Oncology Nursing Society (ONS) Develops Evidence-Based Breast Cancer Chemotherapy and Survivorship Quality Measures (QM)

Purpose:
Determine a reproducible process for developing and testing evidence-based, patient-centered quality measures in the ambulatory oncology setting with breast cancer as a pilot population. Few QM undergo systematic validity and reliability testing, limiting their suitability for national benchmarking.

Significance:
It is critical that oncology nursing practice include interventions from a strong evidence base. To quantify the consistency of evidence-based assessments and interventions taking place, two sets of QM were developed from the ONS Putting Evidence into Practice (PEP) and other evidence sources.

Strategy and Implementation:
The ONS Foundation supported teams of expert nurses to review evidence, draft and prioritize topic areas for potential QM. Final QM were selected after solicitation of national public comment from stakeholders, and were judged on importance to clinical care, prevalence and potential for impact, scientific basis and link between process and outcome. The Joint Commission (TJC) was contracted to conduct testing, and diverse pilot sites were recruited to perform retrospective data abstraction on patient charts. The Breast Cancer Care (BCC) QM set focused on symptom management for patients receiving chemotherapy (testing completed in 2010), and the Breast Cancer Survivorship (BCS) set explores needs in the first year post-treatment (testing underway). TJC and ONS staff co-managed development of QM specifications, abstractor training, clinical and technical support of pilot sites, and re-abstracted 20% of the submitted cases for reliability testing.

Evaluation:
QM scores were examined for gaps in care, and areas significant to nursing practice were identified. Sources of re-abstraction mismatch were scrutinized, and clarifications were made to QM to increase reliability. Additional small-scale re-testing of QM may be used as needed to ensure performance.

Implications for Practice:
Valid and reliable QM provide an instrument to link high-level EBP and practice implementation to improve quality cancer care. National testing across diverse practice sites ensures “real world” performance of QM, and allows use of results for future benchmarking.