Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

Abstract

BackgroundManagement of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments.MethodsA prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings.DiscussionGiven the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.

Screening, evaluation, and management of cancer‐related fatigue: Ready for implementation to practice?

“…Focusing on interventions that have been given the “green light” for dissemination and implementation, it is necessary to overcome the “black box,” or unknown critical elements, of its effectiveness. Interventions using protocols that are ready to be adapted for local use and diverse populations in a variety of settings will promote evaluation for effectiveness, acceptability, and cost in the real world …”

“…Interventions using protocols that are ready to be adapted for local use and diverse populations in a variety of settings will promote evaluation for effectiveness, acceptability, and cost in the real world. 312 Interventions like exercise can be tailored to the individual and the phase of treatment (active, post-treatment, end of life). The Livestrong program at the YMCA, which was designed for adult cancer survivors, is one example of a program that implements guidelines for exercise.…”

Triaging symptom calls with and without practice guides: A case exemplar

“…The case exemplar was developed using findings from a chart audit of nurse-led telephone consultation documentation in an outpatient oncology program. The documentation audits (N = 299 patient health records) were conducted as part of a larger COSTaRS study to determine uptake of the practice guides (Stacey et al, 2012). To protect patient and nurse confidentiality, demographics in the case exemplar were changed.…”

Triage des appels de gestion des symptômes avec et sans guides de pratique : étude de cas

“…L'étude de cas a été élaborée à partir des résultats issus d'une évaluation des dossiers de consultations téléphoniques réalisées par les infirmières d'un programme de suivi externe des patients en oncologie. Cette évaluation des dossiers (N = 299 patients) a été menée dans le cadre d'une étude COSTaRS plus vaste visant à déterminer la mise en application réelle des guides de pratique (Stacey et al, 2012). Pour protéger la confidentialité des patients et des infirmières, les données démographiques de l'étude de cas ont été changées.…”