Oncology Nurses Survey Reveals Inconsistent Adherence to Antiemetic Prophylaxis Guidelines

TON - November 2016, Vol 9, No 6 - Best Practices
Meg Barbor, MPH

Adelaide, Australia—A recent survey of oncology nurses revealed inconsistencies in practice patterns and adherence to antiemetic guidelines for the prevention of chemotherapy-induced nausea and vomiting (CINV), according to Rebecca Clark-Snow, RN, BSN, OCN, Oncology Clinical Nurse Coordinator, University of Kansas Cancer Center, Westwood. Nevertheless, as part of a multidisciplinary team, oncology nurses are in a unique position to promote and reinforce appropriate antiemetic prophylaxis, Ms Clark-Snow said.

“More than 30 years of antiemetic research has provided the global healthcare community with effective agents capable of preventing CINV in many patients, and studies have demonstrated that antiemetic prophylaxis is effective with the use of guideline-recommended regimens. But adherence is not universal, and this negatively affects patient outcomes,” said Ms Clark-Snow at the 2016 Multinational Association of Supportive Care in Cancer Annual Meeting on Supportive Care in Cancer.

A total of 531 practicing oncology nurses in the United States participated in this 2015 online survey conducted by ONS:Edge.

The survey evaluated antiemetic guideline awareness, practice patterns of antiemetic use, adherence to guideline recommendations, and barriers to adherence among oncology nurses.

A total of 66.7% of the nurses who responded to the survey were certified in oncology; 44.8% had practiced as oncology nurses for >10 years; 99.8% worked full time; and 66.4% reported working in an outpatient setting.

More Confident Nurses in Outpatient Settings

“Nearly all of the nurses surveyed (97%) stated that they were at least ‘somewhat confident’ in their awareness of chemotherapeutic agents and their emetic potential,” Ms Clark-Snow reported.

Nurses in outpatient settings were significantly more confident in their knowledge than those in inpatient settings (75% vs 57%, respectively; P = .002); only 65% of staff nurses were confident or very confident compared with 86% of nurse practitioners, 73% of managers, and 70% of clinical nurse specialists. In addition, having worked more years in oncology was associated with greater confidence (P = .011).

Approximately 70% of nurses indicated they used the National Comprehensive Cancer Network guidelines in their practices, “which is not a surprising statistic in the United States,” she said. The American Society of Clinical Oncology guidelines and individual institutional guidelines took second and third place, respectively.

Inconsistencies in Adherence

As for classes of antiemetics used for CINV prevention, the majority of survey respondents reported that patients using highly emetogenic chemotherapy (HEC) received guideline-recommended agents, including a serotonin antagonist, a corticosteroid, and a neurokinin-1 receptor antagonist administered on day 1.

“However, the same can’t be said for the delayed phase—day 2 and beyond,” said Ms Clark-Snow. In terms of moderately emetogenic chemotherapy (MEC), approximately 75% of nurses thought that the antiemetics being used in their practice were consistent with guideline recommendations.

Guideline adherence was calculated based on actual reported use of guideline-recommended antiemetic agents. For HEC, acute and delayed adherence was 73% and 25%, respectively; acute and delayed adherence for MEC was 85% and 91%, respectively.

Barriers to Antiemetic Agents Use

Surveyed nurses were asked to identify barriers interfering with their use of guideline-recommended antiemetics in patients receiving HEC or MEC.

“The majority (70%) of respondents identified ‘physician preference’ as a primary reason, but the survey didn’t allow for an explanation of what ‘physician preference’ involved,” Ms Clark-Snow reported. Other barriers, including satisfaction with current antiemetics, drug cost, and patient preference, have previously been reported as concerns by providers, she added.

Regardless of whether appropriate antiemetics were used, significant unmet needs in preventing and managing CINV were identified, including improving efficacy for acute and delayed CINV, and improving patient quality of life. Only 17% of nurses reported that >75% of CINV cases were optimally controlled in their patients.

Although the majority of nurses thought that antiemetics use in their practice was consistent with guideline recommendations, practice patterns suggest inconsistencies with recommendations in the HEC and the MEC settings, particularly during the delayed phase, Ms Clark-Snow emphasized.

“Improved prophylaxis for both the acute and delayed phases may theoretically improve or eliminate the nausea so many of our patients experience, while improving quality of life for all patients receiving emetogenic chemotherapy. And nurses as integral components of multidisciplinary teams can assist with identifying practical approaches for overcoming barriers that interfere with guideline adherence,” she concluded.

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Last modified: November 22, 2016