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. 2024 Mar 4;41(2):129–139. doi: 10.1177/27527530231222827

Reflections on the Past Decade in Evidence-Based Practice Within the Children's Oncology Group

Elizabeth A Duffy 1,✉, Mary C Hooke 2, Wendy Landier 3
PMCID: PMC11145516  PMID: 38437793

Abstract

Background: The Children's Oncology Group (COG) is the only National Cancer Institute–supported clinical trials organization focused exclusively on childhood and adolescent cancer research. The COG Nursing Discipline Committee has embedded the tenets of evidence-based practice (EBP) into clinical trials nursing in order to standardize the nursing care delivered to children enrolled on these trials. The COG nursing EBP initiative is aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of cancer treatment for patients enrolled on COG clinical trials from diagnosis through survivorship. A rigorous, evidence-based process designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline was developed and was implemented with the first nurse expert team beginning in 2012. Method: The standardized process included (a) selecting EBP projects and nursing expert teams (NETs), (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination of the COG EBP projects. Results: The COG Nursing EBP Subcommittee has developed 15 publications to date that include 90 authors. Eleven of these authors contributed to multiple publications. Discussion: On this 10th anniversary of the development of the EBP within the COG nursing discipline, we recognize its contributions to the professional growth of many of the discipline's members and to advances in nursing care for children enrolled in pediatric cancer clinical trials.

Keywords: evidence-based practice (EBP), patient and family education, nursing care, clinical trials, pediatric, oncology

Introduction

Evidence-based practice (EBP) improves healthcare through its positive impact on the patient experience, advancement of patient outcomes, and reduction of healthcare costs (Melnyk & Fineout-Overholt, 2023). Over time, the definition of EBP has evolved and expanded to include: (a) external evidence from published research, EBP theories, and expert panels; (b) clinical expertise including quality improvement outcomes and EBP projects, individual patient assessment, and consideration of clinical resources; and (c) patient/family preferences (Melnyk & Fineout-Overholt, 2023). The purpose of this article is to describe the process and development of EBP initiatives within the Children's Oncology Group (COG).

The COG is the only National Cancer Institute–supported clinical trials organization focused exclusively on childhood and adolescent cancer research.

Starting with the early days of pediatric cancer clinical trials in the 1970s, nurses have had an important presence within pediatric oncology clinical trials as providers of protocol-driven direct care to children enrolled in trials and as key educators of patients and families (Landier et al., 2013). As a discipline within COG, nursing also conducts research that moves beyond the cure of disease to increase understanding of the illness experience (Landier et al., 2013). As the concept of EBP has advanced within health care, the COG nursing discipline has sought to examine issues that have high priority and importance to the delivery of protocol-related nursing care (Landier et al., 2013).

In a study of U.S. practicing nurses, researchers evaluated EBP competencies in 2,344 nurses and advanced practice nurses and identified factors associated with these competencies (Melnyk et al., 2018). Results demonstrated that nurses were not yet meeting the 24 competencies (Melnyk et al., 2018); competency scores were higher for younger nurses and those with higher education. There is clearly a need to bring EBP to the frontline of nursing care and inform nursing practice. In addressing how the nursing profession can promote EBP competence among nurses, the researchers identified key components that are needed for an organizational culture supportive of EBP. These key components included (a) EBP included as part of the organization's vision and goals; (b) clinical inquiry supported and encouraged by the organization; (c) availability of EBP mentors; (d) leadership that values and supports EBP; and (e) recognition of EBP achievements (Melnyk et al., 2018). These organizational components guided the process used by the COG nursing discipline in developing EBP resources for nurses caring for children in cancer clinical trials.

Embedding Evidence-Practice in Clinical Trials Nursing

The goal of embedding the tenets of EBP into clinical trials nursing is to standardize the nursing care delivered to children enrolled in these trials. This both reduces variations in care, which is important in interpreting clinical trial outcomes and promotes the delivery of best nursing care practices based on current evidence.

Development Process

Development of the EBP Initiative Within the COG Nursing Discipline

The EBP initiative within the COG nursing discipline began in 2011 as an extension of the COG nursing discipline's clinical trials subcommittee. The COG EBP initiative was aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of care for patients enrolled on COG clinical trials and for cancer survivors in long-term follow-up after treatment.

Dr. Marilyn Hockenberry, professor of Pediatrics and Baylor College of Medicine and Quality Transformation Core Lead at Texas Children's Cancer Center and Hematology Centers, provided the initial leadership for this initiative within COG. A seminar to introduce the initiative, “Strengthening Nursing Practice With Evidence,” was led by Dr. Hockenberry at the COG meeting in September 2011. This seminar provided an overview of the EBP process, focused on five key areas: (a) asking the question; (b) searching for evidence; (c) analyzing the evidence; (d) applying the evidence to practice; and (e) evaluating the evidence. A rigorous, evidence-based process—designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline—was introduced to COG nurses at the seminar.

