Graduation Semester and Year
Summer 2025
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Deborah Behan
Abstract
Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.
Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and was reviewed and graded using the Johns Hopkins Hierarchy of Evidence Guide. Recommendations were derived from the graded literature when sent to stakeholders for rating using a Likert scale of 1 to 4 (1 is poor and 4 is excellent).
Results: Four recommendations were created in the categories of assessment, pharmaceutical management, patient education, and follow-up. A Friedman’s Two-Way ANOVA by Ranks was conducted by the statistician using SPSS. The statistical analysis revealed there were no statistically significant differences among stakeholders’ ratings of the recommendations (p = 0.494). The stakeholders responded consistently. The mean rating score ranged from 3.75 to 4.00.
Conclusion: The results concluded that the stakeholders rated all four recommendations for the guideline favorably. Implementation of the guidelines can be studied for enhancement and can be used as a model for implementation at other cancer facilities.
Keywords
Adrenal insufficiency, Immunotherapy, Patient education, Immune checkpoint inhibitors.
Disciplines
Nursing | Oncology
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Patel, Rachna R., "Guideline for the Management of Immunotherapy-Related Adrenal Insufficiency at a Cancer Center" (2025). Doctor of Nursing Practice (DNP) Scholarly Projects. 105.
https://mavmatrix.uta.edu/nursing_dnpprojects/105