Enhancing Self-Management of Chemotherapy-Induced Nausea Vomiting with Patient-Reported Outcome Measures

Abstract

Problem & Purpose: Chemotherapy-induced nausea and vomiting (CINV) occurs in up to 70% of pediatric patients and is reported as one of the most distressing symptoms of cancer treatment. Within an outpatient pediatric oncology clinic, there was no formalized process to assess for symptoms of CINV. Patient reported outcome measures (PROMs) are self-reports of a patient’s health, quality of life, or functional status associated with their care. PROMs allow the healthcare team to monitor patient symptoms and provide remote support. This quality improvement project aimed to evaluate the use of electronic PROMs with nurse alerts for follow-up in the management of CINV. Methods: Within 24 hours of receiving chemotherapy, a PROM survey with the Pediatric Nausea Assessment Tool (PeNAT) was administered. PeNAT is a validated tool used to measure nausea in children ages 4-18. Patients or caregivers then voluntarily reported their level of CINV. Based on the level reported, nursing support and telephone follow-up was initiated. Nurses received PeNAT and PROM survey education, badge buddy cards, and workstation support cards. Monitored outcomes included new calls for CINV and the percentage of patients reporting “complete control” of symptoms. Over the 15-week implementation period, chart audits were conducted to determine if these interventions increased the number of patients reporting “complete control” with a clinic goal of 75%. Results: 403 patients were eligible to complete the PROM survey, and 97 children participated. Nurse initiated PeNAT administration at the patient’s clinic visit was 73% and patients’ and caregivers’ PROM response rate was 24.6%. These interventions resulted in 93.4% of patients reporting “complete control” of CINV symptoms. Together this allowed for a 62.5% reduction in the number of triage calls for complaints of CINV. Conclusions: The use of the PeNAT helped patients, caregivers, and staff better perceive and quantify CINV symptoms. The PROM survey aided in facilitating patient-provider communication and provided opportunities for at-home assessment of CINV symptoms with nursing support. Together these interventions helped patients and caregivers recognize that CINV is not a symptom to be “coped with” but one that can be prevented.