Details of this process were specified in the COG Nursing Evidence-Based Practice Procedure Manual (W. Landier, personal communication, May 30, 2023). Following the seminar, the COG Nursing Discipline moved to incorporate EBP into the discipline's values and goals. An EBP Task Force, led by Dr. Hockenberry, was established within the COG Nursing Discipline's Clinical Trials Subcommittee and charged with (a) selecting COG EBP projects and nursing expert teams (NETs); (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination (e.g., manuscript development, website posting) of the COG EBP projects.

The COG Nursing Discipline supported clinical inquiry with the first competitive call for EBP project proposals, which was released in November 2011; four competitive proposals were submitted. The selected project focused on evidence-based recommendations for physical activity in mononephric cancer survivors. This first COG EBP team was led by Maki Okada, CPNP; Dr. Hockenberry and Dr. Cheryl Rodgers served as comentors for the project. Over the course of 8 months, the team critically appraised the available evidence and developed recommendations for practice that were presented at the COG meeting in September 2012. These recommendations were subsequently incorporated into the COG Long-Term Follow-Up Guidelines (Children's Oncology Group, 2013) and later published in manuscript form (Okada et al., 2016).

In 2013, another call for EBP project proposals was released by the COG Nursing Discipline; 12 competitive proposals were submitted and 3 were selected. Recognizing the importance of consistent mentoring in the EBP process, Drs. Hockenberry and Rodgers were joined by Dr. Janice Withycombe in mentoring these teams. During this same timeframe, parallel EBP work was developing within the Association of Pediatric Hematology/Oncology Nurses (APHON). To maximize progress and minimize duplication between these organizations, the leadership of APHON and the COG Nursing Discipline made the decision to hold a joint EBP mentoring workshop. Led by Dr. Hockenberry, this 2-day workshop was hosted by the Duke University School of Nursing in August 2013, and funded through an Alex's Lemonade Stand Foundation grant (Principal Investigator: Hockenberry). Workshop attendees included two members from each EBP team (three teams from COG, two teams from APHON, and one team from Duke University School of Nursing). The 2013 COG teams presented their evidence summaries and recommendations at the COG meeting in September 2013, and the work from all teams attending the workshop was later featured in a special EBP-focused edition of the Journal of Pediatric Oncology Nursing (Conway et al., 2014; Duran et al., 2014; Fernbach et al., 2014; Mize et al., 2014; Robinson et al., 2014; Rusch et al., 2014), which was guest-edited by Drs. Rodgers, Withycombe, and Hockenberry (Rodgers et al., 2014). Selected EBP projects from COG (Rusch et al., 2014) and Duke University (Mize et al., 2014) were subsequently featured in a COG-led preconference workshop—“The Process of Evidence-Based Practice”—held at the APHON Annual Conference in September 2015.

Given the increased interest in EBP and the productivity of the initiative, and given the need for a process to formally incorporate this work into the COG Nursing Discipline, the COG Nursing Discipline Leadership formally established a Nursing EBP Subcommittee in 2014. Dr. Cheryl Rodgers was selected as the inaugural EBP Subcommittee Chair. The committee was initially charged with assembling two teams to synthesize evidence to inform best practices regarding the delivery of patient/family education in newly diagnosed pediatric oncology patients. Led by Drs. Rodgers and Withycombe, these two teams were assembled through a competitive application process. Support for team leaders and a 2-day training workshop for team members—convened at the Duke University School of Nursing in March 2014—was funded through the cooperative group infrastructure grant (U10CA180886). Findings from these projects were subsequently presented at the COG Nursing Discipline's State of the Science Symposium on Patient/Family Education in September 2015 (R13CA196165) and published in a special Patient/Family Education-focused edition of the Journal of Pediatric Oncology Nursing (Hockenberry & Landier, 2017; Rodgers et al., 2016; Withycombe et al., 2016).

Over the subsequent years, the COG Nursing Discipline has continued to issue calls for EBP projects, aligned with priority areas for the discipline. An additional 2-day training workshop, led by Drs. Hockenberry, Rodgers, and Landier, supported by the cooperative group infrastructure grant (U10CA180886), was convened in February 2018. This workshop focused on the systematic review process (literature search strategies, critically evaluating research papers, synthesizing and grading the evidence, appraising the evidence, and writing recommendation statements). Teams in attendance included newly formed EBP teams, as well as EBP teams that had already been working together over the previous year. Systematic reviews developed by all groups attending this workshop were subsequently published (Browne et al., 2021; Duffy et al., 2020; McLaughlin et al., 2019; Withycombe et al., 2021).

