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

Published

Journal Article

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-HT 3-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. © 2014 Springer-Verlag.

Full Text

Duke Authors

Cited Authors

  • Affronti, ML; Schneider, SM; Herndon, JE; Schlundt, S; Friedman, HS

Published Date

  • January 1, 2014

Published In

Volume / Issue

  • 22 / 7

Start / End Page

  • 1897 - 1905

Electronic International Standard Serial Number (EISSN)

  • 1433-7339

International Standard Serial Number (ISSN)

  • 0941-4355

Digital Object Identifier (DOI)

  • 10.1007/s00520-014-2136-0

Citation Source

  • Scopus