const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch images as base64
const imageUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0ae328d856921139cd5f46478283bf9c20ab5cdd8592f1453d89e22b25707a46.jpg", // Informed consent 5-stage flowchart
  "https://cdn.orris.care/cdss_images/GLGCA_1020481_1766750786940_c87dbfd0-0cec-4af1-a169-5c1cc47d020f_6cbe80c8-23de-411b-96a5-d36f8637d8c4.png", // Shared decision-making diagram
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_aefeb3dc6688dd398c80b0f90e8b9c6036046e12a28d2f853c35e6026a7dd3da.jpg", // LINAC machine
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3e291dcb006427978ef5075751852655f267105969a4e7e167799527c4d992dc.jpg", // Radiation side effects H&N
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_d487db62d81acd6089a50059c5cbf976f984beb4466a52abb32ccaca4e9e7e0a.jpg", // Breast RT skin reactions
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ff173dea13b44b5140de206287e334fbc0268ddbd57399ce2d7290b1566e7a80.jpg", // Patient on RT table
];

console.log("Fetching images...");
let images = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { timeout: 60000 }
  ).toString();
  images = JSON.parse(result);
  console.log("Images fetched:", images.map((img, i) => `${i}: ${img.error ? "ERROR: " + img.error : "OK"}`));
} catch (e) {
  console.error("Image fetch failed:", e.message);
  images = imageUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Informed Consent in Radiation and Medical Oncology";
pres.author = "Oncology Education";

// ─────────────────────────────────────────────
// THEME
// ─────────────────────────────────────────────
const DARK_BG    = "0D1B2A";   // deep navy
const MID_BG     = "1B2D45";   // medium navy
const ACCENT     = "E05C28";   // burnt orange
const ACCENT2    = "2E7DC5";   // sky blue
const WHITE      = "FFFFFF";
const LIGHT_GRAY = "D9E4EF";
const BODY_TEXT  = "D9E4EF";
const SUBTEXT    = "8CADC8";

// Helper: add a decorative top bar
function addTopBar(slide, accentColor = ACCENT) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.08, fill: { color: accentColor }, line: { type: "none" } });
}

// Helper: add a decorative bottom bar
function addBottomBar(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: "100%", h: 0.075, fill: { color: ACCENT2 }, line: { type: "none" } });
  slide.addText("Informed Consent in Radiation & Medical Oncology", {
    x: 0.15, y: 5.4, w: 8, h: 0.22,
    fontSize: 7.5, color: SUBTEXT, fontFace: "Calibri", italic: true
  });
  slide.addText("2026", { x: 9.4, y: 5.4, w: 0.6, h: 0.22, fontSize: 7.5, color: SUBTEXT, fontFace: "Calibri", align: "right" });
}

// ─────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide, ACCENT);

  // Left color block
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: 0.35, h: 5.47, fill: { color: ACCENT }, line: { type: "none" } });

  // Main title
  slide.addText("INFORMED CONSENT", {
    x: 0.55, y: 0.9, w: 9.2, h: 1.1,
    fontSize: 44, bold: true, color: WHITE, fontFace: "Calibri Light",
    charSpacing: 3
  });
  slide.addText("IN RADIATION & MEDICAL ONCOLOGY PRACTICE", {
    x: 0.55, y: 1.95, w: 9.2, h: 0.65,
    fontSize: 22, color: ACCENT, fontFace: "Calibri", bold: true, charSpacing: 1
  });

  // Divider line
  slide.addShape(pres.ShapeType.rect, { x: 0.55, y: 2.72, w: 8.8, h: 0.04, fill: { color: ACCENT2 }, line: { type: "none" } });

  // Subtitle
  slide.addText("Ethical Principles · Legal Framework · Clinical Application", {
    x: 0.55, y: 2.85, w: 9, h: 0.5,
    fontSize: 16, color: SUBTEXT, fontFace: "Calibri", italic: true
  });

  // Image: patient on RT table
  if (images[5] && !images[5].error) {
    slide.addImage({ data: images[5].base64, x: 0.55, y: 3.5, w: 4.2, h: 2.0, rounding: true });
  }
  // Image: LINAC
  if (images[2] && !images[2].error) {
    slide.addImage({ data: images[2].base64, x: 5.2, y: 3.5, w: 4.55, h: 2.0, rounding: true });
  }

