Crellin-Parsons Nicole, Dupuis L Lee, Vettese Emily, Aftandilian Catherine, Agarwal Vibhuti, Baggott Christina, Bradfield Scott M, Freyer David R, Kelly Kara M, King Allison A, Kyono Wade, Nagasubramanian Ramamoorthy, Orgel Etan, Roth Michael E, Sherani Farha, Yu Lolie, Grimes Allison C, Beauchemin Melissa P, Klesges Lisa M, Tomlinson George A, Sung Lillian
Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
Department of Pharmacy, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
JCO Oncol Pract. 2025 Apr 23:OP2400912. doi: 10.1200/OP-24-00912.
Ten pediatric cancer treatment sites previously implemented site-specific symptom management care pathways for 15 symptoms, which were based upon clinical practice guidelines (CPGs). The primary objective of this analysis was to describe the prevalence of care pathway- and CPG-consistent care for symptom management. The secondary objective was to identify factors associated with care pathway-consistent care.
Participants were patients age 8-18 years diagnosed with cancer within the previous 4 weeks. We identified any intervention to manage each of 15 symptoms during a 3-day period 8 weeks after enrollment. We determined whether the intervention appeared in that site's care pathway and whether it was recommended in the CPG. We determined whether type of symptom (observable nonobservable) or patient characteristics were associated with care pathway-consistent care.
Two hundred twenty participants were analyzed. The prevalence of care pathway-consistent care for each symptom ranged from 0% (problems thinking, body or face changes, and diarrhea) to 52.3% (throwing up) and was <27% for 14 of 15 symptoms. Similarly, the prevalence of CPG-consistent care was <50% across all symptoms. Participants received significantly more care pathway-consistent interventions for observable symptoms compared with nonobservable symptoms (difference 30% [95% CI, 3 to 54]). Factors associated with receipt of at least one care pathway-consistent intervention were age group, race, ethnicity, and cancer type.
Care pathway- and CPG-consistent care were surprisingly uncommon. Care pathway-consistent interventions were more common for observable than nonobservable symptoms and were associated with patient characteristics. Future work should identify approaches to improve care pathway-consistent care delivery.
十个儿科癌症治疗点先前针对15种症状实施了基于临床实践指南（CPG）的特定治疗点症状管理护理路径。本分析的主要目的是描述症状管理中护理路径和CPG一致护理的患病率。次要目的是确定与护理路径一致护理相关的因素。
参与者为在过去4周内被诊断患有癌症的8至18岁患者。我们在入组8周后的3天内确定了针对15种症状中每种症状的任何干预措施。我们确定该干预措施是否出现在该治疗点的护理路径中以及是否在CPG中被推荐。我们确定症状类型（可观察的与不可观察的）或患者特征是否与护理路径一致护理相关。
对220名参与者进行了分析。每种症状的护理路径一致护理患病率从0%（思维问题、身体或面部变化以及腹泻）到52.3%（呕吐）不等，15种症状中有14种的患病率低于27%。同样，所有症状的CPG一致护理患病率均低于50%。与不可观察症状相比，参与者在可观察症状方面接受的护理路径一致干预明显更多（差异为30%[95%CI，3至54]）。与接受至少一种护理路径一致干预相关的因素包括年龄组、种族、民族和癌症类型。
护理路径和CPG一致护理出人意料地不常见。护理路径一致干预在可观察症状中比在不可观察症状中更常见，并且与患者特征相关。未来的工作应确定改善护理路径一致护理提供的方法。
