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Search results for "United States of America"

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Journal Article > Review

Interventions to improve oral chemotherapy safety and quality: a systematic review.

Zerillo JA, Goldenberg BA, Kotecha RR, Tewari AK, Jacobson JO, Krzyzanowska MK. JAMA Oncol. 2017 Jun 1; [Epub ahead of print].

This systematic review of quality and safety practices for oral chemotherapy found that telephone calls from nurses identified adverse medication events and supported adherence. Technology-enabled approaches such as text messaging, interactive voice response, and video-observed therapy have not been effective to date.

Journal Article > Commentary

Farewell to a cancer that never was.

Lyon J. JAMA. 2017;317:1824-1825.

Overdiagnosis can result in financial, psychological, and physical harm for patients. This commentary discusses the reclassification of a subtype of thyroid cancer as a nonmalignancy and the impact changing guidelines can have on patients.

Journal Article > Study

Significant and sustained reduction in chemotherapy errors through improvement science.

Weiss BD, Scott M, Demmel K, Kotagal UR, Perentesis JP, Walsh KE. J Oncol Pract. 2017;13:e329-e336.

Prescribing and administering chemotherapy involves complex processes that are vulnerable to error. This study discussed how improvement efforts, including standardization and minimizing interruptions, led to a decrease in the rate of chemotherapy errors reaching patients at a large urban academic pediatric medical center.

Journal Article > Commentary

Ethical dilemma in missed melanoma: what to tell the patient and other providers.

Vangipuram R, Horner ME, Menter A. J Am Acad Dermatol. 2017;76:365-367.

Despite the emphasis on open discussion of errors as a component of transparency, clinicians remain reluctant to disclose the errors of their peers to patients. This commentary discusses an incident involving a diagnosis of melanoma missed during the initial examination with a podiatrist that was later detected during a dermatology evaluation and describes how to manage such conversations between the providers as well as with the patient.

Journal Article > Study

Performance of a trigger tool for identifying adverse events in oncology.

Lipitz-Snyderman A, Classen D, Pfister D, et al. J Oncol Pract. 2017;13:e223-e230.

Investigators developed and validated a trigger tool to identify a range of harms in cancer care. Although their final tool had only a modestly accurate positive predictive value, they advocate refining and automating the trigger approach to enhance the detection of adverse events in oncology.

Journal Article > Commentary

2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, including standards for pediatric oncology.

Neuss MN, Gilmore TR, Belderson KM, et al. J Oncol Pract. 2016;12:1262-1271.

Administration errors involving chemotherapeutic agents can result in patient harm. This set of standards provides guidance to help ensure reliable use of these high-alert medications for both adult and pediatric patients. Components of the revised standards are expanded to include two-person verification, vinca alkaloid mini-bag administration, and labeling enhancements for home-based chemotherapy.

Web Resource > Multi-use Website

Just Bag It.

National Comprehensive Cancer Network.

Vincristine is a chemotherapy agent that can have serious consequences if administered incorrectly. Drawing from guidelines and expert opinion regarding vincristine administration, this campaign advocates for diluting vincristine via a mini-IV drip bag to reduce the likelihood of dangerous dosage mistakes.

Journal Article > Review

Moving toward improved teamwork in cancer care: the role of psychological safety in team communication.

Jain AK, Fennell ML, Chagpar AB, Connolly HK, Nembhard IM. J Oncol Pract. 2016;12:1000-1011.

Psychological safety can empower staff to communicate concerns and offer suggestions in a collaborative way that contributes to effective care. This review spotlights the importance of high-quality communication to help teams manage the complexity of oncology care regimens, geographically dispersed team members, and hierarchy. The authors advocate for further evidence to understand how to improve psychological safety for care team members and patients.

Special or Theme Issue

National Cancer Institute–American Society of Clinical Oncology Teams in Cancer Care Project.

J Oncol Pract. 2016;12:955-1194.

Team-based care has been adopted in various specialties as a strategy to reduce handoff errors and omissions. Highlighting the work of a collaborative project to apply team science to oncology, articles in this special issue explore topics such as engaging patients as team members, the role of psychological safety, and use of shared mental models to augment cancer care.

Journal Article > Study

The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.

Battis B, Clifford L, Huq M, Pejoro E, Mambourg S. J Oncol Pharm Pract. 2016 Oct 12; [Epub ahead of print].

Oral chemotherapy regimens are complex and may lead to severe adverse drug events. In this pilot study, nearly half of patients enrolled in a pharmacist-run oral chemotherapy monitoring clinic experienced a medication-related problem. This finding is consistent with prior studies that demonstrated pharmacist oversight improves safety of oral chemotherapy.

Journal Article > Study

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management.

Finn A, Bondarenka C, Edwards K, Hartwell R, Letton C, Perez A. J Oncol Pharm Pract. 2016 Aug 29; [Epub ahead of print].

Chemotherapy administration has a well known potential for errors. This pre–post study found that implementation of an electronic health record–facilitated, pharmacist-led, standardized ordering and monitoring program for oral chemotherapy led to better identification of prescribing errors. This research adds to the evidence for the role of pharmacists in making cancer care safer.

Journal Article > Study

Errors and nonadherence in pediatric oral chemotherapy use.

Walsh K, Ryan J, Daraiseh N, Pai A. Oncology. 2016;91:231-236.

