Enhancing the Use of 5-Aminolevulinic Acid in Fluorescence-guided Surgery for High-grade Glioma: An Expert Nurse Practitioner Opinion-based Approach.

Purpose: This report details the recommendations of a Nursing Best Practice Working Group, which aims to advance best practice in the use of 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) in patients with high-grade glioma (HGG).

Design: Quality Improvement Project.

Methods: These recommendations were gathered during a meeting of a Nursing Best Practice Working Group comprising expert nurses and practice administrators from five US centers of excellence in the management of HGG. Ahead of the meeting, a survey was taken to evaluate the views of each expert and surgical teams, patients and institutions on current benefits, challenges and practices associated with the use of 5-ALA FGS in HGG. The Nursing Best Practice Working Group then met to share their experiences, explore where consensus exists, and identify opportunities for enhanced patient management.

Findings: The advisors made recommendations to support improvements across a range of areas associated with multidisciplinary team delivery of 5-ALA FGS. These included specific issues surrounding the administration of 5-ALA, photosensitivity and low-light precautions, and key aspects relating to protocol development, content features, format and accessibility, and updates and education of both the multidisciplinary team and patients. Guidance was also gathered on a flowchart to support the practical delivery of patient care and detail roles, responsibilities, and timings.

Conclusions: This guidance provides direction for the development of practical, evidence-based protocols and educational approaches for multidisciplinary teams and patients. Such approaches can improve best practice in 5-ALA FGS in all institutes, irrespective of size, and when developed collaboratively provide the means to share best practice across institutes and reach consensus on patient care.