Characterizing patient-clinician chemotherapy-induced peripheral neuropathy assessment and management communication approaches.
Robert Knoerl, Ellen M L Smith, Amy Han and 3 others
PMID 31003878WHAT IT FOUND
Clinicians discussed and documented chemotherapy-induced neuropathy in less than half of visits.
When they did, they rarely asked about motor symptoms or pain severity, often using vague questions instead of specific descriptors for numbness or tingling.
Key findings
01CIPN was discussed in only 44% of clinical encounters, and documented in 46%.
02Among patients reporting CIPN, clinicians rarely assessed severity (18% for non-painful, 11% for painful) or motor symptoms (34%).
03Clinicians relied heavily on closed-ended questions (average 2.66) rather than open-ended inquiries (average 0.7).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The sample was predominantly Caucasian and male, limiting generalizability. Most participants had received less than one-third of their chemotherapy, so they were at low risk for severe CIPN, which may explain the low discussion rates. The study was a secondary analysis of a trial involving web-based symptom reporting, which may have influenced clinician behavior. Non-verbal communication was not assessed because only audio recordings were analyzed. The threshold used to flag symptoms (score of 50) may have been too high to identify mild but problematic cases.
Declared interests
The study was supported by the National Cancer Institute. No other specific conflicts of interest were declared in the provided text.
The easy way to misread this
Do not conclude that clinicians are ignoring CIPN intentionally. The low rates of discussion and documentation occurred in a context where most patients had mild symptoms early in treatment and where the screening tool used a high threshold (score of 50) that may not have flagged mild cases for clinician attention.