International guidelines are available to guide prescription of antiemetics and pain flare medications in patients receiving palliative radiotherapy for bone metastases, but prescription rates are quite variable. We hypothesized that a simple electronic quality checklist could significantly increase evidence-based use of these medications.
Materials and Methods:
We implemented an electronic quality checklist item for all patients treated in one center with palliative radiotherapy for lumbar spine bone metastases. We reviewed patients in the 6 months pre- and post-intervention. Patients were stratified according to if they were treated within a dedicated rapid palliative (RPAL) radiotherapy program or not. Chi-square tests were used to compare rates of antiemetic and pain flare medications pre- and post-intervention and RPAL vs not.
375 patients were identified with 11.2% treated in dedicated RPAL program. The proportion of patients treated with prophylactic antiemetics and pain flare medications pre- and post-intervention were respectively 33.0% vs 57.0% (p<0.001) and 27.1% vs 39.5% (p=0.01). The effect for antiemetics and pain flare medications. Comparison of overall prescription rates for antiemetics and pain flare medications between RPAL and non RPAL cohorts were respectively 83.3% vs 39.0% (p<0.001) and 74.0 vs 26.0% (p<0.0001).
Our data shows that a relatively simple quality checklist item can have a very significant effect on evidence-based use of antiemetic and pain flare medications in patients treated with palliative radiotherapy for bone metastases. We believe such strategies should be routinely included in other clinical pathways to improve use of symptom control medications.