Abstract
Objective: Gastrointestinal toxicity (GIT) is associated with targeted therapies in cancer treatment. GIT can lead to diminished treatment adherence and poor quality of life. It is among the top causes of emergency room visits and hospitalizations –targeted by value-based payment models including the Oncology Care Model (OCM). Evidence for the prevention and management of GIT exists. Yet, what constitutes “good” versus “poor” GIT management (GITM) has not been defined in a measureable way; little is known about how evidence based guidelines are applied in the real-world practice environment. Because patients on oral oncolytics are typically seen less frequently in the clinic, health care providers are not routinely observing patients. The processes for patient reporting of symptoms and clinician triaging, evaluating, and managing GIT are inconsistently documented in the patient’s health record. Thus, the effect that real world GITM practices have on patient outcomes is unknown. This formative work is the initial part of a larger study to understand real world GITM by defining quality management. Next, the study will quantify provider adherence to these quality management standards. Methods: An expert oncology nurse researcher led a team of 5 oncology advanced practice nurses (OAPN) in the development of an instrument to define quality GITM. The GITM ScoreCard (SC) was developed through processes that included literature review and consensus development for ideal management where evidence gaps existed. The OAPNs developed literature review results of GITM evidence-based practices using a standardized template. The nurse researcher reviewed the literature review results for consistency, flagging sections requiring further discussion. Consensus was achieved through two scheduled sessions with the entire group. Results: An evidence-based SC was developed that can be used in any clinic setting to assess GITM practices. The SC includes four symptoms: Diarrhea, Constipation, Mucositis, and Nausea/Vomiting. GITM practices include 1) prevention, 2) assessment 3) pharmacologic and non-pharmacologic management by toxicity grade, and 4) other. Scoring for each response is 1) Never, 2) Occasionally, < than half time, 3) Most of the time, > half time, and 4) Always. Conclusion: Development of evidence-based GITM SC is the first step in understanding real world GITM. Provider self-assessment using the SC will provide the first known documentation of provider adherence to evidence-based GITM. Recommendations: The GITM SC has the potential to be used in any clinic setting that desires to evaluate and improve the quality of their current GITM practices.