Initially, the clinical questions and teams were identified by COG nurses based on their observations regarding gaps in practice based on their clinical practice (Fernbach et al., 2014; Okada et al., 2016; Robinson et al., 2014; Rusch et al., 2014). These NETs included nursing representation from across COG nursing institutions and provided an opportunity to collaborate and develop an evidence-based summary and clinical tools/resources for the chosen topic. Over the past 10 years, the process of manuscript development and review has been further standardized and developed. A consistent process currently guides the work within the COG EBP subcommittee. Project topics now align with the two overarching goals defined by the COG Nursing Discipline's blueprint for nursing research (patient/family education and illness-related distress in children enrolled on clinical trials; Landier et al., 2013), replacing the previous process in which topics were proposed by NETs. The clinical questions continue to be approved by the COG nursing leadership and include both new questions and revisiting/broadening of previous clinical questions in areas in which there has been further research, in order to continually update evidence-based clinical recommendations on these topics (Browne et al., 2021; Coyne et al., 2019; Duffy et al., 2018, 2020, 2021; McLaughlin et al., 2019; Rodgers et al., 2016, 2018; Smolik et al., 2018; Withycombe et al., 2021; Woods et al., 2017).

Assembling an NET

Depending upon the focus of the clinical questions, COG nurses with clinical expertise in the targeted subject matter are invited to apply to participate in an NET.

Many of the clinical questions also necessitate a multi-disciplinary approach to assure content expertise by including disciplines such as pharmacy, behavioral health, and physicians. Applications for inclusion on the NET are evaluated by a nursing leadership team utilizing a standardized tool and a rigorous process, as the number of applications consistently exceeds the capacity of this mentored experience. The selected team is led by a doctorally prepared nurse with expertise in the systematic review process, under the guidance of the EBP committee chair. The project timeline ranges between 1 and 2 years and includes presentations at the COG fall meeting and subsequent manuscript publication.

Process for Development of COG EBP Nursing Clinical Tools and Resources

The formulated clinical question is determined by the COG nursing leadership utilizing the population, intervention, comparison, outcome, timeline format (Melnyk & Fineout-Overholt, 2023). The NET team then reviews the existing internal and external guidelines/tools for the selected topic (Figure 1). The extensive search of the evidence is foundational to the project. The systematic search of the literature is facilitated by a medical librarian based on a search protocol that is developed collaboratively by the NET and includes the specific inclusion and exclusion criteria related to the clinical question. The reproducible searches for all databases and associated search files are available through the online resource, Rayyan (https://www.rayyan.ai/), a web tool designed to assist researchers working on systematic and scoping reviews expediting the process of screening and selecting relevant studies.

Figure 1.

Figure 1

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COG Systematic Review Process

Note. COG = Children's Oncology Group.

Literature Review of Relevant Evidence

The initial title and abstract review is completed by two members of the NET and captured utilizing Rayyan. The full-text review is initially captured in a smaller set for interrater reliability as each of the team members include or exclude manuscripts based on the project protocol; reasons for exclusion are indicated. This initial review allows discussion between team members to ensure inclusion/exclusion consistency between group members. Following the initial review, the team is divided into two groups to complete the remainder of the review. COG resources and presentations are provided to the NET regarding the process of appraising and summarizing the evidence. Manuscripts selected for inclusion are summarized utilizing matrix/evidence tables by team members, providing the foundation for literature synthesis and the generation of practice recommendation statements based on the clinical question.

Analyze the Evidence

The NET subsequently critically appraises the evidence and prepares a summary document outlining the findings from the review process. To facilitate this process and assure transparency of the reviews, a matrix table with instructions is provided to each team member (Figure 2). Team members are placed in two-person teams to complete this step. Following the analysis of the evidence, the quality of the evidence is assessed by each team member independently utilizing the GRADE criteria (Andrews et al., 2013). Clinical practice guidelines that are included as evidence are evaluated using the AGREE II criteria (Brouwers et al., 2010).

Figure 2.

Figure 2

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Matrix/evidence Table Template

Note. Methodological flaws: Is there insufficient sample size, lack of blinding, large losses to follow up, or incorrect analysis? Inconsistency: Were there differences in the effect that cannot be reasonable explained? Indirectness: Is the research question different from the results in regard to population, intervention, comparison, or outcome? Imprecision: Was their uncertainty of results because of few patients and/or few events (wide confidence intervals)? Publication bias: Is the quality of evidence reduced due to poor or influential reporting of the investigator?

