RESUMO
INTRODUCTION: Past studies indicate delays in adoption of consensus-based guideline updates. In June 2016, the National Comprehensive Cancer Network changed its guidelines from routine testing to omission of ordering complete blood cell count (CBC) and liver function tests (LFT) in patients with early breast cancer. In response, we developed an implementation strategy to discontinue our historical practice of routine ordering of these tests in asymptomatic patients. METHODS: The ordering of CBC and LFT for clinical stage I-IIIA breast cancer patients was audited in 2016. In June 2016, we utilized the levers of the National Quality Strategy implementation methodology to enact a system-wide change to omit routine ordering. To measure the plan's effectiveness, guideline compliance for ordering was tracked continually. RESULTS: Of 92 patients with early stage cancer in 2016, the overall rate of compliance with guidelines for ordering a CBC and LFT was 82% (88/107) and 87% (93/107), respectively. Segregated by the pre- and post-guideline change time period, the compliance rates for ordering a CBC and LFT were 78% and 87% (P = 0.076). CONCLUSION: In contrast to historical reports of delays in adoption of new evidence-based guideline changes, we were able to quickly change provider practice during the transition from routine ordering to omission of ordering screening blood tests in newly diagnosed patients with early breast cancer.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/economia , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/normas , Fidelidade a Diretrizes , Programas de Rastreamento/economia , Programas de Rastreamento/normas , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/patologia , Análise Custo-Benefício , Medicina Baseada em Evidências , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estados UnidosRESUMO
This quality improvement pilot study evaluated the effect of massage therapy on pain, anxiety, and overall well-being in women who received mastectomies at a busy hospital practice. Participants reported a significant reduction in pain, stress, and muscle tension, as well as an increase in relaxation. Oncology nurses should consider the feasibility of massage therapy as a valuable nonpharmcologic pain management strategy.