Abstract
Purpose
While care pathways based upon clinical practice guidelines (CPGs) are important, little is known about optimal approaches to development and adaptation in pediatric oncology. Objectives were to develop care pathway templates for pediatric cancer supportive care that are based upon CPGs and to adapt an infection management care pathway for use at a single institution.
Methods
Study phases were as follows: (1) creation of care pathway templates across multiple supportive care topics; (2) refinement of the infection management care pathway template by interviewing pediatric oncology clinicians at a single institution; and (3) adaptation of the infection management care pathway template for use at a different institution.
Results
Informed by seven CPGs, an initial iteration of the infection management care pathway template was created. This template was then refined based upon 20 interviews with pediatric oncology clinicians. Adaptation of the infection management care pathway template for use at a different institution required many changes to improve its clinical usability. Specificity and additional information not considered by the source CPGs were incorporated.
Conclusion
We developed a process to create care pathway templates across multiple supportive care topics in pediatric oncology and to refine and adapt the infection management care pathway. While we found that the process was feasible, we also identified the need to substantially modify the care pathway during the adaptation process to consider scenarios not addressed by the source CPGs. Future work should measure implementation success.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
All data related to the study are available on request.
Code availability
Not applicable.
References
Statistics. CCSsSCoC (2011) Canadian Cancer Statistics 2011. In: Editor (ed)^(eds) Book Canadian Cancer Statistics 2011. Canadian Cancer Society City
Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (2014) Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64:83–103
Mueller BU (2014) Quality and safety in pediatric hematology/oncology. Pediatr Blood Cancer 61:966–969
Strahlendorf C, Pole JD, Barber R, Dix D, Kulkarni K, Martineau E, Randall A, Stammers D, Strother D, Truong TH, Sung L (2018) Enrolling children with acute lymphoblastic leukaemia on a clinical trial improves event-free survival: a population-based study. Br J Cancer 118:744–749
Truong TH, Pole JD, Barber R, Dix D, Kulkarni KP, Martineau E, Randall A, Stammers D, Strahlendorf C, Strother D, Sung L (2018) Enrollment on clinical trials does not improve survival for children with acute myeloid leukemia: a population-based study. Cancer 124:4098–4106
Lehrnbecher T, Ethier MC, Zaoutis T, Creutzig U, Gamis A, Reinhardt D, Aplenc R, Sung L (2009) International variations in infection supportive care practices for paediatric patients with acute myeloid leukaemia. Br J Haematol 147:125–128
Sung L, Aplenc R, Alonzo TA, Gerbing RB, Lehrnbecher T, Gamis AS (2013) Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children’s Oncology Group. Blood 121:3573–3577
Alexander S, Pole JD, Gibson P, Lee M, Hesser T, Chi SN, Dvorak CC, Fisher B, Hasle H, Kanerva J, Moricke A, Phillips B, Raetz E, Rodriguez-Galindo C, Samarasinghe S, Schmiegelow K, Tissing W, Lehrnbecher T, Sung L, International Pediatric Oncology Mortality Classification G (2015) Classification of treatment-related mortality in children with cancer: a systematic assessment. Lancet Oncol 16:e604-610
Pole JD, Gibson P, Ethier MC, Lazor T, Johnston DL, Portwine C, Silva M, Alexander S, Sung L (2017) Evaluation of treatment-related mortality among paediatric cancer deaths: a population based analysis. Br J Cancer 116:540–545
Schuster MA, McGlynn EA (1998) Brook RH (2005) How good is the quality of health care in the United States? Milbank Q 83:843–895
Shrank WH, Rogstad TL, Parekh N (2019) Waste in the US health care system: estimated costs and potential for savings. JAMA 322:1501–1509
Campbell H, Hotchkiss R, Bradshaw N, Porteous M (1998) Integrated care pathways. BMJ 316:133–137
(1990) Clinical practice guidelines: directions for a new program, Institute of Medicine. National Academy Press, Washington, DC
(2011) Clinical Practice Guidelines We Can Trust. Institute of Medicine, National Academies Press, Washington, D.C.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, Group GW (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926
Wright JD, Neugut AI, Ananth CV, Lewin SN, Wilde ET, Lu YS, Herzog TJ, Hershman DL (2013) Deviations from guideline-based therapy for febrile neutropenia in cancer patients and their effect on outcomes. JAMA Intern Med 173:559–568
Aapro MS, Chrápavá M, Curca R-OD, Gales L, Grigorescu AC, Karlínová B, Kellnerová R, Petru E, Pluzanski A, Rubach M, Steger GG, Tesarova P, Yordanov N, Walaszkowska-Czyz A (2020) Assessing the impact of antiemetic guideline compliance on prevention of chemotherapy-induced nausea and vomiting (CINV): results of the nausea/emesis registry in oncology (NERO). J Clin Oncol 38:12083–12083
Wöckel A, Kurzeder C, Geyer V, Novasphenny I, Wolters R, Wischnewsky M, Kreienberg R, Varga D (2010) Effects of guideline adherence in primary breast cancer–a 5-year multi-center cohort study of 3976 patients. Breast (Edinburgh, Scotland) 19:120–127
