Standardizing the Chemotherapy Call Back Process to Improve Patient Understanding of Therapy and Side Effects in Initial Treatment

Background: As new patients are accepted and scheduled for chemotherapy, it is imperative that the team educates the patient on the expectations during the therapy and how to manage the potential side effects. Patient satisfaction with the organization is captured from patient experience surveys through Press Ganey. In 2020, Press Ganey scores for explaining chemotherapy expectations and side effect management were below the target Top Box Score goal for the Ambulatory Care Treatment Center (ATC) League City. A literature review revealed that contacting patients via a telephone call is a convenient way to reduce chemotherapy toxicity and provide psychological support for the patient.

Objective: The objective of this quality improvement project was to develop a standardized telephone follow-up process for patients at the ATC League City who have completed cycle 1 day 1 (C1D1) chemotherapy/immunotherapy. The goal was to increase the patients’ satisfaction, as evidenced through increased Press Ganey patient experience scores related to the explanation of how to manage side effects and what to expect during chemotherapy/immunotherapy.

Intervention: Initially, education was provided to staff regarding importance of patient education with respect to explaining what to expect during chemotherapy and managing its side effects. Staff was informed to provide C1D1 patients with chemotherapy handbook and chemotherapy drug handouts.

To further develop this project, a literature review was conducted, as well as, a review of best practices for toxicity assessment for research protocol patients and telephone triage guidelines developed by Oncology Nursing Society (ONS). Based on the research findings and feedback from multidisciplinary providers, eight areas of focus were selected to develop a standardized call back process for post C1D1 chemotherapy/immunotherapy patients. Additionally, the team collaborated with nursing informatics to develop standardized documentation and prepared a tip sheet for staff on how to document the follow-up phone call in the electronic health record (EHR). A pilot project was started on August 1st, 2021 with two team members from the workgroup calling their C1D1 patients within 24-48 hours post chemotherapy/immunotherapy.

Results: Nurses engaged in the follow-up telephone call process received positive feedback from patients regarding the post-therapy assessment. The project is still in the early implementation phases, but the preliminary data have shown favorable results. For August 2021, the ATC League City Press Ganey scores for explaining chemotherapy expectations increased to 71.05% from our lowest score of 56.6% in 2020 and explaining management of chemotherapy side effects increased to 62.1% from our lowest score of 60.0% in 2020.

Conclusion: Standardizing the telephone follow-up process for post C1D1 chemotherapy/immunotherapy patients can have a significant impact in oncology patients to improve their overall expectations and side effect management post chemotherapy/immunotherapy and improve the patient experience and satisfaction.