September 2016, Vol. 5, No. 7

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Oncology Nurse Survey Reveals Inconsistent Adherence to Antiemetic Guidelines

MASCC/ISOO

A recent survey of oncology nurses revealed inconsistencies in practice patterns and adherence to antiemetic guidelines for the prevention of chemotherapy-induced nausea and vomiting (CINV), according to Rebecca Clark-Snow, RN, BSN, OCN, Oncology Clinical Nurse Coordinator at the University of Kansas Cancer Center in Westwood. Nevertheless, oncology nurses, as part of a multidisciplinary team, are in a unique position to promote and reinforce appropriate antiemetic prophylaxis, she said.

“More than 30 years of antiemetic research has provided the global healthcare community with effective agents capable of preventing CINV in many patients, and studies have demonstrated that antiemetic prophylaxis is effective with the use of guideline-recommended regimens,” said Ms Clark-Snow at the 2016 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology Annual Meeting on Supportive Care in Cancer. “But adherence is not universal, and this negatively affects patient outcomes.”

Survey Design

In September 2015, a total of 531 practicing oncology nurses based in the United States participated in an online survey conducted by ONS:Edge (a marketing communications company centered on the transfer of cancer knowledge to oncology nurses).

The primary goals of the survey were to assess antiemetic guideline awareness, evaluate practice patterns of antiemetic use, determine adherence to guideline recommendations, and query barriers to adherence among oncology nurses.

A total of 66.7% of the nurses who responded to the survey were oncology certified. Almost half (44.8%) had practiced as oncology nurses for more than 10 years, the vast majority (99.8%) worked full time, and two-thirds (66.4%) reported working in an outpatient setting.

More Confident Nurses in Outpatient Settings

“Nearly all of the nurses surveyed (97%) stated that they were at least ‘somewhat confident’ in their awareness of chemotherapeutic agents and their emetic potential,” Ms Clark-Snow reported.

Nurses in outpatient settings were found to be significantly more confident in their knowledge than those in inpatient settings (75% vs 57%, respectively; P = .002), and only 65% of staff nurses were confident or very confident, compared with 86% of nurse practitioners, 73% of managers, and 70% of clinical nurse specialists (P = .46). Additionally, having worked more years in the oncology field was associated with greater confidence (P = .011).

Approximately 70% of nurses indicated they were familiar with and used the National Comprehensive Cancer Network guidelines in their practices, “which is not a surprising statistic in the United States,” she said. American Society of Clinical Oncology and individual institutional guidelines took second and third place, respectively.

Inconsistencies in Adherence

When surveyed on the classes of antiemetics used to prevent CINV, the majority of respondents reported that patients receiving highly emetogenic chemotherapy (HEC) received appropriate guideline-recommended agents, including a serotonin antagonist, a corticosteroid, and a neurokinin-1 receptor antagonist administered on day 1. “However, the same can’t be said for the delayed phase, day 2 and beyond,” said Ms Clark-Snow. In terms of moderately emetogenic chemotherapy (MEC), approximately 75% of nurses felt that the antiemetics being used in their practice were consistent with guideline recommendations.

Guideline adherence was calculated based on actual reported use of guideline-recommended antiemetic agents. If nurses reported using the guideline-recommended agents, they were considered “adherent,” regardless of whether they used additional agents. For HEC, acute and delayed adherence was 73% and 25%, respectively; acute and delayed adherence for MEC was 85% and 91%, respectively.

Barriers to Use

Surveyed nurses were asked to identify barriers interfering with their use of guideline-recommended antiemetics in patients receiving HEC or MEC. “The majority (70%) of respondents identified ‘physician preference’ as a primary reason, but the survey didn’t allow for an explanation of what ‘physician preference’ involved,” she reported. The remainder of barriers, including satisfaction with current antiemetics, product cost, and patient preference, have previously been reported as concerns by healthcare providers, she added.

Regardless of whether appropriate antiemetics were used, significant unmet needs in preventing and managing CINV were identified through the use of the survey, including improving efficacy for acute and delayed CINV and improving patient quality of life. Only 17% of nurses reported that most (>75%) of their patients’ CINV was optimally controlled.

Although most nurses felt that the antiemetics being used in their practice were consistent with guideline recommendations, practice patterns suggested inconsistencies with recommendations in both the HEC and MEC settings, and particularly during the delayed phase, Ms Clark-Snow observed.

“Improved prophylaxis for both the acute and delayed phases may theoretically improve or eliminate the nausea so many of our patients experience, while improving quality of life for all patients receiving emetogenic chemotherapy,” she added. “And nurses as integral components of multidisciplinary teams can assist with identifying practical approaches for overcoming barriers that interfere with guideline adherence.”

Reference

Clark-Snow R, Rittenberg C, Affronti ML. Results of a survey of oncology nurses assessing practice patterns for prevention of chemotherapy-induced nausea and vomiting (CINV) and adherence to antiemetic guidelines. Presented at: MASCC/ISOO Annual Meeting on Supportive Care in Cancer; June 23-25, 2016; Adelaide, Australia. Abstract PS052.
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