_user["id"], "recipient_role": "had_nurse", "patient_id": 1, "subject": "URGENT - Suspicion neutropénie fébrile Jeanne Durand", "body": "Passage immédiat au domicile requis. Bilan sanguin en urgence (NFS + hémocultures) et antibiothérapie probabiliste selon protocole.", "message_type": "care_team", } msg_resp = oncologist_client.post("/api/messages", json=msg_payload) assert msg_resp.status_code == 201 # Step 7: Nurse reads the instruction message inbox_resp = nurse_client.get("/api/messages?patient_id=1") assert inbox_resp.status_code == 200 nurse_msgs = inbox_resp.json().get("messages", []) assert any("neutropénie fébrile" in m.get("subject", "") for m in nurse_msgs) def test_scenario_nurse_home_visit_and_clinical_export( self, nurse_client, oncologist_client ): """Clinical Scenario 2: Routine Home Nurse Visit and Export. Context: Nurse Moret conducts scheduled home visit, reviews symptom history, enters clinical observation, and exports summary. """ # Step 1: Nurse reviews historical reports for patient 1 reports_resp = nurse_client.get("/api/reports?patient_id=1") assert reports_resp.status_code == 200 reports = reports_resp.json().get("reports", []) assert len(reports) >= 1 # Step 2: Nurse enters observation report obs_payload = { "patient_id": 1, "symptom_id": "fatigue", "symptom_category": "constitutional", "severity_score": 1, "notes": "Visite HAD: TA 120/75, pouls 74 bpm, apyretique. Fatigue legere post-chimio bien toleree.", } obs_resp = nurse_client.post("/api/reports", json=obs_payload) assert obs_resp.status_code == 201 obs_report_id = obs_resp.json()["report_id"] # Step 3: Timeline reflects the newly added clinical note tl_resp = nurse_client.get("/api/timeline?patient_id=1") assert tl_resp.status_code == 200 events = tl_resp.json()["events"] assert any(e["event_type"] == "report" for e in events) # Step 4: Nurse generates structured clinical export summary export_resp = nurse_client.get("/api/export/summary?patient_id=1") assert export_resp.status_code == 200 summary = export_resp.json() # Step 5: Validate clinical summary structure assert "patient" in summary assert summary["patient"]["mrn"] == "MRN-2024-001" assert "treatment_plans" in summary assert len(summary["treatment_plans"]) >= 1 assert "toxicity_summary" in summary assert "fatigue" in summary["toxicity_summary"] assert "generated_at" in summary assert summary["generated_by"] == nurse_client.current_user["username"] def test_scenario_multi_patient_chemotherapy_cycles( self, api_client, session_server ): """Clinical Scenario 3: Multi-Patient Chemo Cycle Segregation. Simulates Patient 1 (Breast Cancer, AC-T) and Patient 2 (Colorectal, FOLFOX6) reporting symptoms on their respective cycles, verified by Dr. Martin. """ from conftest import HADClient # Authenticate Patient 1 (Jeanne Durand) p1 = HADClient(session_server.base_url) p1.login("patient.durand", "demo123") # Authenticate Patient 2 (Pierre Moreau) p2 = HADClient(session_server.base_url) p2.login("patient.moreau", "demo123") # Patient 1 reports Grade 2 Nausea r1 = p1.post("/api/reports", json={ "patient_id": 1, "symptom_id": "nausea", "symptom_category": "gastrointestinal", "severity_score": 5, "notes": "Patient 1 Cycle 4 AC-T nausea", }) assert r1.status_code == 201 assert r1.json()["grading"]["grade"] == 2 assert r1.json()["alert"]["alert_type"] == "urgent" # Patient 2 reports Grade 1 Peripheral Neuropathy (common in FOLFOX/Oxaliplatin) r2 = p2.post("/api/reports", json={ "patient_id": 2, "symptom_id": "peripheral_neuropathy", "symptom_category": "neurologic", "severity_score": 1, "notes": "Patient 2 FOLFOX cycle paresthesies distales", }) assert r2.status_code == 201 assert r2.json()["grading"]["grade"] == 1 assert r2.json().get("alert") is None # Grade 1 is routine # Oncologist Dr. Martin reviews both patient timelines onco = HADClient(session_server.base_url) onco.login("dr.martin", "demo123") tl1 = onco.get("/api/timeline?patient_id=1") assert tl1.status_code == 200 tl1_events = [e["title"].lower() for e in tl1.json()["events"]] assert any("nausea" in t for t in tl1_events) tl2 = onco.get("/api/timeline?patient_id=2") assert tl2.status_code == 200 tl2_events = [e["title"].lower() for e in tl2.json()["events"]] assert any("neuropathy" in t for t in tl2_events) def test_scenario_clinician_observation_vs_patient_self_report( self, patient_client, nurse_client, session_server ): """Clinical Scenario 4: Clinician Observation vs Patient Self-Report.""" # Patient submits subjective self-report p_resp = patient_client.post("/api/reports", json={ "patient_id": 1, "symptom_id": "nausea", "symptom_category": "gastrointestinal", "severity_score": 2, "notes": "Auto-evaluation patient: nausees presentes apres le petit dejeuner", }) assert p_resp.status_code == 201 p_rep_id = p_resp.json()["report_id"] # Nurse submits clinician observation n_resp = nurse_client.post("/api/reports", json={ "patient_id": 1, "symptom_id": "nausea", "symptom_category": "gastrointestinal", "severity_score": 1, "notes": "Evaluation IDE a domicile: bon etat general, prise efficace du primperan", }) assert n_resp.status_code == 201 n_rep_id = n_resp.json()["report_id"] # Verify distinct reporter IDs in SQLite p_row = session_server.query_db("SELECT reporter_id FROM toxicity_reports WHERE id = ?", (p_rep_id,)) n_row = session_server.query_db("SELECT reporter_id FROM toxicity_reports WHERE id = ?", (n_rep_id,)) assert p_row[0]["reporter_id"] == patient_client.current_user["id"] assert n_row[0]["reporter_id"] == nurse_client.current_user["id"] assert p_row[0]["reporter_id"] != n_row[0]["reporter_id"]