新诊断的儿科肿瘤患者的家庭用药方案复杂性
Home Medication Regimen Complexity in Newly Diagnosed Pediatric Oncology Patients.
作者信息
Skipper K Elizabeth, Wadhwa Aman, Rice Marti, York Jocelyn, Bhatia Smita, Landier Wendy
机构信息
Author Affiliations: School of Nursing (Ms Skipper and Drs Rice and Landier), Institute for Cancer Outcomes and Survivorship, School of Medicine (Ms Skipper and Drs Wadhwa, York, Bhatia, and Landier), and Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine (Drs Wadhwa, Bhatia, and Landier), University of Alabama at Birmingham.
出版信息
Cancer Nurs. 2025 Jan 7. doi: 10.1097/NCC.0000000000001452.
BACKGROUND
Parents of children newly diagnosed with cancer require specialized education to provide care for their child at home, including the management of complex medication regimens.
OBJECTIVE
To assess the complexity of home medication regimens in a cohort of newly diagnosed pediatric oncology patients.
METHODS
We inventoried and categorized all discharge medications for each patient and used the Medication Regimen Complexity Index (MRCI) to quantify the complexity of the prescribed medication regimens. We used logistic regression to identify patient sociodemographic and clinical characteristics significantly (P < .05) associated with higher medication burden (ie, higher total MRCI scores).
RESULTS
The cohort consisted of 105 newly diagnosed pediatric oncology patients initially hospitalized between December 2016 and February 2019 (61.9% male, 65.7% non-Hispanic White, 65.7% leukemia or lymphoma; median [range] age at diagnosis, 7.1 [0.4-17.7] years; median [range] number of discharge medications, 9 [1-14]). The proportion of patients prescribed ≥1 medication in each pharmacologic category was as follows: antiemetics, 94.3%; antimicrobials, 93.3%; pain management, 88.6%; oral care, 86.7%; stool softeners/laxatives, 81.0%; gastrointestinal protectants, 60.0%; cancer-directed therapy, 51.5%, other supportive therapies, 49.5%, other, 27.6%. Characteristics associated with ≥ median (≥33.0) MRCI score included a diagnosis of leukemia or lymphoma (odds ratio, 2.7; 95% confidence interval, 1.1-6.6; P = .027; comparison: solid tumor) and older age (odds ratio, 1.1 per year; 95% confidence interval, 1.0-1.2; P = .020).
CONCLUSIONS
Most children newly diagnosed with cancer are discharged with complex medication regimens that parents/caregivers must manage at home.
IMPLICATIONS FOR PRACTICE
Nurses can use these findings to develop tailored medication education plans for parents/caregivers of newly diagnosed pediatric oncology patients.
背景
新诊断出癌症的儿童的父母需要接受专业教育，以便在家中照顾孩子，包括管理复杂的药物治疗方案。
目的
评估一组新诊断的儿科肿瘤患者家庭药物治疗方案的复杂性。
方法
我们对每位患者的所有出院药物进行了清点和分类，并使用药物治疗方案复杂性指数（MRCI）来量化规定药物治疗方案的复杂性。我们使用逻辑回归来确定与较高药物负担（即较高的总MRCI评分）显著相关（P <.05）的患者社会人口统计学和临床特征。
结果
该队列包括105名新诊断的儿科肿瘤患者，他们最初于2016年12月至2019年2月住院（男性占61.9%，非西班牙裔白人占65.7%，白血病或淋巴瘤占65.7%；诊断时的中位年龄[范围]为七岁零一个月[0.4 - 17.7]岁；出院药物的中位数量[范围]为9种[1 - 14]种）。在每个药理学类别中，开具≥1种药物的患者比例如下：止吐药，94.3%；抗菌药物，93.3%；疼痛管理，88.6%；口腔护理，86.7%；大便软化剂/泻药，81.0%；胃肠道保护剂，60.0%；癌症导向治疗，51.5%，其他支持性治疗，49.5%，其他，27.6%。与MRCI评分≥中位数（≥33.0）相关的特征包括白血病或淋巴瘤诊断（比值比，2.7；95%置信区间，1.1 - 6.6；P =.027；比较：实体瘤）和年龄较大（比值比，每年1.1；95%置信区间，1.0 - 1.2；P =.020）。
结论
大多数新诊断出癌症的儿童出院时都带有复杂的药物治疗方案供父母/照顾者在家中管理。
对实践的启示
护士可以利用这些发现为新诊断的儿科肿瘤患者的父母/照顾者制定量身定制的药物教育计划。
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