Clinical Trial

. 2023 Apr 17;23(1):350.

doi: 10.1186/s12885-023-10835-0.

Symptom management care pathway adaptation process and specific adaptation decisions

Emily Vettese¹, Farha Sherani^{2

3}, Allison A King⁴, Lolie Yu⁵, Catherine Aftandilian⁶, Christina Baggott⁶, Vibhuti Agarwal⁷, Ramamoorthy Nagasubramanian⁷, Kara M Kelly⁸, David R Freyer⁹, Etan Orgel⁹, Scott M Bradfield¹⁰, Wade Kyono¹¹, Michael Roth¹², Lisa M Klesges¹³, Melissa Beauchemin¹⁴, Allison Grimes¹⁵, George Tomlinson¹⁶, L Lee Dupuis^{1

17

18}, Lillian Sung^{19

20}

Affiliations

¹ Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
² Driscoll Children's Hospital, Cancer and Blood Disorders Center, 3533 S. Alameda Street, Corpus Christi, TX, 78411, US.
³ Texas A&M University, College Station, TX, US.
⁴ Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, US.
⁵ Louisiana State University Health Sciences Center/Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.
⁶ Stanford University, 800 Welch Road, Palo Alto, CA, 94304, US.
⁷ Nemours Children's Hospital of The Nemours Foundation, 6535 Nemours Parkway, Orlando, FL, 32827, US.
⁸ Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St., Buffalo, NY, 14203, US.
⁹ Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US.
¹⁰ Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, US.
¹¹ Kapi'olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, Hawai'i, 96826, US.
¹² Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, US.
¹³ Division of Public Health Sciences, Washington University School of Medicine, 600 So Taylor Ave, St. Louis, MO, 63110, US.
¹⁴ Columbia University School of Nursing/Herbert Irving Cancer Center, 560 West 168th Street, New York, NY, 10032, USA.
¹⁵ Pediatric Hematology Oncology, University of Texas Health, The Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, US.
¹⁶ Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
¹⁷ Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
¹⁸ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S 3M2, Canada.
¹⁹ Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. lillian.sung@sickkids.ca.
²⁰ Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. lillian.sung@sickkids.ca.

PMID: 37069510
PMCID: PMC10108500
DOI: 10.1186/s12885-023-10835-0

Clinical Trial

Symptom management care pathway adaptation process and specific adaptation decisions

Emily Vettese et al. BMC Cancer. 2023.

. 2023 Apr 17;23(1):350.

doi: 10.1186/s12885-023-10835-0.

Authors

Affiliations

¹ Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
² Driscoll Children's Hospital, Cancer and Blood Disorders Center, 3533 S. Alameda Street, Corpus Christi, TX, 78411, US.
³ Texas A&M University, College Station, TX, US.
⁴ Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, US.
⁵ Louisiana State University Health Sciences Center/Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.
⁶ Stanford University, 800 Welch Road, Palo Alto, CA, 94304, US.
⁷ Nemours Children's Hospital of The Nemours Foundation, 6535 Nemours Parkway, Orlando, FL, 32827, US.
⁸ Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St., Buffalo, NY, 14203, US.
⁹ Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US.
¹⁰ Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, US.
¹¹ Kapi'olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, Hawai'i, 96826, US.
¹² Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, US.
¹³ Division of Public Health Sciences, Washington University School of Medicine, 600 So Taylor Ave, St. Louis, MO, 63110, US.
¹⁴ Columbia University School of Nursing/Herbert Irving Cancer Center, 560 West 168th Street, New York, NY, 10032, USA.
¹⁵ Pediatric Hematology Oncology, University of Texas Health, The Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, US.
¹⁶ Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
¹⁷ Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
¹⁸ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S 3M2, Canada.
¹⁹ Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. lillian.sung@sickkids.ca.
²⁰ Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. lillian.sung@sickkids.ca.

PMID: 37069510
PMCID: PMC10108500
DOI: 10.1186/s12885-023-10835-0

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 .

Keywords: Care pathway; Clinical practice guidelines; Implementation; Oncology; Pediatric; Supportive care; Symptom management.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Phases Required to Adapt the 14 Care Pathway Templates at Each of the 10 Institutions

See this image and copyright information in PMC

References

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1. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guideline. Clinical Practice Guidelines We Can Trust Washington (DC): National Academies Press (US); [Available from: https://www.ncbi.nlm.nih.gov/books/NBK209539/
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Symptom management care pathway adaptation process and specific adaptation decisions

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Symptom management care pathway adaptation process and specific adaptation decisions

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Abstract

Conflict of interest statement

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