Care Pathway– and Guideline-Consistent Care in Pediatric Cancer Symptom Management

PURPOSE Ten pediatric cancer treatment sites previously implemented site-specific symptom management care pathways for 15 symptoms, which were based upon clinical practice guidelines (CPGs). The primary objective of this analysis was to describe the prevalence of care pathway– and CPG-consistent care for symptom management. The secondary objective was to identify factors associated with care pathway–consistent care. METHODS Participants were patients age 8-18 years diagnosed with cancer within the previous 4 weeks. We identified any intervention to manage each of 15 symptoms during a 3-day period 8 weeks after enrollment. We determined whether the intervention appeared in that site’s care pathway and whether it was recommended in the CPG. We determined whether type of symptom (observable v nonobservable) or patient characteristics were associated with care pathway–consistent care. RESULTS Two hundred twenty participants were analyzed. The prevalence of care pathway–consistent care for each symptom ranged from 0% (problems thinking, body or face changes, and diarrhea) to 52.3% (throwing up) and was <27% for 14 of 15 symptoms. Similarly, the prevalence of CPG-consistent care was <50% across all symptoms. Participants received significantly more care pathway–consistent interventions for observable symptoms compared with nonobservable symptoms (difference 30% [95% CI, 3 to 54]). Factors associated with receipt of at least one care pathway–consistent intervention were age group, race, ethnicity, and cancer type. CONCLUSION Care pathway– and CPG-consistent care were surprisingly uncommon. Care pathway–consistent interventions were more common for observable than nonobservable symptoms and were associated with patient characteristics. Future work should identify approaches to improve care pathway–consistent care delivery.