Summarize the Evidence

Following a critical appraisal of the evidence and grading of the overall body of evidence, practice recommendation statements are formulated for protocol-related nursing care or patient/family education. This process is completed through independent team member effort and team interaction is facilitated utilizing tele- or videoconferences and in-person meetings at COG. A manuscript draft is submitted to the nursing discipline leadership for edits and comments with the final review completed by the Chair of COG. The EBP COG Nursing Clinical Resource/Tool Approval Process is summarized in Figure 1.

Implementation of Findings

The practice recommendations generated over the past decade since the formation of the COG EBP Subcommittee have the potential to positively impact individual nursing practice. The final component of the EBP process is the implementation and dissemination of findings. In 2018, a COG EBP fellowship was awarded to two doctorally prepared nurses with the goal of implementing key findings into practice. The primary aim of this COG EBP fellowship was to evaluate the feasibility and fidelity of implementing a standardized checklist of primary educational topics for parents of newly diagnosed pediatric oncology patients into clinical practice at two COG institutions. The secondary aim was to determine the acceptability of the standardized checklist by parents, caregivers, and nursing staff. During this 1-year fellowship, the standardized new diagnosis education checklist was successfully implemented at two COG institutions (Duffy et al., 2021). A PowerPoint® presentation to facilitate new diagnosis education was also developed during this fellowship and served as the basis for the Children's Oncology Group's New Diagnosis Guide: Caring for Your Child at Home (Sullivan et al., 2019), which is currently used by nurses to guide new diagnosis teaching within COG. Future projects will aim to implement additional findings from COG EBP projects in order to improve patient care for children in clinical trials.

Results

Reviews and Projects Completed

As seen in Tables 1 and 2, the COG Nursing EBP Subcommittee has 15 publications to date that include 90 individual COG members as authors. Eleven of these authors have contributed to multiple COG EBP publications. These publications have addressed a wide range of PICO questions and topics related to clinical trials nursing, and demonstrate the far-reaching impact of this initiative within COG.

Table 1.

Children's Oncology Group Nursing Discipline Evidence-Based Practice Publications in Chronological Order

Title, author, by year of publication PICO questionsa No. of studies reviewed Key findings
Evidence-Based Practice Recommendations for Hydration in Children and Adolescents With Cancer Receiving Intravenous Cyclophosphamide (Robinson et al., 2014) In a population of children with cancer (P), what is the appropriate pre- and posthydration (I) for the administration of different dose levels of intravenous cyclophosphamide (C) to prevent bladder toxicity (O)? 15 There is a moderate level of quality evidence related to hydration for high-dose cyclophosphamide and very low-quality evidence related to intermediate or low-dose cyclophosphamide. Three general recommendations were made for hydration associated with cyclophosphamide.
Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer (Fernbach et al., 2014) In pediatric and adolescent and young adult individuals (P), what fertility preservation options (I) can be used in pre- and postpubertal females and males immediately following a cancer diagnosis, before the initiation of cancer treatment (T)? 101 Authors’ final recommendations consisted of two strong and one weak recommendations for both female and male fertility preservation options. Healthcare providers’ knowledge about fertility preservation is essential for caring for and educating patients and families about available fertility preservation options.
Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy (Rusch et al., 2014)

  1. In pediatric oncology patients receiving intrathecal chemotherapy (P), how does hydration, needle type (design and size), and position of the patient during and after the procedure (I) affect the development of postlumbar puncture headache (PLPH) (O) within 1 week of the procedure?

  2. In pediatric oncology patients with PLPHs (P), how do pharmacologic interventions (narcotics, nonnarcotic medications, caffeine) (I) affect the duration and severity of PLPHs (O)?

  3. In pediatric oncology patients with PLPHs (P), how do nonpharmacologic interventions (bed rest, positioning, fluids, blood patch) (I) affect the duration and severity of PLPHs (O)?

 24 Evidence supported strong recommendations for the use of smaller needle sizes and use of pencil-point needles during lumbar puncture procedures. Weak recommendations were made regarding needle orientation and positioning following the procedure as well as for treatment of PLPH.
Reconsidering Physical Activity Restrictions for Mononephric Survivors of Childhood Cancer: A Report From the Children's Oncology Group (Okada et al., 2016). What physical activities and exercise (I and C) are safe (O) in mononephric children and adolescents (P)? 31 Among mononephric patients, kidney loss is most commonly caused by nonsports accidents (such as motor vehicle accidents and falls). The evidence favors encouraging ordinary sports without restriction in mononephric childhood cancer survivors, as benefits of exercise outweigh the very low risk of renal loss.
Understanding Effective Delivery of Patient and Family Education in Pediatric Oncology (A Systematic Review From the Children's Oncology Group (Rodgers et al., 2016)

  1. Among newly diagnosed pediatric oncology patients and their family members (P), what educational method(s) (I) are most effective and preferred by patients and family members to address informational needs (O)?

