A Quality Improvement Initiative to Mitigate Immunotherapy-Related Toxicities among Patients Receiving Immunotherapy using a Novel Grade 2 T

Immune checkpoint inhibitors have significantly improved outcomes in triple-negative breast cancer, but immune-related toxicities (IRT) remain a major concern. This study aimed to develop and evaluate a grade 2 immunotherapy toxicity screening tool designed to identify and prevent progression of IRTs before they result in hospitalization or irreversible organ damage. The tool was created using patient and healthcare provider handouts adapted from the Cancer Care Ontario Immune Checkpoint Inhibitor Toxicity Management Clinical Practice Guideline. A Plan-Do-Study-Act (PDSA) cycle was employed to test, refine, and implement the tool, with iterative changes based on feedback from healthcare providers and patients. Healthcare providers were engaged through team presentations, and the Patient and Family Advisory Committee was consulted for feedback. Handouts were distributed to patients and healthcare providers, and displayed in chemotherapy suites and clinics. The intervention's effectiveness was assessed through surveys distributed to both groups six months after implementation to gather perceptions and identify barriers to use. There were 71 survey participants in total, 43 healthcare providers and 28 patients. Results revealed that both patients and healthcare providers found the tool easy to follow and would recommend its continued use. However, some patients reported that they did not receive the tool during its rollout. Despite this, the tool was considered helpful by both groups in managing IRTs. Ongoing assessment is necessary to evaluate whether the tool effectively reduces the progression of IRTs leading to hospitalization and organ damage, and further refinements may be needed based on continuous feedback from stakeholders.