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Kearns N, Raigal-Aran L, O’Connell K, Davis A, Bermingham K, O’Reilly S, Collins DC, Corrigan M, Coulter J, Cleary V, Cushen S, Flavin A, Byrne F, O’Grady A, O’Neill D, Murphy A, Dahly D, Palmer B, Connolly RM, Hegarty J. The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial. Pilot Feasibility Stud 2022; 8:238. [PMID: 36357934 PMCID: PMC9648029 DOI: 10.1186/s40814-022-01186-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland. METHODS The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021. DISCUSSION This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care. TRIAL REGISTRATION ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.
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Affiliation(s)
- Noreen Kearns
- grid.7872.a0000000123318773Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laia Raigal-Aran
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Kate O’Connell
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Andrea Davis
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Katie Bermingham
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Seamus O’Reilly
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.412702.20000 0004 0617 8029Department of Medical Oncology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Dearbhaile C. Collins
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Mark Corrigan
- grid.411916.a0000 0004 0617 6269Department of Academic Surgery, Cork University Hospital, Cork, Ireland
| | - John Coulter
- grid.411916.a0000 0004 0617 6269Department of Gynaecology Oncology, Cork University Maternity Hospital, Cork, Ireland
| | - Vicki Cleary
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Gynaecology Oncology, Cork University Maternity Hospital, Cork, Ireland
| | - Samantha Cushen
- grid.7872.a0000000123318773School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Aileen Flavin
- grid.411916.a0000 0004 0617 6269Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Fiona Byrne
- grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Aisling O’Grady
- grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Deirdre O’Neill
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Aileen Murphy
- grid.7872.a0000000123318773Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Darren Dahly
- grid.7872.a0000000123318773HRB Clinical Research Facility, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773School of Public Health, University College Cork, Cork, Ireland
| | - Brendan Palmer
- grid.7872.a0000000123318773HRB Clinical Research Facility, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773School of Public Health, University College Cork, Cork, Ireland
| | - Roisin M. Connolly
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Josephine Hegarty
- grid.7872.a0000000123318773Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
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Richmond JP, Kelly MG, Johnston A, Hynes L, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review protocol. HRB Open Res 2022; 4:7. [PMID: 35136853 PMCID: PMC8802151 DOI: 10.12688/hrbopenres.13208.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/01/2023] Open
Abstract
Oncology has been undergoing a profound transition in the last ten years with the increased usage in oral anti-cancer medication. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safety and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on OAMs is of paramount importance. The optimum setting, whether within primary or secondary care, in addition to the appropriate health care professional to carry out patient assessment and monitoring needs to be established. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the literature on the current management of adults receiving OAMs. The review will follow the published guidance to direct the various steps involved. The protocol will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. Independent full text review will be performed by two reviewers and any disagreements resolved through discussion with a third reviewer. The process will be iterative in nature. This scoping review will provide a narrative synthesis and map the literature on the management of individuals receiving OAMs. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced practitioner.
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Affiliation(s)
- Janice P. Richmond
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Mary Grace Kelly
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Alison Johnston
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Lisa Hynes
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
| | - Patrick J. Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
| | - Andrew W. Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
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3
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Richmond JP, Kelly MG, Johnston A, Hynes L, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review protocol. HRB Open Res 2022; 4:7. [PMID: 35136853 PMCID: PMC8802151 DOI: 10.12688/hrbopenres.13208.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
Oncology has been undergoing a profound transition in the last ten years with the increased usage in oral anti-cancer medication. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safety and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on OAMs is of paramount importance. The optimum setting, whether within primary or secondary care, in addition to the appropriate health care professional to carry out patient assessment and monitoring needs to be established. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the literature on the current management of adults receiving OAMs. The review will follow the published guidance to direct the various steps involved. The protocol will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. Independent full text review will be performed by two reviewers and any disagreements resolved through discussion with a third reviewer. The process will be iterative in nature. This scoping review will provide a narrative synthesis and map the literature on the management of individuals receiving OAMs. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced practitioner.