  2. What time frame after an initial pediatric oncology diagnosis (I) is most effective and preferred (O) by patients and family members (P) for delivery of education?

  3. What location (I) is most effective and preferred (O) by patients and family members (P) to deliver and receive education after the initial pediatric oncology diagnosis?

  4. From a patient, family member, and HCP perspective, what educational content (I) is important and preferred (O) for newly diagnosed pediatric oncology patients and their family members (P)?

  5. Among newly diagnosed pediatric oncology patients and their family members (P), what are the demographic factors and/or clinical factors (C) that influence the initial educational information delivered (I) and received (O) after the oncology diagnosis (T)?

  6. Among newly diagnosed pediatric oncology patients and their family members (P), what interventions (I) have been developed to improve the comprehension of information (O) related to the diagnosis, treatment, and care of the pediatric oncology patient?

 83 Ten practice recommendations for practice were developed based on the evidence.
Recommendations address education delivery methods, content, factors influencing education, and interventions for the education of parents and siblings.
From the Children's Oncology Group: Evidence-Based Recommendations for PEG-Asparaginase Nurse Monitoring, Hypersensitivity Reaction Management, and Patient/Family Education (Woods et al., 2017).

  1. For pediatric oncology nurses (P), what monitoring guidelines (I) are needed during and after PEG-asparaginase administration (T) to facilitate the early identification and management of hypersensitivity reactions (O)?

  2. For pediatric oncology patients and their families (P), what education (I) is needed regarding PEG-asparaginase administration to facilitate the early identification and management of hypersensitivity reactions (O)?

 23 Strong recommendations were made based on moderate, low, or very-low-quality evidence. Among the recommendations, four related to nurse monitoring of patients during and after drug administration, eight guided hypersensitivity reaction management, and four related to content of patient/family education.
Nephrotoxicity: Evidence in Patients Receiving Cisplatin Therapy (Duffy et al., 2018). Among patients receiving cisplatin chemotherapy (P) (including various doses and infusion duration), what is an appropriate regimen of hydration and/or forced diuresis (I) to prevent or decrease the incidence of nephrotoxicity (O)? 23 Hydration is needed to prevent nephrotoxicity with cisplatin administration; evidence is inconclusive on the amount, duration, and timing of hydration for patients. Further research is needed for making practice recommendations.
Assessment Tools for Peripheral Neuropathy in Pediatric Oncology: A Systematic Review From the Children's Oncology Group (Smolik et al., 2018) In pediatric patients receiving vincristine (P), what assessment tools (I) best evaluate early onset and progression of peripheral neuropathy (O)? 8 Two established pediatric instruments were recommended for assessing vincristine-induced peripheral neuropathy in children 6 years of age and older. Evidence from several studies demonstrates that subjective symptoms alone are not adequate for assessment.
Factors Affecting Adolescents’ Willingness to Communicate Symptoms During Cancer Treatment: A Systematic Review From the Children's Oncology Group (McLaughlin et al., 2019) Among adolescents with cancer (P), what factors (I) affect their willingness to communicate symptoms (O) to healthcare providers? 11 Barriers and facilitators were identified with five practice recommendations made to support general and symptom communication.
Interventions to Promote Oral Medication Adherence in the Pediatric Chronic Illness Population: A Systematic Review From the Children's Oncology Group (Coyne et al., 2019) What are the effective interventions (I) to promote protocol-driven oral chemotherapy adherence (O) in pediatric oncology patients (P)? 24 Four recommendations (three strong and one weak) were made; most identified interventions were shown to have some benefit; however, most evidence came from nononcology pediatric settings.
Evidence-Based Recommendations for the Appropriate Level of Sedation to Manage Pain in Pediatric Oncology Patients Requiring Procedures: A Systematic Review From the Children's Oncology Group (Duffy et al., 2020) Among patients with pediatric cancer requiring procedures (P), what level (C) of sedation (I) is necessary for pain control (O)? 15 A strong recommendation was made based on a moderate level of evidence that bone marrow aspirates and bone marrow biopsies in pediatric oncology care should be performed under moderate sedation or general anesthesia.
Evidence-Based Recommendations for Nurse Monitoring and Management of Immunotherapy-Induced Cytokine Release Syndrome: A Systematic Review From the Children's Oncology Group (Browne et al., 2021) Among pediatric oncology patients (P) receiving immunotherapy/antibody therapy (I), what nursing interventions (C) are needed for prevention, monitoring, and management of cytokine release syndrome (CRS) (O)? 7 Six nursing practice recommendations (five strong, one weak) were developed based on low or very low-quality evidence; three reflect preinfusion monitoring, one focuses on monitoring during and postinfusion, and three pertain to the nurse's role in CRS management.
Commonly Reported Adverse Events Associated With Pediatric Immunotherapy: A Systematic Review From the Children's Oncology Group (Withycombe et al., 2021) Among pediatric oncology patients (P) receiving immunotherapy agents (dinutuximab, rituximab, brentuximab, inotuzumab, and blinatumomab) (I), what therapy-associated toxicities (O) are commonly reported? 17 Strong recommendations are made for nurses to become knowledgeable with the adverse event (AE) profiles associated with individual immunotherapy agents. Specific nursing practice recommendations were made regarding AEs associated with dinutuximab and rituximab.
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Note. C = comparison; COG = Children's Oncology Group; P = population; I = intervention; C = cyclophosphamide; O = outcome; T = treatment; HCP = health care provider.