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 2 — AGENDA
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("TABLE OF CONTENTS", {
    x: 0.5, y: 0.18, w: 9, h: 0.55,
    fontSize: 11, bold: true, color: ACCENT, fontFace: "Calibri", charSpacing: 4
  });
  slide.addText("Agenda", {
    x: 0.5, y: 0.62, w: 9, h: 0.7,
    fontSize: 34, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.35, w: 9, h: 0.04, fill: { color: ACCENT2 }, line: { type: "none" } });

  const topics = [
    ["01", "Historical Background & Legal Basis"],
    ["02", "Definition & Four Pillars of Informed Consent"],
    ["03", "Ethical Principles: Autonomy, Beneficence, Non-maleficence, Justice"],
    ["04", "The Consent Process in Oncology Practice"],
    ["05", "Shared Decision-Making Model"],
    ["06", "Specific Considerations in Radiation Oncology"],
    ["07", "Side Effects Disclosure in Radiotherapy"],
    ["08", "Special Situations: Incapacity, Surrogates, Emergencies"],
    ["09", "Documentation & Medicolegal Aspects"],
    ["10", "Barriers & Best Practices"],
  ];

  topics.forEach(([num, text], i) => {
    const col = i < 5 ? 0 : 1;
    const row = i % 5;
    const x = col === 0 ? 0.5 : 5.3;
    const y = 1.55 + row * 0.72;

    // Number circle
    slide.addShape(pres.ShapeType.ellipse, { x: x, y: y, w: 0.38, h: 0.38, fill: { color: ACCENT }, line: { type: "none" } });
    slide.addText(num, { x: x, y: y + 0.02, w: 0.38, h: 0.34, fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    slide.addText(text, { x: x + 0.46, y: y + 0.04, w: 4.5, h: 0.34, fontSize: 12, color: BODY_TEXT, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 3 — HISTORICAL BACKGROUND
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Historical Background & Legal Basis", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 4, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  const timeline = [
    ["Plato (400 BC)", "Earliest philosophical basis for patient permission before intervention"],
    ["1767 — England", "First legal case: Judge ruled consent before procedures is the 'rule of the profession'"],
    ["1914 — USA", "Schloendorff v. Society of NY Hospital: 'Every human being of adult years has a right to determine what shall be done with his own body'"],
    ["1957 — USA", "Salgo v. Leland Stanford Jr. University: Term 'Informed Consent' coined; physicians legally obligated to disclose risks, benefits & alternatives"],
    ["1972 — Canterbury v. Spence", "Patient-centered standard: Disclosure should be what a reasonable patient would want to know"],
    ["2000s–Present", "Growing emphasis on shared decision-making, cultural competence, and digital consent tools"],
  ];

  timeline.forEach(([year, desc], i) => {
    const y = 0.85 + i * 0.73;
    slide.addShape(pres.ShapeType.rect, { x: 0.5, y: y, w: 1.8, h: 0.42, fill: { color: ACCENT2 }, line: { type: "none" }, rounding: true });
    slide.addText(year, { x: 0.5, y: y + 0.04, w: 1.8, h: 0.36, fontSize: 8.5, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    slide.addText(desc, { x: 2.45, y: y + 0.04, w: 7.3, h: 0.4, fontSize: 10.5, color: BODY_TEXT, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 4 — FOUR PILLARS DEFINITION
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Definition & The Four Pillars of Informed Consent", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 5, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  // Definition box
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.82, w: 9, h: 0.78, fill: { color: MID_BG }, line: { color: ACCENT2, pt: 1 } });
  slide.addText(
    "Informed consent is a person's autonomous authorization permitting a physician or health professional to undertake diagnostic or therapeutic interventions. " +
    "It is not a one-time event (i.e., just a signature) — it is an evolving process throughout the entire course of diagnosis and treatment.",
    { x: 0.65, y: 0.87, w: 8.7, h: 0.7, fontSize: 11.5, color: BODY_TEXT, fontFace: "Calibri", italic: true }
  );

  const pillars = [
    { icon: "①", title: "Mental Capacity", body: "Patient must be able to understand, appreciate, and reason through information. Adults are presumed legally competent; cognitive disease, medications, or extreme illness may compromise this." },
    { icon: "②", title: "Disclosure", body: "Physician must disclose diagnosis, proposed treatment, material risks, benefits, and reasonable alternatives — including the option of no treatment." },
    { icon: "③", title: "Understanding", body: "Patient must comprehend the disclosed information and its implications for their values and life goals. Adjusted to education level; use of interpreters when needed." },
    { icon: "④", title: "Voluntariness", body: "Decision must be free from coercion, manipulation, or undue influence. The patient has the right to refuse any treatment." },
  ];