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Affiliation(s)
- Janice P. Richmond
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Mary Grace Kelly
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Alison Johnston
- Oncology Department, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
| | - Lisa Hynes
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
| | - Patrick J. Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
| | - Andrew W. Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUIG Galway, Galway, Ireland
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Richmond JP, Kelly MG, Johnston A, Hynes L, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review protocol. HRB Open Res 2022; 4:7. [DOI: 10.12688/hrbopenres.13208.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Oncology has been undergoing a profound transition in the last ten years with the increased usage in oral anti-cancer medication. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safety and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on OAMs is of paramount importance. The optimum setting, whether within primary or secondary care, in addition to the appropriate health care professional to carry out patient assessment and monitoring needs to be established. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the literature on the current management of adults receiving OAMs. The review will follow the published guidance to direct the various steps involved. The protocol will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. Independent full text review will be performed by two reviewers and any disagreements resolved through discussion with a third reviewer. The process will be iterative in nature. This scoping review will provide a narrative synthesis and map the literature on the management of individuals receiving OAMs. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced practitioner.
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5
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Richmond JP, Kelly MG, Johnston A, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review. Eur J Oncol Nurs 2021; 54:102015. [PMID: 34500319 DOI: 10.1016/j.ejon.2021.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Oral anti-cancer medication (OAM) has revolutionised oncology care. Due to their potential toxicities and associated safety challenges ongoing assessment and monitoring is essential; currently generally performed in acute care settings. Internationally there exists a transformative vision to shift patient care from acute to primary care. A nurse-led integrated model of care could be developed for OAM patient management in primary care. The aim of this study was to examine international literature regarding current clinical management practices for assessment and monitoring of patients receiving OAM. METHODS Following PRISMA-ScR guidelines, databases MEDLINE, CINAHL and Web of Science were searched for English studies published between 2010 and 2020 using keywords: assessment, cancer, care, management, oral anticancer medications. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate and make a narrative account of the findings. RESULTS 2261 papers were reviewed, 14 met inclusion criteria. Three phases of management are reported: 1. Patient treatment plan development; 2. Patient education; 3. Patient monitoring. Within these phases seven specific stages of care were identified broadly representing the patient's journey: (1) treatment decision, (2) prescribing of OAM, (3) OAM dispensing and administration, (4) maximising patient safety (5) ongoing patient assessment (6) patient support (7) communication with other health-care professionals. CONCLUSIONS Despite a paucity of international literature, a dedicated OAM clinic was endorsed as a means to achieve improved care. Nurses and pharmacists were identified as being of particular importance especially in education and ongoing management of patients receiving OAMs.
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Affiliation(s)
- J P Richmond
- Letterkenny University Hospital, Donegal, Ireland.
| | - M G Kelly
- Letterkenny University Hospital, Donegal, Ireland
| | - A Johnston
- Letterkenny University Hospital, Donegal, Ireland
| | - P J Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUI Galway, Ireland
| | - A W Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUI Galway, Ireland
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Doolin JW, Berry JL, Forbath NS, Tocci NX, Dechen T, Li S, Hartwell RA, Espiritu JK, Roberts DA, Zerillo JA, Shea M. Implementing Electronic Patient-Reported Outcomes for Patients With New Oral Chemotherapy Prescriptions at an Academic Site and a Community Site. JCO Clin Cancer Inform 2021; 5:631-640. [PMID: 34097439 DOI: 10.1200/cci.20.00191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oral chemotherapy challenges providers' abilities to safely monitor patients' symptoms, adherence, and financial toxicity. COVID-19 has increased the urgency of caring for patients remotely. Collection of electronic patient-reported outcomes (ePROs) has demonstrated efficacy for patients on intravenous chemotherapy, but limited data support their use in oral chemotherapy. We undertook a pilot project to assess the feasibility of implementing an ePRO system for patients starting oral chemotherapy at our cancer center, which includes both an academic site and a community site. METHODS Patients initiating oral chemotherapy were asked to participate. A five-question tool was built in REDCap. Concerning responses triggered outreach within one business day. The primary outcome was time to first symptom assessment. For comparison, we used a historical cohort of patients who had been prescribed oral chemotherapies by providers in the same disease groups at the cancer center. RESULTS Twenty-five of 62 (40%) patients completed ePRO assessments. Fifty historical charts were reviewed. Time to first symptom assessment was 7 days (IQR, 4-14 days) in the historical group compared with 3 days (IQR, 2-4 days) in the ePRO group. Time to clinical action was 14 days (7-35 days) in the historical group compared with 8 days (4-19 days) in the ePRO group. No statistically significant differences were detected in 30-day emergency department visit or hospitalization (12% for both groups) or 90-day emergency department visit or hospitalization rates (historical 28% and ePRO 20%). CONCLUSION An ePRO tool monitoring patient concerns about adherence, cost, and toxicities for patients with new oral chemotherapy regimens is feasible and improves time to symptom assessment. Further investigation is needed to improve patient engagement with ePROs and evaluate the long-term impacts for patients on oral chemotherapy.
