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Table 2 Frequency of Clinicians’ CIPN Assessment and Management Documentation Between the UCP and AP at T3

From: Exploring the impact of a decision support algorithm to improve clinicians’ chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study

Assessment Documentation

Frequency (%)

Usual Care (N = 67)f

Algorithm (N = 72)

Numbness

 Not Documented

11 (16.4%)

18 (25%)

 Documented

56 (83.6%)

54 (75%)

Tingling

 Not Documented

14 (20.9%)

21 (29.2%)

 Documented

53 (79.1%)

51 (70.8%)

CIPN Pain

 Not Documented

46 (68.7%)

60 (83.3%)

 Documented

21 (31.3%)

12 (16.7%)

Reflexes (n = 114)

 No Neuropathy Presenta

19

6

 Not Documented

46 (95.8%)

61 (92.4%)

 Documented

2 (4.2%)

5 (7.6%)

Vibration (n = 109)

 No Neuropathy Presenta

20

10

 Not Documented

47 (100%)

62 (100%)

 Documented

0

0

Functional Assessmentb (n = 114)

 No Neuropathy Presenta

20

5

 Not Documented

30 (63.8%)

41 (61.2%)

 Documented

17 (36.2%)

26 (38.8%)

Functional Deficitsc (n = 109)

 No Neuropathy Presenta

20

10

 Not Documented

36 (76.6%)

49 (79%)

 Documented

11 (23.4%)

13 (21%)

Appropriate Management of Mild CIPN PRO-CTCAE™ = 1

Usual Care

Algorithm

Yes (n = 12)

No (n = 13)

Yes (n = 21)

No (n = 9)

Continue to monitor

5 (41.7%)

0

5 (23.8%)

0

Dose Reduction

1 (8.3%)

0

2 (9.5%)

0

No new management offered; provider documented presence of CIPN

6 (50%)

0

14 (66.7%)

0

No documentation of neuropathy

0

8 (61.5%)

0

4 (44.4%)

No new management offered; Discrepancy in severity of provider documented and patient-reported CIPNd

0

5 (38.5%)

0

5 (55.6%)

Appropriate Management of Moderate-Severe CIPN (PRO-CTCAE™ ≥ 2)

Usual Care

Algorithm

Yes (n = 8)

No (n = 13)

Yes (n = 8)

No (n = 14)

Continue to monitor

0

2 (15.4%)

4 (50%)

0

Dose Reduction

4 (50%)

0

3 (37.5%)

0

No documentation of neuropathy

0

0

0

4 (28.6%)

No new management offerede

2 (25%)

11 (84.6%)

1 (12.5%)

10 (71.4%)

Pharmacological Treatment Offered

2 (25%)

0

0

0

  1. Table 2 describes clinicians’ frequency of CIPN assessment documentation and adherence to evidence-based CIPN management at T3 in both the usual care and algorithm phases
  2. aIf the clinician stated that no neuropathy was present in the reviewed note, we did not code the absence of documentation related to reflexes, vibration, functional assessment, or functional deficits as “Not Documented.” Instead, we removed such instances from the sample size for the variables of reflexes, vibration, functional assessment, or functional deficits. Thus, the frequency of documentation of reflexes, vibration, functional assessment, or functional deficits is calculated from the number of instances in which the clinician documented that neuropathy was present
  3. bIncluded the documentation of gross motor (e.g., walking or balance observations), fine motor (e.g., picking up a penny), or strength tests conducted by the clinician
  4. cIncluded the absence or presence of any limitations in activities of daily living associated with chemotherapy-induced peripheral neuropathy symptoms (e.g., typing, walking, opening jars, writing, weakness, fine motor coordination) documented by the clinician
  5. dPatient reported mild neuropathy, but clinician documented that no neuropathy was present
  6. eThere were three instances where the clinician did not recommend any new CIPN management, but the cases were rated as appropriate CIPN management: 1) the clinician dose reduced neurotoxic chemotherapy prior to T3 and CIPN scores decreased from T2 to T3, 2) the clinician prescribed gabapentin prior to T3 and worst CIPN pain intensity decreased from T2 to T3, and 3) the clinician dose reduced neurotoxic chemotherapy two times prior to T3 and CIPN severity decreased from T1 to T3
  7. fN = 67 instead of 70 because three patient participants did not see a consented clinician at T3
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BMC Cancer

ISSN: 1471-2407

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