  pillars.forEach((p, i) => {
    const x = 0.5 + i * 2.38;
    const y = 1.75;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 2.28, h: 3.5, fill: { color: MID_BG }, line: { color: i % 2 === 0 ? ACCENT : ACCENT2, pt: 1.5 } });
    slide.addText(p.icon, { x, y: y + 0.1, w: 2.28, h: 0.6, fontSize: 28, bold: true, color: i % 2 === 0 ? ACCENT : ACCENT2, fontFace: "Calibri", align: "center" });
    slide.addShape(pres.ShapeType.rect, { x: x + 0.1, y: y + 0.72, w: 2.08, h: 0.04, fill: { color: i % 2 === 0 ? ACCENT : ACCENT2 }, line: { type: "none" } });
    slide.addText(p.title, { x, y: y + 0.84, w: 2.28, h: 0.45, fontSize: 12.5, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    slide.addText(p.body, { x: x + 0.12, y: y + 1.3, w: 2.06, h: 2.1, fontSize: 9.8, color: BODY_TEXT, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 5 — ETHICAL PRINCIPLES
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Ethical Principles Underpinning Consent", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 4.5, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  const principles = [
    {
      name: "AUTONOMY",
      color: ACCENT,
      body: [
        "Respect the patient's right to self-determination",
        "The choice to receive or refuse care must align with patient values",
        "Freely chosen, without external coercion",
        "Patient can refuse radiation therapy even if medically optimal"
      ]
    },
    {
      name: "BENEFICENCE",
      color: ACCENT2,
      body: [
        "Physician obligation to act in the patient's best interest",
        "Offer treatments with proven benefit",
        "In inoperable cervical cancer: radiation > surgery (benefit vs. harm)",
        "Requires thorough knowledge of oncology evidence base"
      ]
    },
    {
      name: "NON-MALEFICENCE",
      color: "4CAF7D",
      body: [
        "'First, do no harm' — Primum non nocere",
        "Disclose toxicities and late effects of radiotherapy",
        "Avoid treatments whose harm outweighs benefit",
        "Justify each radiation field and dose prescribed"
      ]
    },
    {
      name: "JUSTICE",
      color: "B06AD4",
      body: [
        "Fair distribution of oncology resources",
        "Equal access regardless of socioeconomic status",
        "No discrimination in consent or treatment allocation",
        "Equitable enrollment in clinical trials"
      ]
    },
  ];

  principles.forEach((p, i) => {
    const x = 0.5 + i * 2.38;
    const y = 0.9;
    slide.addShape(pres.ShapeType.rect, { x, y, w: 2.28, h: 0.52, fill: { color: p.color }, line: { type: "none" } });
    slide.addText(p.name, { x, y: y + 0.06, w: 2.28, h: 0.42, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", align: "center", charSpacing: 2 });
    slide.addShape(pres.ShapeType.rect, { x, y: y + 0.52, w: 2.28, h: 3.95, fill: { color: MID_BG }, line: { color: p.color, pt: 1 } });
    p.body.forEach((line, j) => {
      slide.addText([
        { text: "▸ ", options: { bold: true, color: p.color } },
        { text: line, options: { color: BODY_TEXT } }
      ], { x: x + 0.1, y: y + 0.62 + j * 0.84, w: 2.08, h: 0.78, fontSize: 10, fontFace: "Calibri" });
    });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 6 — CONSENT PROCESS
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("The Consent Process in Oncology Practice", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 4.5, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  // Informed consent flowchart image
  if (images[0] && !images[0].error) {
    slide.addImage({ data: images[0].base64, x: 0.5, y: 0.85, w: 4.5, h: 3.2 });
  }