Medication errors and nonadherence to medications contribute to increased use of health care resources. This study sought to better characterize the relationship between medication errors and nonadherence in children on oral chemotherapy. Researchers found both to occur in the same population and suggest that family and health system interventions could help mitigate errors and nonadherence in pediatric patients with cancer.

Journal Article > Study

Determinants of patient–oncologist prognostic discordance in advanced cancer.

Gramling R, Fiscella K, Xing G, et al. JAMA Oncol. 2016;2:1421-1426.

Suboptimal communication between patients and physicians can result in patients misunderstanding important aspects of their care. This study found that the majority of patients with cancer reported a more optimistic survival prognosis than their oncologists. These findings suggest the need to improve physician–patient communication about prognosis in order to ensure appropriate discussion of treatment decisions and goals.

Journal Article > Study

Communicating findings of delayed diagnostic evaluation to primary care providers.

Meyer AND, Murphy DR, Singh H. J Am Board Fam Med. 2016;29:469-473.

Gaps in follow-up of abnormal test results are known to contribute to delays in diagnosis in primary care, yet primary care practices still lack standard processes to detect and manage abnormal test results. In this study, investigators identified specific abnormal test results requiring follow-up and tested an escalating strategy of communicating with primary care physicians about test results. The study team first sent a secure email with test results to providers, and if the appropriate diagnostic follow-up action did not occur within one week, they made up to three attempts to reach providers by telephone. Email spurred about 11% of providers to act, and more than two-thirds of providers followed up after receiving telephone calls. For the handful of providers who did not act in response to the email or telephone calls, investigators contacted clinic directors. However, even with this patient-specific communication intervention, follow-up of abnormal test results remained incomplete. These results demonstrate that communicating abnormal results to primary care providers is not sufficient to achieve optimal follow-up. As recommended in the Improving Diagnosis report, team-based results management or technological approaches may be needed to assist primary care providers in tracking and following up on outpatient results to promote timely and accurate diagnosis.

Journal Article > Study

The multidisciplinary approach to GI cancer results in change of diagnosis and management of patients. Multidisciplinary care impacts diagnosis and management of patients.

Meguid C, Schulick RD, Schefter TE, et al. Ann Surg Oncol. 2016;23:3986-3990.

Multidisciplinary team discussions are thought to make cancer care safer and more effective. This pre–post study found that the use of a multidisciplinary program for evaluation of gastrointestinal cancer cases led to changes in diagnosis and treatment. These results support closer collaboration among providers to augment diagnosis, as recommended in the recent Improving Diagnosis report.

Journal Article > Study

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.

Elmore JG, Tosteson AN, Pepe MS, et al. BMJ. 2016;353:i3069.

This study found that eliciting second opinions in pathology improved the accuracy of breast histopathology specimens. This work provides further evidence that diagnostic accuracy can be enhanced with second opinions. The authors suggest that implementing multiple clinician review may augment the diagnostic process.

Journal Article > Commentary

When less is better, but physicians are afraid not to intervene.

Esserman L. JAMA Intern Med. 2016;176:888-889.

Biased physician recommendations can undermine safe, patient-centered care. This commentary and related perspective illustrate how unneeded treatment for breast cancer represents the problem of overdiagnosis and describe the subsequent harm to patients. The author suggests that physicians should provide patients with a range of treatment options along with their associated risks and benefits, consider patients' preferences, and encourage shared decision-making.

Journal Article > Study

Diagnostic delays and errors in head and neck cancer patients: opportunities for improvement.

Franco J, Elghouche AN, Harris MS, Kokoska MS. Am J Med Qual. 2016 Mar 30; [Epub ahead of print].

This retrospective review of 100 consecutive patients with head and neck cancer at a Veterans Affairs Medical Center determined the frequency of specific diagnostic delays and errors. Prior studies have found that delays in cancer care are common and harmful.

Journal Article > Commentary

Chemotherapy errors: a call for a standardized approach to measurement and reporting.

Lennes IT, Bohlen N, Park ER, Mort E, Burke D, Ryan DP. J Oncol Pract. 2016;12:e495-e501.

Chemotherapy is a complicated process, and it is vulnerable to error due to factors that can affect the various steps involved. This commentary describes how one multidisciplinary cancer center designed and applied a taxonomy to report and monitor chemotherapy errors. The authors summarize the results of the work and provide suggestions for organizations that seek to develop similar tracking and analysis methods.

Journal Article > Commentary

An ethical framework for allocating scarce life-saving chemotherapy and supportive care drugs for childhood cancer.

Unguru Y, Fernandez CV, Bernhardt B, et al. J Natl Cancer Inst. 2016;108:djv392.

Drug shortages have become increasingly common in recent years, especially in the United States. Some pediatric chemotherapeutics have frequently been in short supply, posing serious risks to patient safety. This commentary describes an ethical framework developed by a multidisciplinary group of experts and a panel of peer consultants. The framework seeks to guide clinicians' decision-making around allocating life-saving chemotherapies and associated drugs for children with cancer. The authors describe methods for managing shortages by reducing waste. The guideline also provides clear reasoning for actual prioritization across and within common pediatric cancers during a drug shortage. For example, in cases where shortages lead to the inability to provide the standard of care for some children, the authors propose emphasizing curability and prognosis in determining who is likely to have the most benefit. In 2013, the FDA released a strategic plan for preventing drug shortages, but the problem has continued largely unabated.

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