aPICO Questions are directly quoted from manuscripts.

Table 2.

Children's Oncology Group Nursing Discipline Evidence-Based Practice Projects in Chronological Order

Title, author, by year of publication EBP project aim Key outcomes
A Standardized Education Checklist for Parents of Children Newly Diagnosed With Cancer: A Report From the Children's Oncology Group (Rodgers et al., 2018) To develop a checklist, standardized across institutions, to guide nursing education provided to parents of children newly diagnosed with cancer. A team of 21 nurse experts developed a final checklist with primary topics essential to teach before initial hospital discharge, secondary topics to be covered within the first month after diagnosis, and tertiary topics that should be discussed during therapy before it is completed.
Implementing and Evaluating a Standardized New Diagnosis Education Checklist: A Report From the Children's Oncology Group (Duffy et al., 2021) To evaluate the feasibility and fidelity of implementing a standardized checklist of primary educational topics for parents/caregivers of newly diagnosed pediatric oncology patients into clinical practice at two COG institutions. Project implementation was conducted over 5 months with 69 newly diagnosed families. The checklist implementation was feasible (81%). There was moderate fidelity to teaching checklist topics at the two sites.
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Note. EBP = evidence-based practice; COG = Children's Oncology Group.

Nursing Impact

The past decade of EBP projects within COG has fostered the engagement of nurses with strong clinical expertise in the process of EBP; many of whom did not have previous experience with the methodology associated with the appraisal of evidence. Some of these nurses have gone on to further expand their knowledge related to EBP by pursuing doctoral education or leading a subsequent NET. In addition, the professional growth of NET members involved with the EBP initiatives is further demonstrated through subsequent appointments to leadership roles within the COG nursing steering committee.

This continued engagement and interest in participating/leading future projects is a strength of the EBP initiatives within COG. Many NET team members have also had the opportunity to develop professional presentations featuring content from their EBP projects for the nursing discipline sessions at COG meetings and the COG track concurrent sessions at the APHON conferences. Other international presentations include the dissemination of practice recommendations at the International Society of Pediatric Oncology and Pediatric Oncology Group Ontario. The structure and resources of the COG EBP Subcommittee provide an excellent foundation for pediatric oncology nurses to begin to engage in the process of translating evidence into practice.

Discussion

Innovative nurse-led projects seek to provide creative solutions to complex patient care challenges and are facilitated by the proximity of nurses to the point of care, which facilitates a deep understanding of care delivery. One of the strengths of the nursing discipline within COG is the development of the EBP initiatives and foundational resources to facilitate the translation of evidence into practice to improve patient outcomes for children in clinical trials. The goal of this process is to engage and support nurses who have minimal experience with the appraisal of evidence to create practice recommendations to guide protocol-related clinical care through a mentored process of completing a systematic review.

Despite the many benefits of the NETs, there are also challenges related to the substantial time commitment and scholarly effort associated with evidence appraisal and synthesis. The dedication of the nurses engaged in the NET is truly remarkable. This dedication was readily apparent during the pandemic as the NETs continued to complete their systematic reviews by collaborating virtually across the timeframe of the project. In conjunction with this goal is the creation of evidence-based clinical resource materials that are relevant to providing care for children on clinical trials. The COG Supportive Care Committee appraises and recommends the endorsement of clinical practice guidelines and offers an additional opportunity for nurses to engage in the appraisal and critique of evidence.

On this 10th anniversary of the development of the EBP within the COG Nursing Discipline, we recognize that it has contributed to the professional growth of many of the discipline's members and advanced the nursing science of children in pediatric cancer clinical trials. Projects that aim to implement a practice change or evidence-based resource will be an area of future focus, utilizing the mentored team approach that has proven successful over the past decade.

