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Evidence-Based Self-care Guidelines for People Receiving Chemotherapy: Do They Reduce Symptom Burden and
Lucy Lewis1, Anne M Williams, Mariyam Athifa
1Author Affiliations: School of Nursing and Midwifery, Curtin University, Perth (Dr Lewis); Centre for Nursing Research (Drs Lewis and Williams and Ms Athifa), Medical Oncology (Ms Brown), and Department of Research (Ms Budgeon), Sir Charles Gairdner Hospital, Nedlands; School of Nursing and Midwifery, Edith Cowan University, Joondalup (Dr Williams); Centre for Applied Statistics (Ms Budgeon) and School of Population Health (Dr Bremner), The University of Western Australia, Crawley.
Background:
Despite numerous evidence-based guidelines (EBGs) being developed to manage the symptom burden associated with cancer and chemotherapy, there is a paucity of research exploring their efficacy.
Objective:
The aim of this study was to explore the effect of implementing EBGs to reduce the symptom burden and psychological distress of cancer patients requiring outpatient chemotherapy at an acute, tertiary care public hospital in Western Australia.
Methods:
The study was conducted in 2 populations and stages, using action research to promote change. Stage 1 assessed prevalence; in stage 2, specific EBGs were implemented. Symptom prevalence, severity, and bother were determined at baseline and 1 week and 1 month after initial chemotherapy, to allow comparison between stages.
Results:
Stage 2 participants did better at managing feeling low (odds ratio, 2.33; 95% confidence interval, 1.47-3.70; P < .001) and vomiting (odds ratio, 2.37; 95% confidence interval, 1.13-4.97; P = .022). Bother was greater in stage 2 at baseline for vomiting (P = .040), pain (P = .017), feeling tired (P = .038), feeling anxious or worried (P = .001), and feeling low (P = .024). By 1 month, only feeling anxious or worried (P = .023) and feeling low (P = .006) differed. Severity was greater in stage 2 at baseline for pain (P = .025) and feeling anxious or worried (P = .008). By 1 month, only feeling anxious or worried (P = .010) differed.
Conclusion:
Effective self-care strategies to manage the adverse effects of chemotherapy should be evidence based but individualized, as our findings suggest; for some, focusing on their symptoms may not always be beneficial.
Implications For Practice:
Providing patients with pathways to information as needed may be preferable to administering multiple EBGs.
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