Exploring the impact of a decision support algorithm to improve clinicians’ chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study

Abstract

Background Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians’ frequency of CIPN assessment documentation and adherence to evidence-based management. Methods One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians’ CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson’s chi-squared test. Results Clinicians’ frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians’ CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). Conclusions Implementation of a clinician-decision support algorithm did not significantly improve clinicians’ CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. Trial registration ClinicalTrials.Gov, NCT03514680. Registered 21 April 2018.

Towards a novel approach guiding the decision-making process for anticancer treatment in patients with advanced cancer: framework for systemic anticancer treatment with palliative intent

“…Changing the practice of oncology clinicians can insufficiently be achieved by providing algorithms or guidelines, as shown by examples from chemotherapy-induced peripheral neuropathy 93 or chemotherapy-induced nausea and vomiting. 94 In contrast, training of specific skills can be effective in improving shared decisio-making.…”

The effectiveness of clinical guideline implementation strategies in oncology: a systematic review

“…Furthermore, the list of excluded studies at full-text screening stage can be found in the Supplement (eTable 1). A total of six studies published between 2017 and 2021, two stepped-wedge cluster RCTs [30,31] and four controlled NRSIs with before-and after study design [32][33][34][35], were included in the synthesis. Further, ve ongoing trials were identi ed [36][37][38][39][40] and four studies were categorised as awaiting classi cation (due to no published results and a conference abstract with insu cient information), of which all were randomized [41][42][43][44].…”

“…The six included studies assessed multi-component guideline implementation interventions compared to no intervention in 2024 cancer patients and 281 healthcare professionals [30][31][32][33][34][35]. The most frequently used strategies, which were applied in all six interventions, were educational meetings and educational materials (Table 2).…”

Measurement properties of brief neuropathy screening items in cancer patients receiving taxanes, platinums, or proteasome inhibitors

“…In summary, participants were a median of 57 (Range: 27-80) years old, and predominantly female (66%), Caucasian (90%), received undergraduate (33.1%) or post graduate degree training (32.4%), working fulltime (38%), diagnosed with a gastrointestinal (51%) or breast (37%) malignancy or multiple myeloma (11%), and receiving platinum (50%) (e.g., common treatment for gastrointestinal malignancies), taxane (35.9%) (e.g., common treatment for breast cancer), or proteasome-inhibitor-based (11%) cancer therapy (e.g., common treatment for multiple myeloma). Approximately 56% of the sample had received ≥ two-thirds of their planned course of neurotoxic therapy by T3 [22].…”

“…Specifically, we estimated the floor and ceiling effects, test-retest reliability, concurrent validity, longitudinal validity, construct validity of the response categories, and sensitivity and specificity of the PRO-CTCAE numbness and tingling severity and interference items in cancer patients receiving taxanes, platinums, or proteasome inhibitors. impact of a clinician decision support algorithm on clinicians' documentation of CIPN assessment and management [22]. The sample consisted of 142 English speaking patients with breast or gastrointestinal cancer, or multiple myeloma who had received ≥ one infusion of neurotoxic therapy (e.g., taxanes, platinums, or proteasome inhibitors) at the time of consent and were scheduled to receive ≥ three more cycles of neurotoxic therapy.…”