Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.3
Jennifer L. Raybin, PhD, RN, CPNP, Andrew Donson, Nicholas K. Foreman, MRCP, Rajeev Vibhakar, MD, Michael H. Handler, MD, Arthur K. Liu, MD, PhD
Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.
{"title":"Maintaining Survival While Improving Quality of Life: An Advanced Practitioner–Led Pilot Feasibility Study to Reduce Radiation Dose in Children With Brain Tumors","authors":"Jennifer L. Raybin, PhD, RN, CPNP, Andrew Donson, Nicholas K. Foreman, MRCP, Rajeev Vibhakar, MD, Michael H. Handler, MD, Arthur K. Liu, MD, PhD","doi":"10.6004/jadpro.2024.15.1.3","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.3","url":null,"abstract":"Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"148 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139819454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.6
Anna Poullard, DNP, MSN, APRN-BC, Sheena Charles, MS, FNP-BC
The primary objectives of early phase clinical trials are to determine the safety, tolerability, and recommended doses of an investigational agent for patients with advanced cancer. Although these advances in cancer treatment have resulted in patients living longer, patients often experience psychological side effects that may affect sexual health and intimacy. It is estimated that cancer and its subsequent treatments affect the sexual health and intimacy of 40% to 100% of this patient population. Patients with advanced cancer who have undergone numerous treatments may be impacted negatively, not only physically (such as being disfigured by surgical resection) but also emotionally in relationship aspects with their intimate partners. Health-care providers who treat patients with advanced cancer enrolled in early phase clinical trials tend to focus primarily on treatment, physical side effects, and symptom management. Advanced practice providers (APPs) are accustomed to performing comprehensive physical examinations on patients; however, research indicates that intimacy and sexuality are most often excluded in discussions with patients with advanced cancer. The purpose of the article is to increase awareness of the need to address intimacy and sexuality in this patient population and to encourage APPs to make this a part of their everyday practice.
{"title":"Advanced Practice Providers’ Role in Intimacy in Advanced Cancer Patients","authors":"Anna Poullard, DNP, MSN, APRN-BC, Sheena Charles, MS, FNP-BC","doi":"10.6004/jadpro.2024.15.1.6","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.6","url":null,"abstract":"The primary objectives of early phase clinical trials are to determine the safety, tolerability, and recommended doses of an investigational agent for patients with advanced cancer. Although these advances in cancer treatment have resulted in patients living longer, patients often experience psychological side effects that may affect sexual health and intimacy. It is estimated that cancer and its subsequent treatments affect the sexual health and intimacy of 40% to 100% of this patient population. Patients with advanced cancer who have undergone numerous treatments may be impacted negatively, not only physically (such as being disfigured by surgical resection) but also emotionally in relationship aspects with their intimate partners. Health-care providers who treat patients with advanced cancer enrolled in early phase clinical trials tend to focus primarily on treatment, physical side effects, and symptom management. Advanced practice providers (APPs) are accustomed to performing comprehensive physical examinations on patients; however, research indicates that intimacy and sexuality are most often excluded in discussions with patients with advanced cancer. The purpose of the article is to increase awareness of the need to address intimacy and sexuality in this patient population and to encourage APPs to make this a part of their everyday practice.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"139 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.8
Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.
{"title":"Clinical Posters From JADPRO Live 2023","authors":"","doi":"10.6004/jadpro.2024.15.1.8","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.8","url":null,"abstract":"Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"87 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is known among clinicians, including advanced practitioners (APs), that non-medical factors will influence health outcomes and contribute to health disparities. Factors such as socioeconomic position, access to health-care and education systems, and living conditions impact whether a patient will be provided similar treatment, care, or resources as others with the same condition. These are referred to as social determinants of health (SDOHs), and negative social factors lead to patients experiencing deleterious outcomes (Pinheiro et al., 2022).
临床医生（包括高级执业医师）都知道，非医疗因素会影响健康结果并造成健康差异。社会经济地位、获得医疗保健和教育系统的机会以及生活条件等因素都会影响患者是否会获得与其他病情相同的患者类似的治疗、护理或资源。这些因素被称为健康的社会决定因素（SDOHs），负面的社会因素会导致患者经历有害的结果（Pinheiro et al.）
{"title":"The Cost of Care: Financial and Social Factors in Cancer Management","authors":"Beth Faiman, PhD, MSN, APRN-BC, AOCN, BMTCN, FAAN, FAPO","doi":"10.6004/jadpro.2024.15.1.1","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.1","url":null,"abstract":"It is known among clinicians, including advanced practitioners (APs), that non-medical factors will influence health outcomes and contribute to health disparities. Factors such as socioeconomic position, access to health-care and education systems, and living conditions impact whether a patient will be provided similar treatment, care, or resources as others with the same condition. These are referred to as social determinants of health (SDOHs), and negative social factors lead to patients experiencing deleterious outcomes (Pinheiro et al., 2022).","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"15 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139888308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.8
Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.