Footnotes

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: Authors disclose the following financial support: NCTN Operations Center Grant U10CA180886 from NCI/NIH to the Children's Oncology Group (COG).

References

  1. Andrews J., Guyatt G., Oxman A. D., Alderson P., Dahm P., Falck-Ytter Y., Nasser M., Meerpohl J., Post P. N., Kunz R., Brozek J., Vist G., Rind D., Akl E. A., Schunemann H. J. (2013). Grade guidelines: 14. Going from evidence to recommendations: The significance and presentation of recommendations. Journal of Clinical Epidemiology, 66(7), 719–725. 10.1016/j.jclinepi.2012.03.013 [DOI] [PubMed] [Google Scholar]
  2. Brouwers M. C., Kho M. E., Browman G. P., Burgers J. S., Cluzeau F., Feder G., Fervers B., Graham I. D., Grimshaw J., Hanna S. E., Littlejohns P., Makarski J., Zitzelsberger L., Consortium A. N. S. (2010). Agree II: Advancing guideline development, reporting and evaluation in health care. Canadian Medical Association Journal, 182(18), E839–E842. 10.1503/cmaj.090449 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Browne E. K., Daut E., Hente M., Turner K., Waters K., Duffy E. A. (2021). Evidence-based recommendations for nurse monitoring and management of immunotherapy-induced cytokine release syndrome: A systematic review from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 38(6), 399–409. 10.1177/10434542211040203 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Children's Oncology Group. (2013). Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers, Version 4.0. [PubMed] [Google Scholar]
  5. Conway M. A., McCollom C., Bannon C. (2014). Central venous catheter flushing recommendations: A systematic evidence-based practice review. Journal of Pediatric Oncology Nursing, 31(4), 185–190. 10.1177/1043454214532028 [DOI] [PubMed] [Google Scholar]
  6. Coyne K. D., Trimble K. A., Lloyd A., Petrando L., Pentz J., Van Namen K., Fawcett A., Laing C. M. (2019). Interventions to promote oral medication adherence in the pediatric chronic illness population: A systematic review from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 36(3), 219–235. 10.1177/1043454219835451 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Duffy E. A., Adams T., Thornton C. P., Fisher B., Misasi J., McCollum S. (2020). Evidence-based recommendations for the appropriate level of sedation to manage pain in pediatric oncology patients requiring procedures: A systematic review from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 37(1), 6–20. 10.1177/1043454219858610 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Duffy E. A., Fitzgerald W., Boyle K., Rohatgi R. (2018). Nephrotoxicity: Evidence in patients receiving cisplatin therapy. Clinical Journal of Oncology Nursing, 22(2), 175–183. 10.1188/18.CJON.175-183 [DOI] [PubMed] [Google Scholar]
  9. Duffy E. A., Herriage T., Ranney L., Tena N. (2021). Implementing and evaluating a standardized new diagnosis education checklist: A report from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 38(5), 322–330. 10.1177/10434542211011059 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Duran J., Siddique S., Cleary M. (2014). Effects of leukoreduction and premedication with acetaminophen and diphenhydramine in minimizing febrile nonhemolytic transfusion reactions and allergic transfusion reactions during and after blood product administration: A literature review with recommendations for practice. Journal of Pediatric Oncology Nursing, 31(4), 223–229. 10.1177/1043454214532029 [DOI] [PubMed] [Google Scholar]
  11. Fernbach A., Lockart B., Armus C. L., Bashore L. M., Levine J., Kroon L., Sylvain G., Rodgers C. (2014). Evidence-based recommendations for fertility preservation options for inclusion in treatment protocols for pediatric and adolescent patients diagnosed with cancer. Journal of Pediatric Oncology Nursing, 31(4), 211–222. 10.1177/1043454214532025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hockenberry M., Landier W. (2017). Patient/family education as translational science in pediatric oncology. Journal of Pediatric Oncology Nursing, 34(3), 155. 10.1177/1043454216680738 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Landier W., Leonard M., Ruccione K. S. (2013). Children's Oncology Group's 2013 blueprint for research: Nursing discipline. Pediatric Blood & Cancer, 60(6), 1031–1036. 10.1002/pbc.24415 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McLaughlin C. A., Gordon K., Hoag J., Ranney L., Terwilliger N. B., Ureda T., Rodgers C. (2019). Factors affecting adolescents’ willingness to communicate symptoms during cancer treatment: A systematic review from the Children's Oncology Group. Journal of Adolescent and Young Adult Oncology, 8(2), 105–113. 10.1089/jayao.2018.0111 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Melnyk B. M., Fineout-Overholt E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters-Kluwer. [Google Scholar]