  // Steps on right side
  const steps = [
    ["Step 1", "Initial consultation: Explain diagnosis, prognosis, and proposed radiation/chemotherapy plan"],
    ["Step 2", "Disclose material risks: acute & late toxicities, risk of secondary malignancy, infertility"],
    ["Step 3", "Present alternatives: surgery, systemic therapy, watchful waiting, palliative care"],
    ["Step 4", "Assess comprehension — check understanding, invite questions, use plain language"],
    ["Step 5", "Confirm voluntariness — no coercion. Document the process, not just the signature"],
    ["Ongoing", "Update consent if treatment plan changes or new material information emerges"],
  ];

  steps.forEach(([label, text], i) => {
    const y = 0.85 + i * 0.72;
    slide.addShape(pres.ShapeType.rect, { x: 5.25, y, w: 0.9, h: 0.42, fill: { color: i === 5 ? ACCENT2 : ACCENT }, line: { type: "none" } });
    slide.addText(label, { x: 5.25, y: y + 0.04, w: 0.9, h: 0.36, fontSize: 9, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    slide.addText(text, { x: 6.22, y: y + 0.04, w: 3.55, h: 0.44, fontSize: 9.8, color: BODY_TEXT, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 7 — SHARED DECISION-MAKING
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Shared Decision-Making Model", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 3.5, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  // SDM diagram image
  if (images[1] && !images[1].error) {
    slide.addImage({ data: images[1].base64, x: 0.5, y: 0.85, w: 4.5, h: 3.5 });
  }

  const sdmPoints = [
    { head: "Clinician's Role", body: "Provide best available evidence for treatment options (radiotherapy, chemotherapy, surgery) including risks and benefits of each" },
    { head: "Patient's Role", body: "Bring individual values, preferences, fears, and life priorities to the discussion — these are non-negotiable inputs" },
    { head: "The Collaborative Decision", body: "A joint, documented decision that integrates clinical evidence with the patient's value system" },
    { head: "Decision Aids", body: "Booklets, videos, or digital tools that help patients understand radiation therapy choices and improve informed decision-making" },
    { head: "Ask-Tell-Ask", body: "Ask what patient already knows → Tell clinical information → Ask patient to teach it back (teach-back method)" },
  ];

  sdmPoints.forEach((pt, i) => {
    const y = 0.85 + i * 0.86;
    slide.addShape(pres.ShapeType.rect, { x: 5.2, y, w: 4.55, h: 0.78, fill: { color: MID_BG }, line: { color: i % 2 === 0 ? ACCENT : ACCENT2, pt: 1 } });
    slide.addText(pt.head, { x: 5.35, y: y + 0.05, w: 4.2, h: 0.28, fontSize: 11, bold: true, color: i % 2 === 0 ? ACCENT : ACCENT2, fontFace: "Calibri" });
    slide.addText(pt.body, { x: 5.35, y: y + 0.34, w: 4.2, h: 0.4, fontSize: 9.8, color: BODY_TEXT, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 8 — RADIATION ONCOLOGY SPECIFIC
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Specific Considerations in Radiation Oncology", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 4.8, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  // LINAC image
  if (images[2] && !images[2].error) {
    slide.addImage({ data: images[2].base64, x: 0.5, y: 0.82, w: 3.8, h: 2.5 });
  }

  const rtConsiderations = [
    "Explain the radiobiological rationale: fractionation, dose, and why multiple sessions are required",
    "Describe the specific treatment technique: EBRT, IMRT, SBRT/SABR, SRS, brachytherapy, proton therapy",
    "Clarify treatment duration and number of fractions (e.g., 5-week course vs. SBRT 5 fractions)",
    "Discuss immobilization devices, tattoos, simulation CT — patient should understand the full workflow",
    "Address fertility preservation options before pelvic/gonadal irradiation",
    "In head & neck RT: Discuss anticipated mucositis, xerostomia, dysphagia, PEG tube placement",
    "Risk of secondary malignancy — especially relevant for younger patients and pediatric cases",
    "Pregnancy: Contraindication during RT; contraception counseling mandatory",
  ];

  // Right column bullets
  rtConsiderations.slice(0, 4).forEach((text, i) => {
    const y = 0.85 + i * 0.62;
    slide.addText([
      { text: "◆ ", options: { bold: true, color: ACCENT } },
      { text, options: { color: BODY_TEXT } }
    ], { x: 4.55, y, w: 5.2, h: 0.55, fontSize: 10.5, fontFace: "Calibri" });
  });

  rtConsiderations.slice(4).forEach((text, i) => {
    const y = 3.45 + i * 0.48;
    slide.addText([
      { text: "◆ ", options: { bold: true, color: ACCENT2 } },
      { text, options: { color: BODY_TEXT } }
    ], { x: 0.5, y, w: 9.2, h: 0.44, fontSize: 10, fontFace: "Calibri" });
  });

