Promoting evidence-based management of anemia in cancer patients: Concurrent and discriminant validity of RESPOND, a web-based clinical guidance system based on the EORTC guidelines for supportive care in cancer

Goal of work The goal of this study is to test the validity of RESPOND, a web-based decision support system to assess and manage anemia in cancer patients as per the European Organisation for Research and Treatment of Cancer (EORTC) guidelines. The intraclass correlation metrics for the algorithmic definitions were reported previously. Reported here are the concurrent validity, the extent to which clinicians' anemia management is guidelines-congruent when using the system; and discriminant validity, the extent to which clinicians practice in congruence with guidelines when vs. when not using the system. Patients and methods Hybrid matched design with precohort (retrospective; clinicians not using RESPOND) and postcohort (prospective; clinicians using RESPOND) of anemic patients matched on cancer type and chemotherapy regimen and followed up over 4 months after treatment initiation with erythropoietic proteins (34 patients per cohort; total N=68). Congruence scores quantified the extent to which anemia management was congruent with the EORTC guidelines (range 0-10). Main results Hemoglobin (Hb) increased significantly for both cohorts, but the postcohort group showed more rapid rate of Hb increase over time (p<0.006), higher Hb by visit 4(p=0.007), and greater Hb increase by visit 4 (p=0.006). Concurrent validity was high with mean postcohort congruence scores of 8.18± 1.38. Discriminant validity was inferred from statistically significant differences in mean congruence scores between cohorts (p<0.001) and from the postcohort having odds ratios of 3.64 for patients to reach Hb≥ 11 g/dL and 2.91 to achieve Hb≥ 12 g/dL. Conclusions RESPOND, a validated computerized clinical guidance system with an incremental effect beyond the pharmacotherapeutic effect of erythropoietic proteins, offers clinicians accurate and safe guidance in managing anemia in cancer patients. © Springer-Verlag 2009.

Duke Scholars

Author Tara Albrecht School of Nursing