P03S08: Chemotherapy-related nausea
Bottom line: Information on an anti-emetic drug was used to justify the
management of the patient and to persuade them to make a change (new
medication). This contributed to increase patient knowledge and improve patient
functioning (follow-up).
Level 1 outcome (situational relevance): On November 20, 2008, P03 did a search at work, by themselves, and
during an encounter with a patient. P03 searched outside the examination room,
and went back with information (“we don’t
have the capacity to search” in the examination room – no computer). They
retrieved one information hit about nabilone. The reported search objectives
were: to address a clinical question and to share information with a patient or
caregiver. “He [the patient] was born in ’50, so he’d be 58. […] I had been
following him for several months. […] It was a patient on chemotherapy who was
having quite bad nausea, precipitous nausea with his chemotherapy so I was
looking for something else for him to be on as an antiemetic and wanted to look
into this. […] The clinical question was: what side effects the drug [nabilone]
would have, if there’s any contraindication and what the adverse effects were,
because I wanted to explain them to the patient and to review the dosage, because
we don’t commonly use it [P03 searched a printable page ‘information for
patient’, but did not find it].” According to P03,
the information from e-Therapeutics+ (eCPS) was similar to the paper-based CPS.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice improvement, P03 stated: “Now I
have a better understanding of the drug [nabilone] for other
patients. […] I will be more familiar with the safety of this drug and any
precautions around it to use in other people.” P03 learned
the dosing and the prevalence of adverse effects. “There were some aspects I knew about the drug, but others were new.”
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab – Nabilone – Cesamet
monograph (P03S08H01).
Level 3 outcome
(information use): Information on nabilone was retrieved, and used to justify the
management of the patient and to persuade the patient to make changes
(information used as presented in e-Therapeutics+). “The other options, well most of them, he had tried them already. [...]
I looked up the contraindications, warnings and
things and the dosing [about nabilone], and got a prescription for the patient
for the drug. Came in and told him about the contraindications and the warnings
of it, and provided him with a prescription. […] [The information was used to
persuade the patient] because they were anxious about taking medications in
general. […] He is very information seeking, and very involved in his care, and
wanted to know the full toxicity profile before going ahead with any treatment.”
Level 4 outcome (patient health): Regarding patient
health, P03 reported that the information contributed to increase patient
knowledge, and improve patient functioning (probabilistic association between
the drug and the perceived outcome reported by the professional). “He [the patient] still
has nausea but it’s improved with the use of [nabilone]. […] Then he was able
to eat and drink more regularly and didn’t become so dehydrated. […] He is very
‘information seeking’ and involved in his care and wanted to know the full
toxicity profile before going ahead with any treatment.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information |
Practice improved Learned something Reminded something Confirmed Reassured |
Persuade Justify choice |
Improve Patient knowledge |