  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 9 — SIDE EFFECTS DISCLOSURE (with images)
// ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: DARK_BG };
  addTopBar(slide);

  slide.addText("Side Effects Disclosure in Radiotherapy", {
    x: 0.5, y: 0.12, w: 9, h: 0.55,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri Light"
  });
  slide.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.68, w: 4, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  // Two toxicity images
  if (images[3] && !images[3].error) {
    slide.addImage({ data: images[3].base64, x: 0.5, y: 0.85, w: 3.8, h: 2.5 });
    slide.addText("H&N: RTOG Grade 1-2 acute radiation toxicity (erythema, mucositis)", {
      x: 0.5, y: 3.37, w: 3.8, h: 0.35, fontSize: 8, color: SUBTEXT, fontFace: "Calibri", italic: true, align: "center"
    });
  }
  if (images[4] && !images[4].error) {
    slide.addImage({ data: images[4].base64, x: 4.65, y: 0.85, w: 5.1, h: 2.5 });
    slide.addText("Breast RT: Acute (top) & late skin reactions (bottom) at follow-up 10 months–5.3 years", {
      x: 4.65, y: 3.37, w: 5.1, h: 0.35, fontSize: 8, color: SUBTEXT, fontFace: "Calibri", italic: true, align: "center"
    });
  }

  // Table of side effects
  const tableData = [
    [
      { text: "Category", options: { bold: true, color: WHITE, fill: ACCENT2 } },
      { text: "Acute (during/within 90 days)", options: { bold: true, color: WHITE, fill: ACCENT2 } },
      { text: "Late (>90 days post-RT)", options: { bold: true, color: WHITE, fill: ACCENT2 } },
    ],
    [
      { text: "Skin", options: {} },
      { text: "Erythema, desquamation, moist desquamation", options: {} },
      { text: "Fibrosis, telangiectasia, pigmentation changes", options: {} },
    ],
    [
      { text: "Head & Neck", options: {} },
      { text: "Mucositis, xerostomia, dysphagia, odynophagia", options: {} },
      { text: "Osteoradionecrosis, trismus, carotid stenosis", options: {} },
    ],
    [
      { text: "Thorax / Lung", options: {} },
      { text: "Radiation pneumonitis, esophagitis", options: {} },
      { text: "Pulmonary fibrosis, pericarditis", options: {} },
    ],
    [
      { text: "Pelvis / GI", options: {} },
      { text: "Diarrhea, proctitis, cystitis", options: {} },
      { text: "Bowel obstruction, fistula, bladder contracture", options: {} },
    ],
  ];

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    rowH: 0.32,
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  addBottomBar(slide);
}

