Development of An Evidence-based Scorecard to Assess Provider Adherence to Gastrointestinal Toxicity Management
Carrie T Stricker, PhD, NP1; Karen Hammelef, DNP, RN1; June Eilers, PhD, RN, APRN-CNS2 ; Beth Faiman, PhD, NP3 ; Amy Goodrich, MSN, RN, CRNP-AC4 ; Mary Pat Lynch, CRNP, MSN, AOCN5; Beth Sandy, CRNP6; Susan Beck, PhD, RN7; Debra Wujcik, PhD, RN1
1Carevive Systems, Inc. (Miami, FL); 2University of Nebraska Medical Center (Omaha, NE); 3Cleveland Clinic (Cleveland, OH); 4Johns Hopkins School of Medicine; 5University of Pennsylvania School of Nursing; 6University of Pennsylvania School of Medicine. 7University of Utah (Salt Lake City, Utah)
Gastrointestinal toxicity (GIT) is associated with targeted therapies in cancer treatment. GIT can lead to diminished treatment adherence and poor quality of life. It is among the top causes of emergency room visits and hospitalizations –targeted by value-based payment models including the Oncology Care Model (OCM). Evidence for the prevention and management of GIT exists yet what constitutes “good” versus “poor” GIT management (GITM) has not been defined in a measurable way, and little is known about how evidence based guidelines are applied in the real-world practice environment. Because patients on oral oncolyticsare typically seen less frequently in the clinic, health care providers are not routinely observing patients. The processes for patient reporting of symptoms and clinician triaging, evaluating, and managing GIT are inconsistently documented in the patient’s health record. Thus, the effect that real world GITM practices have on patient outcomes is unknown. This formative work is the initial part of a larger study to understand real world GITM.
An expert oncology nurse researcher led a team of five oncology advanced practices nurses (OAPN) in the development of an instrument to define quality of GITM. The GITM ScoreCard (SC) was developed through processes that included literature review and consensus development for ideal management where evidence gaps existed. The OAPNs developed literature review results of GITM evidence-based practices using a standardized template. The nurse researcher reviewed the literature review results for consistency, flagging sections requiring further discussion. Consensus was achieved through two scheduled decision making sessions including all project faculty.
Development of evidenced-based GITM is the first step in understanding real world GITM. Provider self-assessment using the SC is underway at 5 institutions and will provide the first known documentation of provider adherence to evidence-based GITM. Scorecards may provide a method to evaluate current knowledge of evidence-based management of targeted therapies’ side effects. Having this knowledge base is critical for prevention of side effects that lead to emergency department visits and hospitalizations, and scorecards allow clinicians to self-identify areas where knowledge can be increased.