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Affiliation(s)
- Jim W Doolin
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan L Berry
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Natalia S Forbath
- Center for Healthcare Deliver Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Noah X Tocci
- Center for Healthcare Deliver Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Tenzin Dechen
- Center for Healthcare Deliver Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stephanie Li
- Center for Healthcare Deliver Science, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Jessica A Zerillo
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Meghan Shea
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA
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Oratz T, Ogletree R, Gettis M, Cherven B. Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste. Clin J Oncol Nurs 2021; 25:272-281. [PMID: 34019028 DOI: 10.1188/21.cjon.272-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Safe handling practices for patient waste have focused on patients receiving IV chemotherapy, but these practices do not address safe handling for patients receiving oral chemotherapy. OBJECTIVES The aim of this article is to evaluate evidence and formulate best practice recommendations for handling and disposing waste from patients receiving oral chemotherapy. METHODS A literature search established a framework for the project. For healthcare providers and staff, procedures were established to access biohazard supplies and to follow safe handling of patient waste post-oral chemotherapy administration. Supply cost utilization was evaluated pre- and postimplementation. Staff perceptions were assessed six months after project implementation. FINDINGS The cost of supplies per patient day increased minimally. Staff self-reported use of biohazard precautions when handling patients' waste increased. The majority of staff reported that they had access to supplies and were knowledgeable regarding safe handling procedures six months after this practice change.
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Richmond J, Kelly MG, Johnston A, Hynes L, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review protocol. HRB Open Res 2021; 4:7. [DOI: 10.12688/hrbopenres.13208.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/20/2022] Open
Abstract
Oncology has been undergoing a profound transition in the last ten years or more with the increase in oral anti-cancer medications. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safely and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on oral anti-cancer is of paramount importance but as to the location of such patient assessment and monitoring and by which health care professional is subject to ongoing debate. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the available literature on the current management of adults receiving oral anti-cancer medications. The scoping review will follow the published guidance to direct the various steps involved. The report will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. The review will be performed by two reviewers and checked by a third reviewer and will be iterative in the process. This scoping review will provide a narrative synthesis and map the extent of available literature on the management of individuals receiving oral anti-cancer medication. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced nurse.
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Kinnaer LM, Nelis M, Van Hecke A, Foulon V. Patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs: An importance-performance analysis. Eur J Oncol Nurs 2020; 47:101765. [PMID: 32563842 DOI: 10.1016/j.ejon.2020.101765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE To analyse the importance and performance of key elements in patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs. METHOD In four Belgian non-academic hospitals, the importance and performance of a set of 82 key elements was cross-sectionally evaluated by primary and secondary healthcare professionals and by patients. These key elements were divided in 6 themes: coordination of care, style and content of patient contacts, medication counseling at treatment initiation, follow-up of treatment, psychosocial support, and involvement of family and friends. Participants were asked to indicate for each key element if it was implemented in the current care process for patients on oral anticancer drugs ('yes', 'no', 'I don't know') and if they considered it important that the component was implemented or would be in the future ('yes' or 'no'). Three levels of performance were defined, based on the number of participants who had answered 'yes' or 'no': 'systematically performed' (≥90% of participants), 'not systematically performed' (≥75% and <90%) and 'not performed' (<75%). Importance-rates were based on the number of 'yes' or 'no'. RESULTS In total, 85 participants evaluated the key elements. More than half of key elements, 13/82 (15.9%) and 35/82 (42.6%) respectively, were considered as 'not' or 'not systematically performed'. The majority of these elements concerned coordination of care, medication counseling at treatment initiation and follow-up of treatment. Especially key elements on involving primary care and on discussing adherence had low performance rates. Nearly all key elements were assigned an importance score of ≥90%. CONCLUSIONS Performance of key elements of patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs proved moderate. Our findings suggest that strategies are needed to prioritize and operationalize key elements to coordinate transmural care and to provide effective education and counseling.
