Symptom management care pathway adaptation process and specific adaptation decisions
Posted on 2023-04-18 - 04:40
Abstract Background There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. Methods Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, resulting in institution-specific symptom management care pathway drafts. Institutional adaption teams distributed the 14 care pathway drafts to their respective teams; their feedback led to care pathway modifications. Results Initial care pathway adaptation decision making was completed over a median of 4.2 (interquartile range 2.0-5.3) weeks per institution. Across all institutions and among 1350 statements, 551 (40.8%) were adopted, 657 (48.7%) were adapted, 86 (6.4%) were rejected and 56 (4.1%) were no longer applicable because of a previous decision. Most commonly, the reason for rejection was not agreeing with the statement (70/86, 81.4%). Institutional-level factors were not significantly associated with statement rejection. Conclusions Acceptability of the 14 care pathways was evident by most statements being adopted or adapted. The adaptation process was accomplished over a relatively short timeframe. Future work should focus on evaluation of care pathway compliance and determination of the impact of care pathway-consistent care on patient outcomes. Trial registration clinicaltrials.gov, NCT04614662. Registered 04/11/2020, https://clinicaltrials.gov/ct2/show/NCT04614662?term=NCT04614662&draw=2&rank=1 .
CITE THIS COLLECTION
Vettese, Emily; Sherani, Farha; King, Allison A.; Yu, Lolie; Aftandilian, Catherine; Baggott, Christina; et al. (2023). Symptom management care pathway adaptation process and specific adaptation decisions. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.6604405.v1
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AUTHORS (20)
EV
Emily Vettese
FS
Farha Sherani
AK
Allison A. King
LY
Lolie Yu
CA
Catherine Aftandilian
CB
Christina Baggott
VA
Vibhuti Agarwal
RN
Ramamoorthy Nagasubramanian
KK
Kara M. Kelly
DF
David R. Freyer
EO
Etan Orgel
SB
Scott M. Bradfield
WK
Wade Kyono
MR
Michael Roth
LK
Lisa M. Klesges
MB
Melissa Beauchemin
AG
Allison Grimes
GT
George Tomlinson
LD
L. Lee Dupuis
LS
Lillian Sung