{"title":"Clinical Posters From JADPRO Live 2023","authors":"","doi":"10.6004/jadpro.2024.15.1.8","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.8","url":null,"abstract":"Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"27 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.8.3
Karla V. Ow, MSN, APRN, AOCNP, Ann Vo, MSN, APRN, FNP, Jonathan Cunningham, MPAS, PA-C
T-cell lymphomas (TCLs) have a unique pathobiology, clinically aggressive course, and poor prognosis. Recently, there have been significant advances in understanding the molecular genetic alterations of TCLs through next-generation sequencing. This has led to the development of specific therapeutic molecules. This review aims to provide an up-to-date overview of the current therapeutic approaches for the subtype peripheral T-cell lymphoma, not otherwise specified.
{"title":"Peripheral T-Cell Lymphoma, Not Otherwise Specified: Diagnosis and Therapeutic Approaches for the Advanced Practice Provider","authors":"Karla V. Ow, MSN, APRN, AOCNP, Ann Vo, MSN, APRN, FNP, Jonathan Cunningham, MPAS, PA-C","doi":"10.6004/jadpro.2024.15.8.3","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.8.3","url":null,"abstract":"T-cell lymphomas (TCLs) have a unique pathobiology, clinically aggressive course, and poor prognosis. Recently, there have been significant advances in understanding the molecular genetic alterations of TCLs through next-generation sequencing. This has led to the development of specific therapeutic molecules. This review aims to provide an up-to-date overview of the current therapeutic approaches for the subtype peripheral T-cell lymphoma, not otherwise specified.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"963 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.
{"title":"Does Use of Intratumoral Injections in Solid Tumor Malignancies Improve Outcomes and Reduce Adverse Events? An Integrative Review","authors":"Maggie Matyola, APRN, FNP-C, Ashley Martinez, DNP, APRN, FNP-BC, Joyce Dains, DrPH, JD, APRN, FNP-BC, FNAP, FAANP, FAAN","doi":"10.6004/jadpro.2024.15.1.4","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.4","url":null,"abstract":"The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"183 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.7
Catherine Joseph, MSN, APN, AGACNP-BC
Magnetic resonance imaging (MRI) of the brain is an important diagnostic tool used by neurologists. This article explores the workup and management for a patient with a brain lesion and highlights the importance of neuroimaging. Similarities and differences in MRI findings for meningioma, central nervous system lymphoma, and glioblastomas are discussed, along with common MRI sequences and their utility.
{"title":"Guess What Is in My Brain","authors":"Catherine Joseph, MSN, APN, AGACNP-BC","doi":"10.6004/jadpro.2024.15.1.7","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.7","url":null,"abstract":"Magnetic resonance imaging (MRI) of the brain is an important diagnostic tool used by neurologists. This article explores the workup and management for a patient with a brain lesion and highlights the importance of neuroimaging. Similarities and differences in MRI findings for meningioma, central nervous system lymphoma, and glioblastomas are discussed, along with common MRI sequences and their utility.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"56 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.2
Tina Harris, DNP, NP-C, AOCNP, Julie Brinzo, DNP, APRN, MBA, FNP-C, Christopher Pell, PhD
Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.