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Affiliation(s)
- Lise-Marie Kinnaer
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Leuven, Belgium.
| | - Maxim Nelis
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Leuven, Belgium
| | - Ann Van Hecke
- Ghent University, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium; Ghent University Hospital, Department of Nursing, Ghent, Belgium
| | - Veerle Foulon
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Leuven, Belgium
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Cirillo M, Carlucci L, Legramandi L, Baldini E, Sacco C, Zagonel V, Leo S, Di Fabio F, Tonini G, Meacci ML, Tartarone A, Farci D, Tortora G, Zaninelli M, Valori VM, Cinieri S, Carrozza F, Barbato E, Fabbroni V, Cretella E, Gamucci T, Lunardi G, Zamboni S, Micallo G, Cascinu S, Pinto C, Gori S. Oral anticancer therapy project: Clinical utility of a specific home care nursing programme on behalf of Italian Association of Medical Oncology (AIOM). J Clin Nurs 2019; 29:119-129. [PMID: 31532035 DOI: 10.1111/jocn.15064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/26/2019] [Accepted: 08/31/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of a specific home care nursing programme in addition to standard care in patients (pts) receiving oral anticancer treatments. BACKGROUND Oral anticancer therapy present challenges for pts since treatment is a home-based therapy. This study evaluates the potentiality of a home care nursing programme in decreasing hospital accesses for not severe toxicity. METHODS This is an open-label, multicentre, randomised trial including pts who were receiving an anticancer oral drug. The study complies with the CONSORT checklist published in 2010. Concomitant use of radiation therapy, intravenous or metronomic therapies, or the intake of previous oral drugs was not allowed. Pts were randomly assigned to home care nursing programme (A) or standard care (B). In arm A, dedicated nurses provided information to pts, a daily record on which pts would take note of drugs and dosages and a telephone monitoring during the first two cycles of therapy. The primary outcome was the reduction in improper hospital accesses for grade 1-2 toxicity according to CTCAE v4.0. RESULTS Out of 432 randomised pts, 378 were analysed (184 pts in arm A and 194 in arm B). Hospital accesses were observed in 41 pts in arm A and in 42 pts in arm B (22.3% vs. 21.6%, respectively). No difference was detected in proportion of improper accesses between arm A and arm B (29.3% vs. 23.8%, respectively). CONCLUSIONS Our experience failed to support the role of a specific home care nursing programme for pts taking oral chemotherapy. An improved attention to specific educational practice and information offered to pts can explain these results. RELEVANCE TO CLINICAL PRACTICE Our results underline the role of nurse educational practice and information offered to patients. A careful nurse information of patients about drugs is essential to reduce toxicities avoiding the opportunity of a specific home monitoring.
