ID #586 A Nursing-Led Quality Improvement Initiative to Increase Neuropsychological Testing Completion in Pediatric Patients Diagnosed with CNS Tumors

Background

Children and adolescents with central nervous system (CNS) tumors are at high risk for neurocognitive and functional impairments that negatively affect academic performance and quality of life. Neuropsychological testing is a critical component of survivorship care; however, completion rates remain suboptimal, with only 40–60% of eligible pediatric oncology patients completing recommended assessments[1]. Prior studies have identified parental understanding of the purpose and long-term value of testing, inconsistent provider messaging, and lack of standardized referral workflows as key barriers. As frontline educators and care coordinators, nurses are uniquely positioned to address these gaps.

Methods

A two-phase quality improvement (QI) initiative was conducted at a pediatric oncology center. Phase 1 consisted of a retrospective chart review of patients aged 4-25 years who completed treatment for any CNS tumor and had a neuropsychological testing referral placed between 2023 and 2025. Outcomes included completion of testing within 12 months, time from referral to completion, and documented scheduling barriers with particular attention to parental perceptions of testing necessity. Phase 2 (planned) will implement a nursing-led parental education intervention incorporating standardized educational materials, in-clinic counseling, referral workflow modifications, and real-time tracking.

Results

Of 178 eligible patients, 47% completed neuropsychological testing within 12 months, consistent with published benchmarks. The mean time from referral to test completion was 7 months. Among patients who did not complete testing, 64% did not return scheduling calls and 29% declined testing, most commonly citing lack of perceived necessity. Phase 2 outcomes will be reported at the time of the meeting.

Conclusion

Neuropsychological testing remains underutilized among survivors of pediatric CNS tumors, highlighting a critical gap in post-treatment care. Phase 1 findings identified modifiable, education-related barriers well suited to nursing-led intervention. Integrating structured nurse-driven education and consistent follow-up into routine practice may improve testing completion and long-term survivorship outcomes.

1. Oswald, K., Bitensky, D., Stuchell, E. et al. Neuropsychological assessment in pediatric oncology survivorship care: utilization of services, results of evaluation, and educational and behavioral health outcomes. Support Care Cancer 29, 7965–7974 (2021). https://doi.org/10.1007/s00520-021-06401-8