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- Title
CLINICAL PATHWAYS IN BREAST CANCER TEACH EVIDENCE BASED PRACTICE AND MONITOR NURSING SENSITIVE PATIENT OUTCOMES.
- Authors
Bryce, Jane; Bell, Carol; Connola, Marianna
- Abstract
Oncology nurses are challenged to develop programs that promote the planning and delivery of evidence based (EB) care and the evaluation of treatment outcomes. Clinical pathways are tools for planning, documenting and evaluating patient care. The purpose of this project was to implement EB symptom management of breast cancer patients using clinical pathways (CP) with a specific focus on EB interventions and nursing sensitive patient outcomes (NSPO) measurement. A multidisciplinary team at NCI Naples developed CPs for patients undergoing breast cancer surgery, radiation therapy, adjuvant therapy and long-term follow-up. Nursing identified 4 initial priority areas for providing EB symptom management: fatigue, lymphedema, oral mucositis, cognitive dysfunction. Fatigue assessment and interventions were based on the NCCN fatigue guidelines and allow for individualized nursing interventions, facilitated during patient visits with the use of the ONS PEP fatigue card. Lymphedema prevention guidelines were based on physiologic rationale and standardized measurement criteria were integrated with patient education materials. Early diagnosis and prompt referral for lymphedema treatment are key outcomes measures. Oral mucositis guidelines were based on existing systematic reviews and included standard grading and oral care instructions. Cognitive dysfunction is screened using subjective patient reports and thresholds that prompt further investigations based on clinician findings and the mini mental status exam. This process was used as a model for teaching EB practice (and some of its inherent difficulties) to nurses. Some lessons learned: Fatigue interventions must be both EB and individualized for this complex and multifactorial symptom. Lymphedema: rational prevention guidelines may be used in the absence of experimental evidence, simple measurement criteria are important for prospective evaluation. Mucositis: Systematic reviews are helpful in teaching about levels of evidence and little experimental evidence was applicable to our setting. Cognitive dysfunction: In depth testing is impractical in the nonresearch setting but increased clinician awareness permits simplified screening and referral. The clinical pathway model provides a method for planning evidence based care with clear measurement and outcome criteria. The model facilitates teaching nurses the process of evaluation of evidence with its application in clinical practice, links interventions with NSPO when applicable, and permits ongoing review.
- Subjects
BREAST cancer; ONCOLOGY nursing; EVIDENCE-based nursing; HEALTH outcome assessment; NURSING
- Publication
Oncology Nursing Forum, 2007, Vol 34, Issue 2, p532
- ISSN
0190-535X
- Publication type
Article