Four Clinician Flaws That Delay Chemo Treatment

Chemotherapy delays can negatively affect patient outcomes, highlighting the importance of clinician communication, according to a study recently published in Oncology Nursing Forum.¹

“Chemotherapy treatment delays or wait times impede progress toward optimal health outcomes and place patients at risk for unfavorable events, such as missed medication administration, suboptimal disease control, or death,” the authors wrote.

The researchers observed 8 ambulatory oncology practices, where they shadowed clinicians (oncology nurses, physicians, and advanced practice providers), and conducted semi-structured interviews.

Ultimately, they discovered 4 factors that were correlated with treatment delays: discrepancies in care plan and missing orders for uncoupled visits; undocumented and uncommunicated day-of-treatment order changes; orders not signed in advance by physicians; and laboratory testing processes.

Care Plan Discrepancies

When patients had an uncoupled visit, meaning that they have an appointment for a chemotherapy infusion but do not to see their physician, there were delays if there were discrepancies in the care plan and the prescribing physician was not there to clarify.

In this situation, on-call doctors may be hesitant to make decisions when they are unfamiliar with the patients, especially if progress notes were unclear or undocumented, the authors explained.

“Care plan discrepancies between the original and on-call physician resulted in patients having their treatments canceled on the same day as their appointments, which led to treatment delays of days or weeks in some circumstances,” the authors wrote.

While this was a major problem in 1 particular location that was observed, other practices were more successful in preventing these delays by implementing a standard process with clearly assigned clinician roles and daily huddles between clinic and infusion nurses to ensure that everyone was prepared for administering the proper treatment.

Day-of Treatment Changes

Sometimes during coupled visits, when patients see their provider and have chemotherapy infusions, the prescriber may change the treatment plan because of lab results or physical assessment findings. This becomes an issue when they do not update the electronic health record.

As a result, the infusion nurses must then verify changes that were made before giving the patient their treatment.

“Getting clarification from the physician can take as long as 60 minutes or more, causing a delay in chemotherapy treatment,” the authors wrote. “Infusion nurses commented that every time they had to go find a physician to verify an order, it took them away from the infusion room floor and caring for their patients.”

Not to mention, this can negatively affect patients’ confidence in their treatment team.

Unsigned Orders

Some physicians reported that they insist on seeing their patients before they sign treatment orders, which could lead to delays on the day of scheduled treatment.

One infusion nurse interviewed said, “They’re supposed to have [treatment orders] approved before the patient is scheduled. That doesn’t always happen, and we find ourselves, at the last minute, standing in front of the patient saying, ‘I’ll be right back.’”

To combat this, some sites will fully staff the infusion centers when certain oncologists are working, while others continually message them reminding them to sign orders.

Additionally, some practices even created policies that ensure that all chemotherapy orders are signed and routed to the pharmacy before the appointment. That way, the treatment is ready to go, given the patient’s laboratory and physical assessments are within normal parameters.

Laboratory Delays

When a treatment team must wait for laboratory results before administering chemotherapy, there can be delays if the lab is running behind schedule.

So, some practices encourage patients to have their lab work completed the day prior to their infusion in an uncoupled visit. However, this can lead to difficulties on the patients’ ends, regarding transportation, caregiver schedules, and work schedules.

Ultimately, clinician communication can go a long way when it comes to getting patients’ treatment on time.

“These results align with previous studies that have found delays in chemotherapy delivery and wait times are caused at least in part by poor communication and coordination among clinicians in various areas of the practice, such as infusion, laboratory, and pharmacy.”

Reference

Lafferty M, Fauer A, Wright N, Manojlovich M, Friese CR. Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study. Oncology Nursing Forum. 47(4), 417-427 DOI: 10.1188/20.ONF.417-427