School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
Support Care Cancer. 2021 Feb;29(2):841-849. doi: 10.1007/s00520-020-05551-5. Epub 2020 Jun 4.
To determine the quality of cancer symptom management when evidence from clinical practice guidelines are used in telephone-based oncology nursing services.
Guided by the Knowledge to Action Framework, we conducted a quality improvement (QI) project focused on "monitoring knowledge use" (e.g., use of practice guides) and "measuring outcomes." In 2016, 15 Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides that synthesize evidence from guidelines were implemented with training for all oncology nurses at a regional ambulatory oncology program. Eighteen months post-implementation, Symptom Management Analysis Tool (SMAT) was used to analyze audio-recorded calls and related documentation of cancer symptom management.
Of 113 audio-recorded calls, 66 were COSTaRS symptoms (58%), 43 other symptoms (38%), and 4 medically complex situations (4%). Of 66 recorded calls, 63 (95%) were documented. Average SMAT quality score was 71% (range 21-100%) for audio-recordings and 63% (range 19-100%) for documentation of calls. COSTaRS practice guide use was documented in 33% calls. For these calls, average SMAT quality scores were 74% with COSTaRS versus 69% without COSTaRS for audio-recording and 73% (range 33-100%) with COSTaRS versus 58% without COSTaRS for documentation. Patient outcomes indicated symptom was resolved (38%), worse (25%), unchanged (3%), or unknown (33%). Eight patients (13%) had an ED visit within 14 days post that was related to the symptom discussed.
Only a third of nurses indicated use of COSTaRS practice guides. There were higher quality symptom management scores when COSTaRS use was reported. Nurses documented less than what they discussed.
在电话肿瘤护理服务中使用临床实践指南的证据时，确定癌症症状管理的质量。
在知识转化框架的指导下，我们开展了一项质量改进（QI）项目，重点关注“监测知识使用”（例如，使用实践指南）和“测量结果”。2016 年，在区域门诊肿瘤学项目中对所有肿瘤护士进行培训，实施了 15 项综合指南证据的泛加拿大肿瘤症状分类和远程支持（COSTaRS）实践指南。实施后 18 个月，使用症状管理分析工具（SMAT）分析癌症症状管理的音频记录电话和相关文件。
在 113 个音频记录电话中，66 个是 COSTaRS 症状（58%），43 个是其他症状（38%），4 个是医学复杂情况（4%）。在记录的 66 个电话中，63 个（95%）有记录。音频记录的平均 SMAT 质量得分为 71%（范围 21-100%），电话记录的平均 SMAT 质量得分为 63%（范围 19-100%）。在 33%的电话中记录了 COSTaRS 实践指南的使用。对于这些电话，音频记录的平均 SMAT 质量得分为 74%，有 COSTaRS 为 74%，无 COSTaRS 为 69%，电话记录的平均 SMAT 质量得分为 73%（范围 33-100%），有 COSTaRS 为 58%，无 COSTaRS 为 58%。患者结局表明症状得到缓解（38%）、恶化（25%）、无变化（3%）或未知（33%）。有 8 名患者（13%）在症状讨论后 14 天内急诊就诊，与讨论的症状有关。
只有三分之一的护士表示使用了 COSTaRS 实践指南。报告 COSTaRS 使用时，症状管理质量评分更高。护士记录的内容少于他们讨论的内容。
