Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM.
JCO Oncol Pract. 2020 Oct;16(10):e1209-e1215. doi: 10.1200/JOP.19.00418. Epub 2020 May 27.
The numbers and types of oral oncolytics in oncology are expanding rapidly. Oral oncolytics have serious adverse effects, and pharmacist-driven patient education has the potential to reduce adverse events. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated a patient education and consent process for oral oncolytics in our minority, rural, and economically disadvantaged population.
The UNM CCC initiated a pharmacist-driven education and consent process from August 2016 to October 2018. The process metric measured via statistical process control charts was the percentage of patients receiving oral oncolytic therapy who were educated and consented. The balancing metric was time for benefit investigation. The intervention was pharmacy team members providing standardized education for and obtaining consent from each patient, supported by electronic medical record orders, physician education, pharmacy notifications, and hospital discharge planning.
The initial monthly education and consent rate was 17.9%, followed by 45.5% the subsequent month. This quickly grew to an average of 87.0% (95% CI, 81.5% to 92.4%) for the subsequent 15 months in which control was achieved. Additional changes increased the education rate to 95.7% (95% CI, 93.4% to 98.1%). These 2 periods were statistically different ( = .0025). There was no change in time for benefit investigation (5.60 5.52 days; = .75).
A pharmacist-driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate a majority of patients. Future directions will include ensuring patient adherence and educating patients who fill oral oncolytic prescriptions outside UNM CCC.
肿瘤学中口服肿瘤药物的数量和类型正在迅速增加。口服肿瘤药物有严重的不良反应，药剂师主导的患者教育有可能减少不良反应事件。新墨西哥大学综合癌症中心（UNM CCC）在我们的少数民族、农村和经济弱势群体中启动了一项针对口服肿瘤药物的患者教育和知情同意流程。
UNM CCC 于 2016 年 8 月至 2018 年 10 月启动了一项由药剂师主导的教育和知情同意流程。通过统计过程控制图衡量的流程指标是接受口服肿瘤药物治疗的患者接受教育和同意的百分比。平衡指标是利益调查的时间。干预措施是由药房团队成员为每位患者提供标准化的教育，并获得他们的同意，同时得到电子病历医嘱、医生教育、药房通知和医院出院计划的支持。
初始每月教育和同意率为 17.9%，随后一个月为 45.5%。此后，在接下来的 15 个月中，这一比例迅速增长至平均 87.0%（95%置信区间，81.5%至 92.4%），达到控制状态。其他变化将教育率提高至 95.7%（95%置信区间，93.4%至 98.1%）。这两个时期在统计学上有显著差异（ =.0025）。利益调查的时间没有变化（5.60 天与 5.52 天； =.75）。
在开始使用口服肿瘤药物时，由药剂师主导的教育和同意计划是可行的，可以成功地教育大多数患者。未来的方向将包括确保患者的依从性，并教育在 UNM CCC 以外地点领取口服肿瘤药物处方的患者。
