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Preventing Infection in Pediatric Patients Receiving Chemotherapy: A Survey of Provider Recommendations
Rachel Offenbacher1,2, Chloe Citron3, Juan Lin4
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
Insights
Pediatric cancer patients on chemotherapy face infection risks. Recommendations on public activities vary significantly among healthcare providers, highlighting a need for standardized guidelines to balance safety and quality of life.
Area of Science:
- Pediatric Oncology
- Infectious Disease Management
- Healthcare Policy
Background:
- Sepsis is a primary cause of mortality in pediatric cancer patients undergoing chemotherapy.
- Pediatric hematology/oncology and transplant (PHOT) providers must balance infection risk with social/developmental benefits of activities.
- Hypothesis: Significant variability exists in PHOT provider recommendations regarding public activities.
Purpose of the Study:
- Assess current practices for educating patients on limiting infectious exposures.
- Evaluate how PHOT providers balance safety and health-related quality of life (HRQoL) in clinical decision-making.
- Identify variability in recommendations for public activity participation.
Main Methods:
- Anonymous electronic survey developed and piloted by PHOT providers.
- Inclusion of five clinical vignettes to explore risk-benefit balancing.
- Dissemination to PHOT providers affiliated with the Children's Oncology Group across the U.S.
Main Results:
- 545 clinicians completed the survey (physicians, fellows, APPs, nurses).
- Nurses and fellows provided more conservative recommendations than attending physicians and APPs (P < .0001).
- Less experienced providers were more cautious; more experienced providers were less cautious (P = .0072).
Conclusions:
- Survey reveals significant variation in recommendations for limiting infectious exposures.
- Highlights the need for collaboration among care team members for consistent patient messaging.
- Underscores the necessity for universal guidelines to standardize recommendations for pediatric chemotherapy patients.
Purpose:
Sepsis is the leading cause of mortality in patients with childhood cancer receiving cytotoxic chemotherapy. Pediatric hematology/oncology and transplant (PHOT) providers must counsel their patients on the safety of public activities and weigh the risk of infection exposure with the social and developmental benefits of in-person school and social outings. We hypothesize that there is significant variability in recommendations given by PHOT providers.
Methods:
An electronic anonymous survey was developed and piloted by a group of PHOT providers to assess current methods for educating patients and families on limiting infectious exposures. Five clinical vignettes were created by the study team to explore how providers balance the competing priorities of safety and health-related quality of life (HRQoL). The electronic survey was institutional review board-approved and disseminated via email to all PHOT providers affiliated with the Children's Oncology Group across the United States.
Results:
In total, 545 clinicians completed the survey. Most respondents were attending physicians (393, 72%), followed by fellows (61, 11%), advanced practice providers (APPs; 38, 7%), and nurses (37, 7%). On average, nurses and fellows made more conservative recommendations for avoiding infectious exposures compared with the recommendations from attending physicians and APPs (P < .0001). On average, providers with more years of clinical experience expressed less cautious recommendations, whereas those with less years of experience provided more cautious recommendations for avoiding infectious exposures (P = .0072).
Conclusion:
This survey demonstrates the importance of collaboration between all members of the care team in defining priorities for balancing safety risk and HRQoL to provide consistent messaging to patients. The variations in survey responses highlight the need for universal guidelines to standardize physician recommendations for limiting infectious exposures in pediatric patients on chemotherapy.
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