Establishing a standardized clinical thinking model for oncology pharmacy outpatients in China: A mixed-method study

Abstract

Background

Oncology pharmacy clinics play a crucial role in improving medication adherence, managing drug-related problems (DRPs), enhancing quality of life, and reducing costs. However, standardized protocols for such clinics are currently lacking in China.

Objectives

This study aimed to develop a standardized clinical thinking model for oncology medication consultations to ensure consistent and high-quality pharmaceutical care.

Methods

A mixed-method study was conducted, analyzing 100 oncology medication consultations from January to July 2024 at Shanghai Xinhua Hospital. Retrospective statistics and root cause analysis, using a fishbone diagram across four dimensions (personnel, materials, methods, environment), were employed to identify gaps in current practices. Based on findings, the “Information gathering, Reasoning, Judgement, Enacting a decision” (IRJE) model was developed. Pharmacists received IRJE-based training, and its effectiveness was evaluated using pre- and post-training questionnaires.

Results

A total of 100 medication-related cases were analyzed. The results revealed issues such as incomplete medication evaluations by pharmacists. Root cause analysis using the fishbone diagram identified key factors across the four dimensions. In response, the IRJE clinical thinking model was established to guide safe antitumor medication use. Post-training, pharmacists demonstrated significantly improved confidence in identifying medication-related factors, maintaining standardized records, and conducting medication consultations (p < 0.05).

Conclusions

The IRJE model provides a structured decision-making pathway for oncology pharmaceutical care. It has the potential to standardize consultations and improve patient outcomes across pharmacy clinics in China.

Keywords

Oncology pharmacy clinical decision-making medication consultation standardized care mixed-methods study

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References

Fitzmaurice

Akinyemiju

, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study. Jama Oncol 2018; 4: 1553–1568.

Council GOOT. China's medium - and long-term plan for Non-communicable Diseases Prevention and control (2017–2025). 2017. https://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.

Goh

Lai

Chew

. Prevalence and risk of polypharmacy among elderly cancer patients receiving chemotherapy in ambulatory oncology setting. Curr Oncol Rep 2018; 20: 38.

Vrijkorte

de Vries

Schaafsma

, et al. Optimising pharmacotherapy in older cancer patients with polypharmacy. Eur J Cancer Care 2020; 29: e13185.

LeBlanc

McNeil

Kamal

, et al. Polypharmacy in patients with advanced cancer and the role of medication discontinuation. Lancet Oncol 2015; 16: e333–e341.

Yeoh

Tay

, et al. Drug-related problems in elderly patients with cancer receiving outpatient chemotherapy. J Geriatr Oncol 2015; 6: 280–287.

Kondryn

Edmondson

Hill

, et al. Treatment non-adherence in teenage and young adult patients with cancer. Lancet Oncol 2011; 12: 100–108.

Shah

Dowell

Greene

. Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting. Ann Pharmacother 2006; 40: 1527–1533.

Caracuel

Baños

Herrera

, et al. Influence of pharmaceutical care on the delayed emesis associated with chemotherapy. Int J Clin Pharm-Net 2014; 36: 287–290.

10.

Michaud

. Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer. Am J Health-Syst Ph 2010; 67: S20–S30. quiz S31-3.

11.

Wong

Bounthavong

Nguyen

, et al. Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic. Am J Health-Syst Ph 2014; 71: 960–965.

12.

Mae

Yokokawa

Kawakami

, et al. Usefulness of pharmaceutical outpatient clinic in XELOX therapy. Japanese Journal of Hospital Pharmacy 2011; 37: 611–615.

13.

Kimura

Iwai

, et al. Evaluation of the role and usefulness of a pharmacist outpatient service for patients undergoing monotherapy with oral anti-cancer agents. J Oncol Pharm Pract 2017; 23: 413–421.

14.

Yamada

Nabeshima

. Pharmacist-managed clinics for patient education and counseling in Japan: current status and future perspectives. J Pharm Health Care 2015; 1: 2.

15.

Commission GOOT. Opinions on strengthening drug administration in medical institutions to promote rational drug use. 2020. http://www.nhc.gov.cn/yzygj/s7659/202002/ea3b96d1ac094c47a1fc39cf00f3960e.shtml.

16.

Commission GOOT. Notice on the issuance of five standards such as the pharmaceutical outpatient service standards of medical institutions. 2021. http://www.nhc.gov.cn/yzygj/s7659/202110/f76fc77acd87458f950c86d7bc468f22.shtml.0010/1/1.

17.

Zhang

Wan

Tang

, et al. A national online survey of pharmacist-managed clinics in tertiary hospitals in China. Chin Pharmacol J 2021; 56: 849–853.

18.

Vogel

Zwolinsky

Griffiths

, et al. A delphi study to build consensus on the definition and use of big data in obesity research. Int J Obesity 2019; 43: 2573–2586.

19.

Schmalz

Spinler

Ringbeck

. Lessons learned from a two-round delphi-based scenario study. Methodsx 2021; 8: 101179.

20.

Manzano

. Conducting focus groups in realist evaluation. Evaluation-US 2022; 28: 406–425.

21.

Defoe

Jupp

Leslie

. Integration of clinical pharmacists into an ambulatory, pediatric hematology/oncology/transplant clinic. J Oncol Pharm Pract 2019; 25: 607–612.

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