// ─────────────────────────────────────────────
// SLIDE 10 — SPECIAL SITUATIONS
// ─────────────────────────────────────────────
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  slide.addText("Special Situations in Oncology Consent", {
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      color: ACCENT,
      points: [
        "Disease, medications, or neurological insult may impair decision-making",
        "Incompetence in one domain ≠ incompetence in all domains",
        "Cognitive capacity assessment tools (e.g., MacCAT-T) may be used",
        "Involves psychiatry/ethics consultation if uncertainty persists"
      ]
    },
    {
      title: "Surrogate Decision Makers",
      color: ACCENT2,
      points: [
        "Legal hierarchy varies by jurisdiction (state/country)",
        "Order: Court guardian > Durable Power of Attorney > Spouse > Adult children > Parents",
        "Surrogate must act as the patient would have acted (substituted judgment)",
        "Advance directives (living will, DNR) should be reviewed before RT planning"
      ]
    },
    {
      title: "Pediatric Patients",
      color: "4CAF7D",
      points: [
        "Parents are primary surrogates; child's assent should be sought",
        "Conflict of interest must be identified (religious, social, financial)",
        "Court intervention warranted if parents refuse life-saving radiation",
        "Adolescents may have evolving decision-making capacity"
      ]
    },
    {
      title: "Clinical Trials",
      color: "B06AD4",
      points: [
        "Trial consent is separate from treatment consent — must be distinct",
        "Patient cannot be coerced into trial participation",
        "Right to withdraw without affecting standard treatment",
        "Ethics committee (IRB/IEC) approval mandatory before enrollment"
      ]
    },
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// ─────────────────────────────────────────────
// SLIDE 11 — DOCUMENTATION & MEDICOLEGAL
// ─────────────────────────────────────────────
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  slide.addText("Documentation & Medicolegal Aspects", {
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  slide.addText("What Must Be Documented", { x: 0.65, y: 0.88, w: 4.2, h: 0.36, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri" });
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    "Date and time of consent discussion",
    "Clinician identity and specialty",
    "Diagnosis and clinical indication",
    "Treatment proposed: radiation modality, dose, target",
    "Risks discussed: both general and site-specific",
    "Alternatives presented (including no treatment)",
    "Patient's questions and responses",
    "Interpreter used (yes/no) and language",
    "Patient's decision: acceptance or refusal",
    "Signature of patient (or legal representative)",
    "Witness signature where required by institution",
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  slide.addText("Medicolegal Principles", { x: 5.35, y: 0.88, w: 4.2, h: 0.36, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri" });
  const legalItems = [
    ["Standard of Disclosure", "Either 'reasonable physician' standard or 'reasonable patient' (materiality) standard — jurisdiction dependent"],
    ["Failure of Consent ≠ Negligence", "Plaintiff must prove that had they been properly informed, a reasonable patient would have refused treatment"],
    ["Battery vs. Negligence", "Performing a procedure without any consent = battery; inadequate consent = negligence"],
    ["Emergency Exception", "Implied consent in life-threatening emergencies when patient is unable to consent and delay would cause serious harm"],
    ["Revocation", "Patients may revoke consent at any time, even mid-treatment; document carefully"],
    ["Therapeutic Privilege", "Narrow exception: withholding information that would cause severe psychological harm — ethically controversial, rarely applicable"],
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// ─────────────────────────────────────────────
// SLIDE 12 — BARRIERS & BEST PRACTICES
// ─────────────────────────────────────────────
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  slide.addText("⚠  Common Barriers", { x: 0.65, y: 0.87, w: 4.2, h: 0.36, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri" });
  const barriers = [
    "Physician's fear of frightening the patient with risk information",
    "Patient fear of hearing prognosis or side effect details",
    "Health literacy gaps — inability to process technical jargon",
    "Language and cultural barriers",
    "Time pressure in busy oncology clinics",
    "Cognitive impairment due to metastatic CNS disease",
    "Emotional distress at time of diagnosis",
    "Power imbalance — patient reluctance to question physician",
    "Incomplete disclosure by physician (inadequate training)",
  ];
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    "Use plain language (6th-grade reading level) — avoid acronyms",
    "Employ the teach-back method to verify understanding",
    "Use professional interpreters, never family members (conflict of interest)",
    "Provide written materials + verbal discussion",
    "Allow adequate time — separate consent discussion from procedure day",
    "Document the process narratively, not just the signature",
    "Use standardized institutional consent templates for RT sites",
    "Offer multidisciplinary support: oncology nurse, social worker, chaplain",
    "Revisit consent if treatment intent changes (curative → palliative)",
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}

// ─────────────────────────────────────────────
// SLIDE 13 — KEY TAKEAWAYS / SUMMARY
// ─────────────────────────────────────────────
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    { num: "2", text: "The four pillars — Capacity, Disclosure, Understanding, Voluntariness — must all be fulfilled", color: ACCENT2 },
    { num: "3", text: "Radiation oncology carries unique obligations: explain fractionation, treatment workflow, acute and late toxicities, and fertility impact", color: "4CAF7D" },
    { num: "4", text: "Shared decision-making integrates clinical evidence with individual patient values — both are mandatory inputs", color: "E8B84B" },
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    { num: "6", text: "Document the conversation narratively — record what was discussed, questions asked, and the patient's understanding", color: ACCENT2 },
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// ─────────────────────────────────────────────
// SLIDE 14 — CLOSING
// ─────────────────────────────────────────────
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  slide.addText("\"Every human being of adult years and sound mind", {
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  slide.addText("— Justice Benjamin N. Cardozo, Schloendorff v. Society of NY Hospital, 1914", {
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  slide.addText("Informed consent is the cornerstone of the therapeutic relationship in oncology.\nRespect for patient autonomy is not optional — it is the ethical and legal foundation of care.", {
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// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
const outPath = "/home/daytona/workspace/informed-consent-oncology/Informed_Consent_Radiation_Medical_Oncology.pptx";
pres.writeFile({ fileName: outPath })
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