Heather Jacobs

Heather.jacobs@yale.edu
10/04/2011
N717, Context of Care
Assignment 1, Part 2

Memorandum

To: Veronica Nieva, PhD
From: Heather Jacobs, RN, MPH, SNP
Date: October 4, 2011
RE: AHRQ Health Care Innovations Exchange- High Quality Tool for Pediatric Leukemia

I have recently become acquainted with a quality tool from the AHRQ website: Childhood Acute Lymphoblastic Leukemia Treatment: Physician Data Query (CALL-PDQ) (found online at http://innovations.ahrq.gov/node/5536). The PDQ was created in July 2007, and it was funded and designed by the National Cancer Institute (AHRQ, 2008). I have found it to be very useful in my advanced study and practice of Pediatric Nursing at Yale because my nursing program is accelerated, leaving me with a feeling of doubt about my clinical preparation for more rare diagnoses, such as pediatric leukemia. For example, I diagnose numerous ear infections in a given semester of clinical practice, while I have never seen a pediatric patient with cancer; thus, the PDQ is a tremendous safety net for clinical practice because it supplies providers with comprehensive, peer-reviewed, evidenced-based information, and it does so online, in an incredibly accessible manner.

A tool with comprehensive information is important for treating every patient, but it is particularly important in Pediatrics. MDs and PNPs know that children often have atypical presentations of a diagnosis when their guardian brings them to seek care, so at every visit, we consider child development, mental health, diet, sleep, elimination, and growth when taking a health history and when creating a plan at the end of the visit. Therefore, when a child finally gets diagnosed with cancer, it will have an impact on most of those factors, and a variety of professionals will enter the child’s life. The comprehensive PDQ acts as the bridge between numerous professionals, including myself as the PNP, plus “pediatric surgical subspecialists, radiation oncologists, pediatric medical oncologists/hematologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others to ensure that children receive treatment, supportive care, and rehabilitation that will achieve optimal survival and quality of life” (NCI, 2011). The PDQ sets the standard of care, the best practice, so that each key player understands his/her role and the evidence behind the decisions that are made for the cancer diagnosis. The PDQ allows professionals to work with the families effectively and efficiently.

The PDQ takes some, if not most, of the “guess work” out of treating children with ALL. As a new practitioner, this makes me feel secure that I know the treatment plan as well as reasonable expectations for outcomes when I work with the family, inside the office, and over the phone. In the future, I will often be “on call” for my practice- taking calls at anytime, day or night- and having easily accessible resources will be critical. Whether I am counseling the family of a child with ALL at 3am from my bed or 1pm in a 10 minute appointment, I cannot afford to waste time or compromise the child’s well being. The PDQ is helpful with a newly diagnosed patient and can be referred to as many times as necessary afterward as an independent practitioner in any location in the country where there is a computer with internet access. If I need to know about palliative care recommendations, for example, then I just click on the “Supportive and Palliative Care” link, and I am oriented and ready to confer with other professionals (NCI, 2011).

Overall, I find the PDQ to be enormously helpful for providing high quality information on childhood ALL for a diverse group of professionals, and it is in one central, accessible location. I have already recommended the PDQ to my colleagues for their future reference. If I was going to change anything at all, I would expand it to be a global pediatric cancer PDQ because it is so helpful. I understand that ALL was chosen initially because it is the most common cancer diagnosis in children and has had an increasing survival rate over time, but I think that oncologists and other providers would benefit from the PDQ being broadened to cover other cancer information (NCI, 2011). Please join me in supporting the expansion of evidenced-based health care with tools like PDQ. They are fundamental to optimal practice, particularly when the diagnosis is rare and many players affect the outcome and quality of life of the patient.


References

“Childhood Acute Lymphoblastic Leukemia Treatment: Physician Data Query (PDQ).” 2011. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/childALL/healthprofessional

“Quality Tool: Childhood Acute Lymphoblastic Leukemia Treatment: Physician Data Query (PDQ), Health Professional Version.” 2008. AHRQ Health Care Innovations Exchange. http://innovations.ahrq.gov/node/5536

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