No votes yet
Journal Club
Open Access Article

Oncology Nurses' Use of National Comprehensive Cancer Network Clinical Practice Guidelines for Chemotherapy-Induced and Febrile Neutropenia

Anita Nirenberg
Nancy K. Reame
Kenrick D. Cato
Elaine L. Larson
ONF 2010, 37(6), 765-773 DOI: 10.1188/10.ONF.765-773

Purpose/Objectives: To describe oncology nurses' use of National Comprehensive Cancer Network (NCCN) clinical practice guidelines for chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN).

Design: Cross-sectional survey design; descriptive, correlational analysis.

Setting: E-mail invitation to Web-based survey.

Sample: Random sample of 309 Oncology Nursing Society (ONS) members with e-mail addresses who provide care to adult patients receiving chemotherapy.

Methods: The investigator-developed Neutropenia Oncology Nurses Survey™ was used. Descriptive tests compared respondents' personal and professional characteristics to those of general ONS members; nonparametric chi-square and Kruskal-Wallis tests were used to correlate respondents' survey subscale scores with demographic data. Significant associations were entered into multiple logistic regression models.

Main Research Variables: The Neutropenia Oncology Nurses Survey's subscales measured subjective norm, attitude, perceived competence and confidence, perceived barriers, and use of NCCN clinical practice guidelines for CIN and FN.

Findings: Response rate of nurses who opened the survey was 50%. Most practiced in community versus academic centers. Eighty percent reported using the NCCN clinical practice guidelines for CIN and FN. Respondents were more likely to use clinical practice guidelines when they were expected to by physician and nurse colleagues, they perceived fewer barriers, or they held advanced oncology certification.

Conclusions: This study was the first to assess oncology nurses' reported use of NCCN clinical practice guidelines for CIN and FN. It also demonstrated the feasibility of partnering with ONS for Web-based survey research.

Implications for Nursing: The findings give insight into work-place barriers to evidence-based practice in various settings. Expanding dissemination and implementation of clinical practice guideline recommendations will support the development of oncology nursing standards for risk assessment, management, and patient and family education in CIN and FN.


Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. <i>Journal of Applied Social Psychology, 32</i>, 665-683. dx.doi.org/10.1111/j.1559-1816.2002.tb00236.x

Ajzen, I., & Fishbein, M. (1980). <i>Understanding attitudes and predicting social behavior.</i> Englewood Cliffs, NJ: Prentice-Hall.

Cabana, M. D., Rand, C. S., Becher, O. J., & Rubin, H. R. (2001). Reasons for pediatrician nonadherence to asthma guidelines. <i>Archives of Pediatric Adolescent Medicine, 155</i>, 1057-1062.

Crawford, J., Dale, D. C., Kuderer, N. M., Culakova, E., Poniewerski, M. S., Wolff, D., & Lyman, G. H. (2008). Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: The results of a prospective nationwide study of oncology practice. <i>Journal of the National Comprehensive Cancer Network, 6</i>, 109-118.

Crawford, J., Dale, D. C., & Lyman, G. H. (2004). Chemotherapy-induced neutropenia: Risks, consequences, and new directions for its management. <i>Cancer, 100</i>, 228-237. dx.doi.org/10.1002/cncr.11882

Dillman, D. A. (2007). <i>Mail and Internet surveys: The tailored design method</i> (2nd ed.). Hoboken, NJ: Wiley.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. <i>Lancet, 362</i>, 1225-1230. dx.doi.org/10.1016/S0140-6736(03)14546-1

Hughes, W. T., Armstrong, D., Bodey, G. P., Bow, E. J., Brown, A. E., Calandra, T., … Young, L. S. (2002). Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. <i>Clinical Infectious Diseases, 34</i>, 730-751. dx.doi.org/10.1086/339215

Klastersky, J., Paesmans, M., Rubenstein, E. B., Boyer, M., Elting, L., Feld, R., … Talcott, J. (2000). The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. <i>Journal of Clinical Oncology, 18</i>, 3038-3051.

Lyman, G. H., Kuderer, N. M., Crawford, J., Wolff, D. A., Culakova, E., Poniewierski, M. S., & Dale, D. C. (2006). Prospective validation of a risk model for first cycle neutropenic complications in patients receiving cancer chemotherapy. <i>Journal of Clinical Oncology, 24</i>(18, Suppl.), 8561.

National Cancer Institute. (2006). <i>Director's update. NCI Cancer Bulletin, 3</i>(42), 1.

National Comprehensive Cancer Network. (2009). <i>NCCN Clinical Practice Guidelines in Oncology™: Fever and neutropenia</i> [v.1.2009]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/PDF/fever.pdf'>http://ww...

Nirenberg, A., Bush, A. P., Davis, A., Friese, C. R., Gillespie, T. W., & Rice, R. D. (2006a). Neutropenia: State of the knowledge. Part I. <i>Oncology Nursing Forum, 33</i>, 1193-1201. dx.doi.org/10.1188/06.ONF.1193-1201

Nirenberg, A., Bush, A. P., Davis, A., Friese, C. R., Gillespie, T. W., & Rice, R. D. (2006b). Neutropenia: State of the knowledge. Part II. <i>Oncology Nursing Forum, 33</i>, 1202-1208. dx.doi.org/10.1188/06.ONF.1202-1208

Ozer, H., Armitage, J. O., Bennett, C. L., Crawford, J., Demetri, G. D., Pizzo, P. A., … American Society of Clinical Oncology. (2000). 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: Evidence-based clinical practice guidelines. <i>Journal of Clinical Oncology, 18</i>, 3558-3585.

Quiros, D., Lin., S., & Larson, E. L. (2007). Attitudes toward practice guidelines among intensive care personnel: A cross-sectional anonymous survey. <i>Heart and Lung, 36</i>, 287-297. dx.doi.org/10.1016/j.hrtlng.2006.08.005

Smith, T. J., Khatcheressian, J., Lyman, G. H., Ozer, H., Armitage, J. O., Balducci, L., … Wolff, A. C. (2006). 2006 update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline. <i>Journal of Clinical Oncology, 24</i>, 3187-3205. dx.doi.org/10.1200/JCO.2006.06.4451

Talcott, J. A., Siegel, R. D., Finberg, R., & Goldman, L. (1992). Risk assessment in cancer patients with fever and neutropenia: A prospective two-center validation of a prediction rule. <i>Journal of Clinical Oncology, 10</i>, 316-322.