Children's Oncology Group Examines National Educational Practices in Pediatric Patients

Premier study examines current delivery of patient/family education to pediatric patients with newly diagnosed cancer.
Premier study examines current delivery of patient/family education to pediatric patients with newly diagnosed cancer.

ORLANDO, FL—The first study to examine current delivery of patient/family education to pediatric patients with newly diagnosed cancer across Children's Oncology Group (COG) institutions has found a need for evidence-based interventions to improve that delivery, according to survey results presented at the ONS 40th Annual Congress.

What's also needed is determining the impact of education “on knowledge acquisition, resource utilization, and pediatric oncology nursing practice,” said Janice Withycombe, PhD, RN, MN, CCRP, Palmetto Health, Columbia, South Carolina, on behalf of her COG colleagues.

Of the estimated 10,450 cases of newly diagnosed cancer in children ages birth to 14 years annually in the United States, 90% are managed at COG institutions.

“Although patient/family education is acknowledged as a core component of nursing practice, and is essential prior to discharge of newly diagnosed patients, there remains a deficit of evidence regarding educational practices within pediatric oncology,” Withycombe said.

To provide that evidence, each of the 223 COG facilities was asked to select one nurse representative actively engaged in patient/family education for patients with new diagnoses. SurveyMonkey was used to collect data, which was analyzed using descriptive statistics and multivariable logistic regression.

Omitting the 29.6% of COG sites (66) yet to select a survey nurse, a total of 130 surveys from 157 institutions (82.8%) had been completed, 55.4% of which had a specialized pediatric oncology unit. The RN:patient day shift ratio was less than 3 in 59% of institutions, and 31.5% had more than 25% of families who did not speak English. The nurse primarily responsible for education was advanced practice (33%), bedside (26%), educator (18%), and other (30%).

Topics that were rated mandatory for newly diagnosed cancer by more than 90% of sites included diagnosis (96.2%), chemotherapy/side effects (97%), signs/symptoms of infection (99%), fever (98.5%), home medications (94.6%), and how/when to call the treatment team (97.7%).

Nursing was rated as having primary responsibility for teaching all mandatory topics except diagnosis, clinical trial participation, diagnostic tests, and treatment plan.

“Barriers included inadequate nurse time for education (66%) and lack of clear communication among team members (57%),” Withycombe said.

After controlling for inpatient unit type (general pediatric vs. specialized pediatric oncology), RN:patient ratio, and nurse responsible for education (bedside vs. other), a multivariable logistic regression model analysis showed a lack of clear communication among team members (odds ratio [OR] 2.8; 95% confidence intervals [CI] 1.2-7.0; P=0.023) and more than 25% of families were non-English or limited English-speaking (OR 3.4; 95% CI 1.5-7.8; P=0.004) to be significantly associated with discharge delays that were associated with teaching not being complete.

“Next steps include publishing our results,” Withycombe concluded.

Underwriting or funding source was National Clinical Trials Network Grant–Children's Oncology Group (U10CA180886).

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