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Affiliation(s)
| | - Luciano Carlucci
- IRCCS Mario Negri Institute for Pharmacological Research, Milano, Italy
| | | | | | | | | | | | | | | | | | - Alfredo Tartarone
- IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Sonia Zamboni
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Giovanni Micallo
- Oncologia, Nurse's AIOM Working Group, Istituto Tumori Fondazione Pascale, Napoli, Italy
| | - Stefano Cascinu
- Modena Cancer Center, A.O.U. di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pinto
- OECI Clinical Cancer Center, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Stefania Gori
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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Redelico TJ, Walton SM, LaFollette J, Adams Curry M, Bernal-Mizrachi L. Assessment of Provider Adherence to Recommended Monitoring Parameters for Oral Anticancer Medications. J Oncol Pract 2018; 14:e446-e450. [PMID: 29813011 DOI: 10.1200/jop.17.00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Oral anticancer medications (OAMs) offer convenient administration but create new challenges with unique toxicity profiles, specific monitoring parameters and non-continuous dosing schedules. We evaluated provider compliance with US Food and Drug Administration (FDA) drug labeling-specified monitoring parameters for commonly dispensed OAMs at a public academic health system. METHODS A retrospective chart review of patients receiving OAMs was conducted at Grady Health System between July 2015 and June 2016. Patients included in the evaluation were dispensed one of the ten most common OAMs used in our cancer center. Laboratory data and provider documentation were collected and compared to FDA drug labeling-specified monitoring parameters, and the primary outcome was the percentage of fully-compliant cycles. Secondary outcomes included patient adherence assessed by provider documentation and fill history. Descriptive statistics were used to evaluate the data. RESULTS The initial report comprised 422 patients, of which 77 patients with a total of 349 treatment cycles were included for final analysis. One hundred twenty-six (36.1%) of the treatment cycles were fully compliant with the FDA drug labeling-specified monitoring parameters. Sixty-four of the 199 (32.2%) applicable clinic notes documented patient adherence, and 15 (39.5%) of 38 patients were adherent based on fill history. CONCLUSION This study revealed low compliance with FDA-recommended monitoring parameters for commonly dispensed OAMs at our institution. In addition, this study confirmed national concerns about adherence to oral regimens. It also suggests that provider compliance with monitoring parameters is an area that needs to be addressed in order to improve the ambulatory OAM process.
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Affiliation(s)
- Tyler J Redelico
- Grady Health System; and Emory University School of Medicine, Atlanta, GA
| | - Suzanne M Walton
- Grady Health System; and Emory University School of Medicine, Atlanta, GA
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Jordan JT, Sanders AE, Armstrong T, Asher T, Bennett A, Dunbar E, Mohile N, Nghiemphu PL, Smith TR, Ney DE. Quality improvement in neurology: Neuro-oncology quality measurement set. Neurology 2018; 90:652-658. [PMID: 29500290 PMCID: PMC10681057 DOI: 10.1212/wnl.0000000000005251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Justin T Jordan
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Amy E Sanders
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Terri Armstrong
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Tony Asher
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Amy Bennett
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Erin Dunbar
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Nimish Mohile
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - P Leia Nghiemphu
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Timothy R Smith
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Douglas E Ney
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
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Jordan JT, Sanders AE, Armstrong T, Asher T, Bennett A, Dunbar E, Mohile N, Nghiemphu PL, Smith TR, Ney DE. Quality improvement in neurology: Neuro-Oncology Quality Measurement Set. Neuro Oncol 2018; 20:531-537. [PMID: 29509930 PMCID: PMC5909638 DOI: 10.1093/neuonc/nox245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Justin T Jordan
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA
| | - Amy E Sanders
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Clinical Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tony Asher
- Department of Neurological Surgery, Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Amy Bennett
- American Academy of Neurology, Minneapolis, MN
| | - Erin Dunbar
- Department of Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, GA
| | - Nimish Mohile
- Department of Neurology, University of Rochester, Rochester, NY
| | | | - Timothy R Smith
- Cushing Neurosurgical Outcomes Center, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Douglas E Ney
- Departments of Neurology and Neurosurgery, University of Colorado School of Medicine, Aurora, CO
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Klein A, Hermes-Moll K, Osburg S, Walawgo T, Mödder M, Baumann W. [Feedback strategies for routine surveys of quality indicators in outpatient oncology care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 134:18-26. [PMID: 29428626 DOI: 10.1016/j.zefq.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The study deals with the efficiency and possible improvements of quality promotion with quality indicators (QI). The goal is to investigate the practical use of feedback from QI surveys in the field of oncology office practices. It captures both the acceptance of results and the independent initiation of search- and improvement strategies. The value of best practice examples is of further interest. METHODS Within one year, data of six QI of 31 physicians from 24 oncology practices were collected twice and the results were sent back in individual reports including a benchmarking. Practices with particularly good results in individual QI sectors were surveyed in semi-structured telephone interviews about their processes. Based on these results, best practice examples were created and provided to all participating practices to stimulate improvement. Further, two paper-based surveys about the acceptance and handling of results as well as the use of best practice examples were conducted. RESULTS The practices accepted the reported results as an instrument to assess their own care quality (70 %) and indicated that had been able to identify improvement potentials (75 %). Improvement strategies were developed or planned by approximately every second practice in the respective sectors. The practices were interested in the best practice examples and rated them as helpful (70 %). Many of them indicated that they were already taking up some of the suggestions for improving the organization of their own processes or were planning to do so. CONCLUSION The extraction of information on QI from patient files is a tedious task for the practices. Both the implementation of the necessary internal measures after receiving the results report as well as the adaptation of external process examples to their own processes is challenging. Nevertheless, oncology practices benefit from the feedback of the results of QI surveys and best practice examples. Thus, QI surveys and the reporting of results can actively encourage quality development.