  16. Melnyk B. M., Gallagher-Ford L., Zellefrow C., Tucker S., Thomas B., Sinnott L. T., Tan A. (2018). The first US study on nurses’ evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16–25. 10.1111/wvn.12269 [DOI] [PubMed] [Google Scholar]
  17. Mize L., Harris N., Stokhuyzen A., Avery T., Cash J., Kasse M., Sanborn C., Leonardelli A., Rodgers C., Hockenberry M. (2014). Neutropenia precautions for children receiving chemotherapy or stem cell transplantation for cancer. Journal of Pediatric Oncology Nursing, 31(4), 200–210. 10.1177/1043454214532027 [DOI] [PubMed] [Google Scholar]
  18. Okada M., Hockenberry M. J., Koh C. J., Meeske K. A., Rangan K. E., Rodgers C., Rosenthal Y., Ruccione K. S., Freyer D. R. (2016). Reconsidering physical activity restrictions for mononephric survivors of childhood cancer: A report from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 33(4), 306–313. 10.1177/1043454215607341 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Robinson D., Schulz G., Langley R., Donze K., Winchester K., Rodgers C. (2014). Evidence-based practice recommendations for hydration in children and adolescents with cancer receiving intravenous cyclophosphamide. Journal of Pediatric Oncology Nursing, 31(4), 191–199. 10.1177/1043454214532024 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rodgers C., Bertini V., Conway M. A., Crosty A., Filice A., Herring R. A., Isbell J., Lown Dr P. E., Miller K., Perry M., Sanborn P., Spreen N., Tena N., Winkle C., Darling J., Slaven A., Sullivan J., Tomlinson K. M., Windt K., Landier W. (2018). A standardized education checklist for parents of children newly diagnosed with cancer: A report from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 35(4), 235–246. 10.1177/1043454218764889 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rodgers C. C., Laing C. M., Herring R. A., Tena N., Leonardelli A., Hockenberry M., Hendricks-Ferguson V. (2016). Understanding effective delivery of patient and family education in pediatric oncology (a systematic review from the Children's Oncology Group). Journal of Pediatric Oncology Nursing, 33(6), 432–446. 10.1177/1043454216659449 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rodgers C., Withycombe J. S., Hockenberry M. J. (2014). Evidence-based practice projects in pediatric oncology nursing. Journal of Pediatric Oncology Nursing, 31(4), 182–184. 10.1177/1043454214532023 [DOI] [PubMed] [Google Scholar]
  23. Rusch R., Schulta C., Hughes L., Withycombe J. S. (2014). Evidence-based practice recommendations to prevent/manage post-lumbar puncture headaches in pediatric patients receiving intrathecal chemotherapy. Journal of Pediatric Oncology Nursing, 31(4), 230–238. 10.1177/1043454214532026 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Smolik S., Arland L., Hensley M. A., Schissel D., Shepperd B., Thomas K., Rodgers C. (2018). Assessment tools for peripheral neuropathy in pediatric oncology: A systematic review from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 35(4), 267–275. 10.1177/1043454218762705 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sullivan J., Duffy E. A., Herriage T., Ranney L., Tena N. (Eds.). (2019). The Children's Oncology Group new diagnosis guide: Caring for your child at home. Children's Oncology Group. https://childrensoncologygroup.org/downloads/Diagnosis_Guide_Slide_Set_English.pptx [Google Scholar]
  26. Withycombe J. S., Andam-Mejia R., Dwyer A., Slaven A., Windt K., Landier W. (2016). A comprehensive survey of institutional patient/family educational practices for newly diagnosed pediatric oncology patients. Journal of Pediatric Oncology Nursing, 33(6), 414–421. 10.1177/1043454216652857 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Withycombe J. S., Carlson A., Coleman C., Leslie S. L., Skeens M., Tseitlin H., Duffy E. A. (2021). Commonly reported adverse events associated with pediatric immunotherapy: A systematic review from the Children's Oncology Group. Journal of Pediatric Oncology Nursing, 38(1), 16–25. 10.1177/1043454220966590 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Woods D., Winchester K., Towerman A., Gettinger K., Carey C., Timmermann K., Langley R., Browne E. (2017). From the Children's Oncology Group: Evidence-based recommendations for peg-asparaginase nurse monitoring, hypersensitivity reaction management, and patient/family education. Journal of Pediatric Oncology Nursing, 34(6), 387–396. 10.1177/1043454217713455 [DOI] [PMC free article] [PubMed] [Google Scholar]

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