Research and Scholarship

Implementing a Clinical Decision Tool to Improve Oncologic Venous Thromboembolism Management

Jibran Majeed,(1,2) DNP, ACNP-BC, CCRN, Barbara S. Turner,(1) PhD, RN, FAAN, Deirdre Kelly,(2) ACNP-BC, Chester Poon,(2) Julie A. Thompson,(1) PhD, John Barrett,(3) DNP, FNP-BC, AGACNP-BC, and Gerald A. Soff,(4) MD

From (1)School of Nursing, Duke University, Durham, North Carolina; (2)Memorial Sloan Kettering Cancer Center, New York, New York; (3)School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; (4)University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Jibran Majeed, DNP, ACNP-BC, CCRN, 1275 York Avenue, New York, NY 10065. E-mail: majeedj@mskcc.org


J Adv Pract Oncol 2022;13(4):382–391 | https://doi.org/10.6004/jadpro.2022.13.4.3 | © 2022 Harborside™


  

ABSTRACT

Background: Cancer patients with venous thromboembolic (VTE) disease are complex, and many factors must be considered when initiating anticoagulation management. Clinical decision support systems can aid in decision-making by utilizing guidelines at the point of care. Objectives: The purpose of our project was to develop, implement, and evaluate an electronic clinical decision tool (CDT) utilizing evidence-based guidelines to aid in decision-making for adult oncologic patients who present with new VTE to symptom care clinics. Methods: We compared a pre-intervention group of patients who were prescribed anticoagulation (n = 98) with two post-intervention groups: CDT applied (n = 96) and not applied (n = 46). Outcomes included whether the CDT anticoagulation recommendations were followed and if the tool was perceived to be helpful or improve confidence in initiating management for new VTE by the SCC advanced practitioners and physicians. Results: There was no significant difference between the pre- and post-intervention groups in how many of the CDT anticoagulation recommendations were followed (68.8% pre-intervention, 60.8% post-intervention tool applied, and 63.5% post-intervention tool not applied; χ2 [2, N = 161] = .921, p = .631). However, the tool was found to be helpful and improved confidence of the providers in initiating management for new VTE (pre median = 3, interquartile range [IQR] = 2, 3.5; post median = 3, IQR 3, 4; p = .033). Conclusion: This CDT provided evidence-based anticoagulation recommendations for cancer-associated VTE and enhanced familiarity with the standard of care. Further development of the CDT will be required to account for situations that resulted in deviation from the recommendations.




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