The cause for delays in chemotherapy delivery in ambulatory oncology settings may be multifactorial, according to results of a multisite, qualitative study published in the Oncology Nursing Forum.
While previous studies have determined that hindering the timely delivery of chemotherapy is associated with increased risks of unfavorable clinical outcomes in patients with cancer for whom such treatment is prescribed, less is known about the specific patient-, clinician-, and organization-related factors that lead to prolonged and avoidable delays.
A multiphase study was performed as part of a sequential, mixed-methods project that evaluated communication approaches in Michigan-based ambulatory oncology care practices that were participating in a statewide quality improvement program related to the delivery of cancer care.
Twenty nine practices took part in the first phase of this study, which involved the completion of paper surveys by staff registered nurses, physicians, nurse practitioners, and physician assistants that consisted of questions relating to “communication satisfaction, practice environments, and communication technology at the ambulatory oncology practices.” In total, 297 clinicians participated in the first phase and the survey response rate was 68%.
Based on survey responses, the ambulatory oncology practices were separated into 4 groups according to level of electronic health record technology use and clinician–clinician communication; those with “high” scores in both categories (group 1), a “high” score in 1 category and a “low” score in the other (groups 2 and 3), and “low” scores in both categories (group 4).
In the second phase of the study, 2 practices from each of the 4 groups were selected for in-person site visits during which chemotherapy infusion-related practices were directly observed, and individual clinicians were shadowed to assess workflow and communication approaches. Recorded interviews were subsequently conducted with 46 clinicians at these practices to elicit their perspectives regarding barriers and facilitators to chemotherapy delivery.
Finally, to determine whether the collective findings were relevant beyond these 8 practice sites, focus groups were conducted with clinicians and clinician leaders at 6 other ambulatory oncology care practices within the same statewide consortium as part of the third phase of the study.
Following analyses of these findings, 4 themes were identified as being associated with delays in the delivery of chemotherapy as follows: