Exploring the impact of a decision support algorithm to improve clinicians' chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study

Robert Knoerl, Emanuele Mazzola, Fangxin Hong, Elahe Salehi, Nadine McCleary, Jennifer Ligibel, Kaitlen Reyes, Donna L Berry, Robert Knoerl, Emanuele Mazzola, Fangxin Hong, Elahe Salehi, Nadine McCleary, Jennifer Ligibel, Kaitlen Reyes, Donna L Berry

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management.

Methods: One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test.

Results: Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468).

Conclusions: Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice.

Trial registration: ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.

Keywords: Algorithms; Chemotherapy-induced peripheral neuropathy; Clinical; Decision Support systems; Documentation; Neoplasms; Peripheral nervous system diseases.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chemotherapy-Induced Peripheral Neuropathy Symptom Summary Report. The figure describes a sample symptom summary report. The summary report describes the severity, duration, characteristics, and location (i.e., body map) of non-painful and painful CIPN symptoms. In addition, the report describes the degree that CIPN symptoms interfere with activities of daily living
Fig. 2
Fig. 2
Chemotherapy-Induced Peripheral Neuropathy Assessment and Management Algorithm. This figure displays the CIPN assessment and management algorithm that clinicians received during the algorithm phase. The algorithm outlines assessment and management recommendations based on the patients CIPN symptom presentation. Note: The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute offers exercise, nutrition, yoga, acupuncture, massage, and mindfulness services.
Fig. 3
Fig. 3
Participant Flow Diagram. This figure describes patients’ progress through the usual care and algorithm phases, respectively

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