Identifying, Understanding, and Overcoming Barriers to the Use of Clinical Practice Guidelines in Pediatric Oncology

PRIMARY OBJECTIVES:

I. To measure the rate of adherence to selected Children's Oncology Group (COG)-endorsed
supportive care clinical practice guidelines (CPG) recommendations at National Cancer
Institute (NCI) Community Oncology Research Program (NCORP) sites. (Aim 1) II. To describe
the possible influence of NCORP site size and the number of patients enrolled in COG studies
per site on the delivery of CPG-consistent care. (Aim 1a) III. To describe the clinical
outcome of episodes during which patients receive CPG-consistent or CPG-inconsistent care.
(Aim 1b) IV. To describe facilitators of and barriers to the use of CPGs elicited via focus
group interviews with a diverse set of potential users (physician, nurse, nurse practitioner
and pharmacists) who provide pediatric cancer care at NCORP sites. (Aim 2) V. To improve how
well CPG recommendations are understood by health care providers by refining the CPG
recommendation format based on an iterative process of cognitive interviewing and formatting
revisions. (Aim 3)

OUTLINE:

AIM 1 (CHART REVIEW): Patients are separated for each CPG evaluated (fever and neutropenia
[FN], chemotherapy induced nausea and vomiting [CINV], fertility preservation [FP]) and are
randomly selected for medical chart review. Patients with eligible episodes of FN, CINV or FP
within the health records are selected and have the data from their records abstracted and
reviewed by COG for adherence to COG endorsed CPGs.

AIM 2 (FOCUS GROUPS): Health care providers who provide direct care to pediatric oncology
patients are identified and separated to participate in three types of focus groups:
physician-only, non-physician, and mixed.

AIM 3 (INTERVIEWS): Health care providers undergo one-on-one interviews consisting of think
aloud technique (TAL) of cognitive interviewing.

Inclusion Criteria:

- Willingness to participate in all 3 aims

- AIM 1 - ELIGIBILITY CRITERIA FOR INCLUSION IN RETROSPECTIVE CENTRALIZED CHART REVIEW

- Received care as an inpatient or outpatient at a participating COG NCORP site during
the time period between January 1, 2014 and December 31, 2015

- Ever enrolled on any COG trial (episode does not have to occur while on trial and the
COG trial may be therapeutic or non-therapeutic)

- CPG-Specific Eligibility

- FN

- Has any of the following diagnoses:

- Newly diagnosed acute lymphoblastic leukemia

- Relapsed acute lymphoblastic leukemia

- Any acute myeloid leukemia

- Burkitt's or mature B cell non-Hodgkin's lymphoma

- Any myeloablative autologous or allogeneic hematopoietic stem cell
transplantation

- CINV

- Diagnosis of cancer

- Received moderately or highly emetogenic chemotherapy as an inpatient

- < 12 years of age at the start of a CINV episode and received highly emetogenic
chemotherapy as an in-patient

- FP

- Newly diagnosed cancer

- >= 15 years of age at cancer diagnosis

- Note: a single patient may contribute data for multiple episodes

- AIM 2 AND AIM 3 INCLUSION CRITERIA

- Healthcare professional currently employed at a participating COG NCORP institution

- Eligible healthcare providers include but are not limited to: physicians, nurses,
nurse practitioners, pharmacists, social workers, dieticians, psychologists, and
physical therapists/physiotherapists

- Provides direct care for children with cancer as part of current position at NCORP
site

Exclusion Criteria:

- AIM 2 AND AIM 3 EXCLUSION CRITERIA

- Trainees are excluded

- Previous participation in this study either for Aim 2 or Aim 3

- Each health care provider can only be involved in one event (focus group or interview)