Albert Katherine, Pollard Deborah, Klemp Jennifer, Kondapalli Lavanya, Tuffield Deborah
Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Denver, Colorado.
KU Medical Center, The University of Kansas, Kansas City, Kansas.
J Adv Pract Oncol. 2021 Nov;12(8):795-807. doi: 10.6004/jadpro.2021.12.8.3. Epub 2021 Nov 1.
Cardiac risk factors are known to compound the development of cardiotoxicities (CTx) in patients exposed to anthracycline (ANT) chemotherapy agents. National oncology and cardiology organizations have published recommendations for cardiovascular risk stratification and screening cancer patients following exposure to ANTs. The frequency with which oncology providers are integrating these principles into practice is unknown. This knowledge-based quality improvement (QI) project was designed to heighten oncology provider competencies such that screening frequency of cancer patients for CTx in the post-ANT setting aligns more closely with national guidelines for care. A web-based educational intervention, cardiac screening tool, and evidence-based literature were shared with 20 oncology providers over the course of 5 months. Retrospective chart reviews and pre- and post-project surveys were performed to assess competencies and practice trends. Qualitative and quantitative data were analyzed to illustrate whether the interventions improved knowledge and changed practice. Findings revealed an increase in the number of provider-perceived percentage of high cardiac risk patients and the number of patients screened, knowledge did not improve, and the frequency by which oncology providers ordered echocardiograms increased minimally. Factors such as organizational system changes, time constraints, and change fatigue limited effective and consistent implementation of the project interventions. The trajectory of cancer survivorship is affected by cardiovascular disease. Cardiac screening of cancer patients is a critical component of cancer care that has the potential to positively impact economic and health outcomes of this susceptible population.
已知心脏危险因素会使接受蒽环类（ANT）化疗药物治疗的患者发生心脏毒性（CTx）的情况更为复杂。国家肿瘤学和心脏病学组织已发布了关于心血管风险分层以及对接触ANTs后的癌症患者进行筛查的建议。肿瘤学医护人员将这些原则融入实践的频率尚不清楚。这个基于知识的质量改进（QI）项目旨在提高肿瘤学医护人员的能力，使在ANT治疗后对癌症患者进行CTx筛查的频率更符合国家护理指南。在5个月的时间里，与20名肿瘤学医护人员分享了基于网络的教育干预措施、心脏筛查工具和循证文献。进行了回顾性病历审查以及项目前后的调查，以评估能力和实践趋势。对定性和定量数据进行了分析，以说明这些干预措施是否提高了知识水平并改变了实践。结果显示，医护人员认为的高心脏风险患者的百分比数量以及接受筛查的患者数量有所增加，知识水平并未提高，肿瘤学医护人员开具超声心动图检查的频率略有增加。组织系统变化、时间限制和变革疲劳等因素限制了项目干预措施的有效和持续实施。癌症幸存者的轨迹会受到心血管疾病的影响。对癌症患者进行心脏筛查是癌症护理的一个关键组成部分，有可能对这一易感人群的经济和健康结果产生积极影响。
