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 +188,101 @@ document.addEventListener('DOMContentLoaded', () => {
   }
 })
 
+// Breast density factors are edited in place rather than on their own page,
+// so there's no submit button to save them - each change posts on its own.
+function setupBreastDensityFactorsAutosave() {
+  const container = document.querySelector('[data-breast-density-factors-save-url]')
+  if (!container) {
+    return
+  }
+
+  const saveUrl = container.dataset.breastDensityFactorsSaveUrl
+  if (!saveUrl) {
+    return
+  }
+
+  const factorsName = 'breastDensityFactors'
+  const hrtName = 'breastDensityFactorsHrt'
+
+  const checkboxes = container.querySelectorAll(`input[name="${factorsName}"]`)
+  const hrtRadios = container.querySelectorAll(`input[name="${hrtName}"]`)
+
+  if (checkboxes.length === 0 && hrtRadios.length === 0) {
+    return
+  }
+
+  // Keep the expander's "n factors added" line in step with the inputs.
+  // Only the review page wraps these in an expander, so this does nothing
+  // elsewhere.
+  const updateContentsSummary = () => {
+    const summary = container
+      .closest('.js-expandable-section')
+      ?.querySelector('.app-details__contents-summary')
+
+    if (!summary) {
+      return
+    }
+
+    // "No" to HRT is an answer, not a factor - match the count in
+    // getBreastDensityFactors so the two never disagree
+    const checkedFactors = container.querySelectorAll(
+      `input[name="${factorsName}"]:checked`
+    ).length
+    const hrtYes = container.querySelector(`input[name="${hrtName}"]:checked`)?.value === 'yes'
+    const count = checkedFactors + (hrtYes ? 1 : 0)
+
+    if (count === 0) {
+      summary.textContent = 'No breast density factors added'
+    } else if (count === 1) {
+      summary.textContent = '1 breast density factor added'
+    } else {
+      summary.textContent = `${count} breast density factors added`
+    }
+  }
+
+  // Changes can land faster than the requests complete, so keep them in a
+  // queue - otherwise an earlier response could be the last one to arrive
+  let pendingSave = Promise.resolve()
+
+  const saveFactors = () => {
+    const formData = new URLSearchParams()
+
+    container
+      .querySelectorAll(`input[name="${factorsName}"]:checked`)
+      .forEach((checkbox) => formData.append(factorsName, checkbox.value))
+
+    const selectedHrt = container.querySelector(`input[name="${hrtName}"]:checked`)
+    if (selectedHrt) {
+      formData.append(hrtName, selectedHrt.value)
+    }
+
+    updateContentsSummary()
+
+    pendingSave = pendingSave
+      .then(async () => {
+        const response = await fetch(saveUrl, {
+          method: 'POST',
+          headers: {
+            'Content-Type': 'application/x-www-form-urlencoded',
+            'X-Requested-With': 'XMLHttpRequest'
+          },
+          body: formData.toString()
+        })
+
+        if (!response.ok) {
+          throw new Error(
+            `Breast density factors auto-save failed (${response.status})`
+          )
+        }
+      })
+      .catch((error) => console.error(error))
+  }
+
+  container
+    .querySelectorAll(`input[name="${factorsName}"], input[name="${hrtName}"]`)
+    .forEach((input) => input.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/generators/medical-information-generator.js

@@ -1,10 +1,9 @@
 // app/lib/generators/medical-information-generator.js
 
 const { generateSymptoms } = require('./medical-information/symptoms-generator')
-const { generateHRT } = require('./medical-information/hrt-generator')
 const {
-  generatePregnancyAndBreastfeeding
-} = require('./medical-information/pregnancy-and-breastfeeding-generator')
+  generateBreastDensityFactors
+} = require('./medical-information/breast-density-factors-generator')
 const {
   generateOtherMedicalInformation
 } = require('./medical-information/other-medical-information-generator')
@@ -59,23 +58,13 @@ const generateMedicalInformation = (options = {}) => {
     medicalInfo.symptoms = symptoms
   }
 
-  // Generate HRT information
-  const hrt = generateHRT({
-    probability: probabilityOfHRT
+  // Generate breast density factors (HRT, pregnancy, breastfeeding)
+  const breastDensityFactors = generateBreastDensityFactors({
+    probabilityOfHrt: probabilityOfHRT,
+    probabilityOfPregnancyBreastfeeding
   })
 
-  if (hrt) {
-    medicalInfo.hrt = hrt
-  }
-
-  // Generate pregnancy and breastfeeding information
-  const pregnancyAndBreastfeeding = generatePregnancyAndBreastfeeding({
-    probability: probabilityOfPregnancyBreastfeeding
-  })
-
-  if (pregnancyAndBreastfeeding) {
-    medicalInfo.pregnancyAndBreastfeeding = pregnancyAndBreastfeeding
-  }
+  Object.assign(medicalInfo, breastDensityFactors)
 
   // Generate other medical information
   const otherMedicalInformation = generateOtherMedicalInformation({

app/lib/generators/medical-information/breast-density-factors-generator.js

@@ -0,0 +1,56 @@
+// app/lib/generators/medical-information/breast-density-factors-generator.js
+
+/**
+ * Generate breast density factors
+ *
+ * Replaces the old separate HRT and pregnancy/breastfeeding generators. The
+ * question is now a simple yes/no for HRT plus a checkbox group for pregnancy
+ * and breastfeeding, so the generated data is just as simple.
+ *
+ * Pregnancy and breastfeeding are rare in the screening cohort (routine
+ * screening starts at 50), so they stay well below the HRT rate.
+ *
+ * @param {object} [options] - Generation options
+ * @param {number} [options.probabilityOfHrt] - Chance of currently taking HRT (0-1)
+ * @param {number} [options.probabilityOfPregnancyBreastfeeding] - Chance of being pregnant or breastfeeding (0-1)
+ * @param {number} [options.probabilityOfBeingAsked=0.8] - Chance the question was asked at all
+ * @returns {object} Object with breastDensityFactors and breastDensityFactorsHrt, either may be absent
+ */
+const generateBreastDensityFactors = (options = {}) => {
+  const {
+    probabilityOfHrt = 0.3,
+    probabilityOfPregnancyBreastfeeding = 0.05,
+    probabilityOfBeingAsked = 0.8
+  } = options
+
+  const result = {}
+
+  // Not every appointment has got as far as asking. Leaving the answer unset
+  // keeps "no medical information" a possible outcome, and lets the summaries
+  // distinguish "not answered" from a recorded "no"
+  if (Math.random() < probabilityOfBeingAsked) {
+    result.breastDensityFactorsHrt =
+      Math.random() < probabilityOfHrt ? 'yes' : 'no'
+  }
+
+  const factors = []
+
+  if (Math.random() < probabilityOfPregnancyBreastfeeding) {
+    // Breastfeeding is the more likely of the two at screening age
+    if (Math.random() < 0.7) {
+      factors.push('breastfeeding')
+    } else {
+      factors.push('pregnant')
+    }
+  }
+
+  if (factors.length > 0) {
+    result.breastDensityFactors = factors
+  }
+
+  return result
+}
+
+module.exports = {
+  generateBreastDensityFactors
+}