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Affiliation(s)
- Astrid Klein
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland.
| | - Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Sandra Osburg
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Thomas Walawgo
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Martin Mödder
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
| | - Walter Baumann
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO) GmbH, Köln, Deutschland
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Mulkerin DL, Bergsbaken JJ, Fischer JA, Mulkerin MJ, Bohler AM, Mably MS. Multidisciplinary Optimization of Oral Chemotherapy Delivery at the University of Wisconsin Carbone Cancer Center. J Oncol Pract 2017; 12:e912-e923. [PMID: 27858570 DOI: 10.1200/jop.2016.013748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Use of oral chemotherapy is expanding and offers advantages while posing unique safety challenges. ASCO and the Oncology Nursing Society jointly published safety standards for administering chemotherapy that offer a framework for improving oral chemotherapy practice at the University of Wisconsin Carbone Cancer Center. METHODS With the goal of improving safety, quality, and uniformity within our oral chemotherapy practice, we conducted a gap analysis comparing our practice against ASCO/Oncology Nursing Society guidelines. Areas for improvement were addressed by multidisciplinary workgroups that focused on education, workflows, and information technology. Recommendations and process changes included defining chemotherapy, standardizing patient and caregiver education, mandating the use of comprehensive electronic order sets, and standardizing documentation for dose modification. Revised processes allow pharmacists to review all orders for oral chemotherapy, and they support monitoring adherence and toxicity by using a library of scripted materials. RESULTS Between August 2015 and January 2016, revised processes were implemented across the University of Wisconsin Carbone Cancer Center clinics. The following are key performance indicators: 92.5% of oral chemotherapy orders (n = 1,216) were initiated within comprehensive electronic order sets (N = 1,315), 89.2% compliance with informed consent was achieved, 14.7% of orders (n = 193) required an average of 4.4 minutes review time by the pharmacist, and 100% compliance with first-cycle monitoring of adherence and toxicity was achieved. CONCLUSION We closed significant gaps between institutional practice and published standards for our oral chemotherapy practice and experienced steady improvement and sustainable performance in key metrics. We created an electronic definition of oral chemotherapies that allowed us to leverage our electronic health records. We believe our tools are broadly applicable.
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Affiliation(s)
- Daniel L Mulkerin
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
| | - Jason J Bergsbaken
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
| | - Jessica A Fischer
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
| | - Mary J Mulkerin
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
| | - Aaron M Bohler
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
| | - Mary S Mably
- University of Wisconsin Carbone Cancer Center; UW Health, Madison, WI; and Riverside Health System, Newport News, VA
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LeFebvre KB, Felice TL. Nursing Application of Oral Chemotherapy Safety Standards:An Informal Survey. Clin J Oncol Nurs 2017; 20:258-62. [PMID: 27206292 DOI: 10.1188/16.cjon.258-262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the use of oral chemotherapy continues to rise, new approaches are needed to ensure patient safety. To help address this issue, the American Society of Clinical Oncology/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards were expanded in 2013 to include additional measures addressing oral anticancer drugs (OACs). Because minimal data assessing the application of these standards exist, ONS conducted an independent survey of oncology nurses to evaluate the application of these standards in practice as they relate to several areas of OAC use: assessment, consent, patient education, drug verification, and monitoring. The data revealed that, although the standards are followed in many settings, a large number of settings do not have processes in place to support safety standards and ensure patient safety when administering OACs. Information gained in this informal survey can be used to guide additional research and educational initiatives.
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Salgado TM, Mackler E, Severson JA, Lindsay J, Batra P, Petersen L, Farris KB. The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices. Support Care Cancer 2017; 25:1797-1807. [DOI: 10.1007/s00520-017-3584-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
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