Chemotherapy-induced nausea and vomiting (CINV) is a side effect reported by 40%–80% of patients receiving cancer treatment. However, CINV can be prevented in 70%–80% of those cases with appropriate antiemetic prophylaxis. Few studies have evaluated approaches to improve provider adherence to antiemetic guidelines, and those who do adhere often have limited demonstrated success.
Researchers at the University of North Carolina (UNC) Cancer Hospital conducted a study to assess barriers to guideline adherence and sought to provide educational information to improve provider knowledge, specifically for RNs and advanced practice providers (APPs).
Corrine Mellin, BSN, RN, OCN®, from UNC at Chapel Hill School of Nursing, and coauthors presented the findings during a poster session at the ONS 42nd Annual Congress in Denver, CO. The poster was titled “Improving Antiemetic Guideline Adherence for Inpatient Adults Receiving Highly Emetogenic Chemotherapy (HEC).”
The researchers conducted a retrospective chart analysis and found that of 86 patients on the inpatient unit at UNC who were receiving HEC between July 2015 and July 2016, 7% were receiving treatment and management that adhered to guideline recommendations.
Baseline knowledge levels of CINV management and evidence-based guidelines were assessed via a survey that included 20 questions, and the APPs and RNs were timed to take the survey in no more than 10 minutes to ensure prompt answers and discourage the use of outside materials for assistance.
Following, the pretest, a PowerPoint education session was provided to 82 RNs and 6 APPs. A follow-up survey was emailed to all participants right after the educational intervention, as well as three months after, and included the same questions as the preintervention survey.
The researchers reported nonsignificant change in survey results for the APP population. However, they noted that the small sample size and adequate baseline knowledge may have impacted the results.
For the RN population, the researchers noted significant survey result changes from the pre- to post-test for 8 of 13 questions, “demonstrating successful improvement in knowledge...and the continued need for provider education and reinforcement.” Most of the significant improvement was related to the use of lorazepam in breakthrough CINV and understanding the definitions of different CINV types (e.g., acute, delayed, breakthrough).
Knowledge gaps included the purpose of using an neurokinin 1 receptor antagonists, understanding the guideline limitations, and where to locate guidelines. There was also a decreasing trend in significance of survey results from the pre-test to the three-month post-test, which demonstrates the importance of reinforcing the guidelines, the researchers noted.