Causes and Consequences of Chemotherapy Delays in Ambulatory Oncology Practices: A Multisite Qualitative Study

Megan Lafferty, PhD; Alex Fauer, PhD, RN, OCN®; Nathan Wright, MA; Milisa Manojlovich, PhD, RN, FAAN; Christopher R. Friese, PhD, RN, AOCN®, FAAN


Purpose: In oncology, chemotherapy treatment delays potentially jeopardize patient safety and impede progress toward disease remission. The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care.

Participants & Setting: The current authors selected a purposive sample of eight ambulatory oncology practices for ethnographic site visits, which lasted five days each.

Methodologic Approach: The authors conducted 290 observation hours, including clinician shadowing, and 46 semistructured interviews with clinicians (oncology nurses, physicians, and advanced practice providers). Deductive and inductive thematic analysis was performed on all data.

Findings: The authors identified four primary themes from the analysis that affect delays: discrepancies in care plans and missing orders, uncommunicated day-of-treatment order changes, orders not signed in advance by physicians, and laboratory testing processes.

Implications for Nursing: Future investigations should examine nurses’ communication practices in the context of timely chemotherapy administration because communication and documentation technologies within healthcare settings continuously evolve.

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