背景：对多学科团队进行经济毒性（FT）风险、筛查和护理协调方面的教育，是解决新诊断的 III 期或 IV 期癌症患者护理差距的一种方法。目标：本质量改进项目（QIP）的目标是为多学科团队提供一项教育计划，为实现以下目标提供启示：（1）提高未进行基线筛查的财务毒性筛查率；（2）在出现财务毒性的患者中增加资源护理协调转介；以及（3）在为期 8 周的项目中评估财务毒性与所选人口统计学识别指标之间的关系。方法：采用 "计划-实施-研究-行动"（Plan-Do-Study-Act，PDSA）模式来学习和引导 QIP 期间的变革，重点关注财务毒性综合评分（COST）和新诊断的 III 期或 IV 期妇科癌症参与者的资源护理协调。结果：在 42 名（80.75%）同意参加 QIP 的参与者中，61.90% 的 COST 评分低于 23 分，100%（26 名）的参与者接受了资源护理协调转介。平均有 6.50 名患者进入诊所接受治疗，其中 50%（3.25 人）报告有家庭病史。按此比例计算，在 50 周的一年中，有 162.50 名患者经历了 FT，但未接受资源护理协调。然而，由于部分患者未同意参与 QIP，在 50 周的一年中，FT（是）患者的平均人数可能在 199.50 到 225.00 之间，从而导致可能有 62.50 名 FT 患者（或 225.00 患者中的 28%）未接受转介。在这一质量改进项目中，年龄是影响固定电话转诊成本得分的主要因素。在这一质量改进项目中，许多变量都是不可观测的，可能会影响固定电话成本得分。然而，单独建模显示，年龄本身就能解释所观察到的 FT COST 分数变化的约 15%。对更多变量的控制可能会使模型更加完善，但从数据分析来看，年龄作为 FT COST 分数变化的驱动因素似乎不太可能消失。结论制定一项以结构化 QIP-PDSA 计划为重点的多学科教育计划，可以作为规范 FT 筛查和护理协调计划的一个范例。QIP 团队成功地将 PDSA 模型路线图筛查计划纳入其中，识别出了出现 FT 的参与者，并及时将 100% 的参与者转介到资源护理协调机构。
{"title":"A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice","authors":"Tina Harris, DNP, NP-C, AOCNP, Julie Brinzo, DNP, APRN, MBA, FNP-C, Christopher Pell, PhD","doi":"10.6004/jadpro.2024.15.1.2","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.2","url":null,"abstract":"Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139891143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Oral chemotherapy drug development and use has increased, and evidence in the literature suggests variability in practices nationally. Thus, there is a need for continuous review of the process of oral chemotherapy administration that focuses on improving adherence to national standards. Objectives: This quality improvement project evaluated provider and staff general knowledge on oral chemotherapy and national safety standards and the implementation and ease of use of an electronic medical record (EMR)-integrated chemotherapy documentation template geared toward improving compliance with national chemotherapy administration standards. Methods: This project utilized a pre-test and post-test design comparing provider and staff knowledge as well as the intervention of a chemotherapy documentation template to assess compliance with national chemotherapy administration safety standards in an academic medical center. Through chart review, 24 national safety standards relevant to oral chemotherapy administration were used to assess compliance prior to and following the introduction of the intervention. Additionally, feasibility, accessibility, and usability of the intervention were evaluated through a validated questionnaire. Findings: Knowledge gained from pre-test to post-test improved (p value of < .001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < .001). The participants (n = 29) scored the documentation template as above average, indicating overall ease of use and feasibility for continued use.
{"title":"Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for Improving Knowledge and Compliance With National Safety Standards","authors":"Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP, Rita D'Aoust, PhD, MS, RN, Deborah Baker, DNP, CRNP, NEA-BC, Ginger Hanson, PhD, MS, Lauren Gjolaj, RN, MBA, Lawrence Negret, MD, Daniel O'Neil, MD","doi":"10.6004/jadpro.2024.15.8.1","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.8.1","url":null,"abstract":"Background: Oral chemotherapy drug development and use has increased, and evidence in the literature suggests variability in practices nationally. Thus, there is a need for continuous review of the process of oral chemotherapy administration that focuses on improving adherence to national standards. Objectives: This quality improvement project evaluated provider and staff general knowledge on oral chemotherapy and national safety standards and the implementation and ease of use of an electronic medical record (EMR)-integrated chemotherapy documentation template geared toward improving compliance with national chemotherapy administration standards. Methods: This project utilized a pre-test and post-test design comparing provider and staff knowledge as well as the intervention of a chemotherapy documentation template to assess compliance with national chemotherapy administration safety standards in an academic medical center. Through chart review, 24 national safety standards relevant to oral chemotherapy administration were used to assess compliance prior to and following the introduction of the intervention. Additionally, feasibility, accessibility, and usability of the intervention were evaluated through a validated questionnaire. Findings: Knowledge gained from pre-test to post-test improved (p value of < .001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < .001). The participants (n = 29) scored the documentation template as above average, indicating overall ease of use and feasibility for continued use.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"13 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139687596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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