Cook S, Vettese E, Soman D, Hyslop S, Kuczynski S, Spiegler B, Davis H, Duong N, Ou Wai S, Golabek R, Golabek P, Antoszek-Rallo A, Schechter T, Lee Dupuis L, Sung L (2019) Initial development of Supportive care Assessment, Prioritization and Recommendations for Kids (SPARK), a symptom screening and management application. In: Editor (ed)^(eds) Book Initial development of Supportive care Assessment, Prioritization and Recommendations for Kids (SPARK), a symptom screening and management application, City, pp. 9
Robinson PD, Tomlinson D, Beauchemin M, Gibson P, Grimes A, Dadzie G, Safi M, Vettese E, Dupuis LL, Sung L (In press) Identifying Clinical Practice Guidelines for Symptom Control in Pediatric Oncology Submitted to Supportive Care in Cancer
The Children's Oncology Group (2020) COG Supportive Care Guidelines. In: Editor (ed)^(eds) Book COG Supportive Care Guidelines, City
National Guideline Clearinghouse (2014) Inclusion Criteria. http://www.guideline.gov/about/inclusion-criteria.aspx. In: Editor (ed)^(eds) Book Inclusion Criteria. http://www.guideline.gov/about/inclusion-criteria.aspx, City. Accessed 6 Dec 2021
Guyatt GH, Schunemann HJ, Djulbegovic B, Akl EA (2015) Guideline panels should not GRADE good practice statements. J Clin Epidemiol 68:597–600
Lehrnbecher T, Fisher BT, Phillips B, Alexander S, Ammann RA, Beauchemin M, Carlesse F, Castagnola E, Davis BL, Dupuis LL, Egan G, Groll AH, Haeusler GM, Santolaya M, Steinbach WJ, van de Wetering M, Wolf J, Cabral S, Robinson PD, Sung L (2020) Guideline for antibacterial prophylaxis administration in pediatric cancer and hematopoietic stem cell transplantation. Clin Infect Dis 71:226–236
Lehrnbecher T, Fisher BT, Phillips B, Beauchemin M, Carlesse F, Castagnola E, Duong N, Dupuis LL, Fioravantti V, Groll AH, Haeusler GM, Roilides E, Science M, Steinbach WJ, Tissing W, Warris A, Patel P, Robinson PD, Sung L (2020) Clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation recipients. J Clin Oncol 38:3205–3216
Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, Carlesse F, Groll AH, Haeusler GM, Santolaya M, Steinbach WJ, Castagnola E, Davis BL, Dupuis LL, Gaur AH, Tissing WJE, Zaoutis T, Phillips R, Sung L (2017) Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol 35:2082–2094
Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, Langston AA, Nastoupil LJ, Rajotte M, Rolston K, Strasfeld L, Flowers CR (2018) Outpatient management of fever and neutropenia in adults treated for malignancy: American society of clinical oncology and infectious diseases society of America clinical practice guideline update. J Clin Oncol 36:1443–1453
Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, Langston AA, Nastoupil LJ, Rajotte M, Rolston KV, Strasfeld L, Flowers CR (2018) Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol 36:3043–3054
National Institute for Health and Care Excellence (NICE) (2012) 2020 exceptional surveillance of neutropenic sepsis: prevention and management in people with cancer, https://www.nice.org.uk/guidance/cg151. In: Editor (ed)^(eds) Book 2020 exceptional surveillance of neutropenic sepsis: prevention and management in people with cancer, https://www.nice.org.uk/guidance/cg151, City. Accessed 6 Dec 2021
Smith TJ, Bohlke K, Lyman GH, Carson KR, Crawford J, Cross SJ, Goldberg JM, Khatcheressian JL, Leighl NB, Perkins CL, Somlo G, Wade JL, Wozniak AJ, Armitage JO (2015) Recommendations for the use of WBC growth factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 33:3199–3212
Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs Cochrane Database Syst Rev: CD006632
Chawla A, Westrich K, Matter S, Kaltenboeck A, Dubois R (2016) Care pathways in US healthcare settings: current successes and limitations, and future challenges. Am J Manag Care 22:53–62
Roberts KC, Pate M (2021) From evidence to implementation: using clinical practice guidelines to create care pathways, https://www.aaos.org/aaosnow/2021/oct/research/research01/. In: Editor (ed)^(eds) Book From evidence to implementation: using clinical practice guidelines to create care pathways, https://www.aaos.org/aaosnow/2021/oct/research/research01/, City. Accessed 6 Dec 2021
The Cochrane Effective Practice and Organisation of Care (EPOC) group (2022) About us, https://epoc.cochrane.org/about-us. In: Editor (ed)^(eds) Book About us, https://epoc.cochrane.org/about-us, City. Accessed 6 Dec 2021
Funding
This study was supported by the Pediatric Oncology Group of Ontario and operating grants from the Canadian Institutes of Health Research (PJT 169165) and the National Institutes of Health (1R01CA251112).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception, design, material preparation, data collection, and analysis. The first draft of the manuscript was written by DT and LS; all authors reviewed the manuscript and contributed to revisions. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
The study was approved by the Research Ethics Board at The Hospital for Sick Children.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent for publication
Not applicable.
Competing interests
Thea authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
First page of initial and refined templates and an adaptation example of the infection management care pathway. a Initial Template, b Refined (Final) Template, c Adapted Care Pathway at McMaster Children’s Hospital
Rights and permissions
About this article
Cite this article
Tomlinson, D., Robinson, P.D., Gibson, P. et al. Creating and adapting an infection management care pathway in pediatric oncology. Support Care Cancer 30, 7923–7934 (2022). https://doi.org/10.1007/s00520-022-07216-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-022-07216-x