Evidence Based Practice Article Critique

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Introduction

The effectiveness of any treatment regime is determined on the accuracy and the sensitivity of measurements used in the evaluation of the various domains pertaining to the individual, as well as the risk factors. This is not always possible, especially considering that a large number of instruments or measures used are insensitive to the psychological, physical and cognitive functionality of an individual (Kleplin et al, 2011b). This is the case for the current ECOG index used in acute mylogenous leukemia. The study outlined would, essentially, be helpful in enhancing the treatment outcomes as it considers the risk factors, vulnerabilities, as well as the varied aspects of an individual including cognitive, physical and psychological functioning, all of which have a bearing on the treatment outcome.

Acute Myelogenous Leukemia mainly affects older adults, with research showing that it has a relatively worse survival with older age. It is unclear whether older adults get optimal therapy. While standard induction chemotherapy may be beneficial to some older adults, older adults in general have greater treatment-related toxicity, as well as lower overall survival compared to younger individuals. However, limited attention has been paid to host-specific features such as physical, emotional, cognitive functions that may have a bearing on the risk of toxicity in an individual, and for which use of age as the sole measure would be inadequate. This is the basis for the study by Klepin et al (2011). The study acknowledged that the insufficient capacity to identify individuals who have the capacity to tolerate, as well as potentially benefit from the standard curative induction chemotherapy is a hindrance to treatment decision-making in the case of older adults suffering from acute myelogenous leukemia. The translation of strategies pertaining to geriatric assessment (GA) in assessing older adults suffering from AML may be helpful in enhancing evaluation of reserve capacity, as well as informing decision-making pertaining to treatment. This is specifically for a geriatric assessment that includes the assessment of psychological state, cognitive function, comorbid disease and physical function, as it may identify individuals that stand a higher risk of AML Chemotherapy side effects.

The study had the sole aim of determining the viability of bedside geriatric assessment in older adults that have been hospitalized suffering from newly diagnosed AML. It also aimed at outlining how older adults that had newly diagnosed AML performed on varied GA evaluation domains, as well as determining whether the measures contributed information pertaining to evaluation of tumor biology (cytogenetic risk group classification) and functional status (ECOG score). The information obtained from the geriatric assessment may be helpful in optimizing decision making pertaining to treatment, as well as the clinical outcomes of older adults that have AML (Kleplin et al, 2011).

The study used individuals aged 60 years or more, who had newly diagnosed AML and who planned to undergo chemotherapy. The study nurse carried out bedside geriatric assessment at the inpatient ward once the patient was enrolled. The nurse would administer all survey measures in form of an interview, with physical performance measures being carried out in the patient’s room. Varied measures were used in the study including Distress Thermometer, modified Mini-Mental State Examination, Pepper Assessment Tool for Disability, and Center for Epidemiologic Studies Depression Scale, Short Physical Performance Battery, Hematopoietic Cell Transplantation Comorbidity Index, and grip strength (Kleplin et al, 2011).

The researchers detected numerous impairments in the participants including impairment in ADLs (48.2%), depression (38.9%), cognitive impairment (31.5%), impaired physical performance (53.7%) distress (53.7%), as well as comorbidity (46.3%). 92.6% had at least one impairment with 63% of the participants, having being functionally impaired in one or more domains.

The study confirmed the researchers’ assertions as to the fact that presently used ECOG performance status index are subjective and deficient of sensitivity, and fail to address specific tasks. A large number of older adults who have “good” performance scores also have significant impairments in their physical functioning that may lower their reserve capacity. The current ECOG PS is deficient of information pertaining to functional domains such as psychological health and cognition. This study, therefore, underlined the viability, as well as utility of carrying out a bedside GA in order to detect impairment in varied domains in older adults that are starting induction chemotherapy (Kleplin et al, 2011). Detecting these impairments can enhance treatment for older adults suffering from AML, through the identification of individuals who have the capacity to tolerate standard, aggressive therapies, as well as older adults at risk and to whom novel therapeutic agents would be beneficial (Kleplin et al, 2011b). It would also allow for the identification of modifiable risk factors that can affect one’s tolerance to treatment, and that can be amenable to intervention.

This article would undoubtedly be useful not only as a basis for further research but also in informing the nursing practice. It underlines the loopholes that exist within the current measurement indexes and clearly demonstrates how effective and viable a geriatric assessment would be in increasing detection of impairments. This information would be extremely crucial in informing treatment therapies, as well as enhancing the nursing outcomes. The main or intended audience for the article is the entire registered nurses family especially those that deal with cases pertaining to cancer and acute myelogenous leukemia. The improvement of their treatment outcomes necessitates the use of sensitive and accurate measurements in determining the vulnerability of an individual, which would then inform the treatment regime that would be appropriate for him or her (Kleplin et al, 2011b).

References

Klepin, HD., Geiger, A.M., Tooze, J.A., Kritchevsky, S.B., Williamson, J.D., Ellis, L.R., Levitan, D., Pardee, T.S., Isom, S & Powell, B.L (2011). The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia. Journal of American Geriatric Society, vol. 59, No. 10

Klepin HD, Danhauer SC, Tooze JA., Stott, K., Daley, K., Vishnevsky, T., Powell, B & Mihalko, S.L (2011). Exercise for older adult in-patients with acute myelogenous leukemia: A pilot study. Journal of Geriatric Oncology, vol. 2:11–17.