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Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

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Abstract

Purpose

A quality improvement project was implemented to improve adherence to evidence-based antiemetic guidelines for malignant glioma patients treated with moderately emetic chemotherapy (MEC). Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair cancer patients’ quality of life (QOL). A review of Duke University Preston Robert Tisch Brain Tumor Center (PRTBTC)’s usual practice demonstrates a high incidence (45 %) of CINV, despite premedication with short-acting 5-HT3-serotonin-receptor antagonists (5-HT3-RAs). National Comprehensive Cancer Network (NCCN)’s evidence-based guidelines recommend the combination of the long-acting 5-HT3-RA palonosetron (PAL) and dexamethasone (DEX) for the prevention of acute and delayed CINV with MEC. Low adherence (58 %) to antiemetic guidelines may have explained our high CINV incidence.

Methods

One-sample binomial test, quasi-experimental design, evaluated a combination intervention that included a provider education session; implementation of risk-assessment tool with computerized, standardized antiemetic guideline order sets; and a monthly audit-feedback strategy. Post-implementation adherence to evidence-based antiemetic order sets and patient outcomes were measured and compared to baseline and historical data. Primary outcome was the guideline order set adherence rate. Secondary outcomes included nausea/vomiting rates and QOL.

Results

Adherence to ordering MEC guideline antiemetics increased significantly, from 58 % to a sustained 90 %, with associated improvement in nausea/vomiting. In acute and delayed phases, 75 and 84 % of patients, respectively, did not experience CINV. There was no significant change in QOL.

Conclusion

Combination intervention and audit-feedback strategy to translate evidence into oncology practice improved and sustained adherence to antiemetic guidelines. Adherence corresponded with effective nausea/vomiting control and preserved QOL in patients with malignant gliomas.

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Acknowledgments

The authors would like to thank Dawn Minkley, Karen Vinson, Sarah Woodring, Joy Gleason, and Susan Boulton for their support in distributing the surveys and for their assistance with data de-identification.

Disclaimer

The authors declare no conflict of interest

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Authors and Affiliations

  1. Department of Surgery, Duke University Health System, Durham, NC, 27710, USA

    Mary Lou Affronti & Henry S. Friedman

  2. Duke University School of Nursing, Duke University Health System, Durham, NC, 27710, USA

    Mary Lou Affronti & Susan M. Schneider

  3. Department of Biostatics and Bioinformatics, Duke University Health System, Durham, NC, 27710, USA

    James E. Herndon II

  4. Duke University Health System Technology Services, Duke University Health System, Durham, NC, 27710, USA

    Susan Schlundt

  5. Duke Medicine, Duke University Health System, Durham, NC, 27710, USA

    Henry S. Friedman

  6. The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Room 047 Baker House, South Hospital, Trent Drive, Durham, NC, 27710, USA

    Mary Lou Affronti

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Correspondence to Mary Lou Affronti.

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Affronti, M.L., Schneider, S.M., Herndon, J.E. et al. Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice. Support Care Cancer 22, 1897–1905 (2014). https://doi.org/10.1007/s00520-014-2136-0

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  • DOI: https://doi.org/10.1007/s00520-014-2136-0

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