| Background The incidence of breast cancer is the highest female cancer.However,the improvement of medical technology,economical level and patients' attention to their health makes the survival rate increase.Therefore,we should pay attention to the quality of life of breast cancer patients.Breast cancer-related lymphedema is the important and serious complication after surgery,which affects patients' quality of life seriously.At present,preventive behavior is a significant factor to prevent breast cancer-related lymphedema.Hence,our team constructed the draft of clinical practice guideline for preventive behavior of breast cancer-related lymphedema by setting up guideline developmental group,exploring the status of cognition of breast cancerrelated lymphedema among doctors,nurses and breast cancer patients,using evidence-based approach(Meta-analysis,systematical review and integrate the related guideline resource)to integrate evidence to form draft of clinical nursing practice guideline for preventive behavior of breast cancer-related lymphedema.In order to test and revise the draft guideline's feasibility,effectiveness and quality,we put it into clinic and invited reviewers to evaluate the guideline.In the end,we would finalize this guideline.Objective Based on the approach of forming clinical nursing practical guideline,we finalize the feasibility study of clinical practice guideline for preventive behavior of breast cancer-related lymphedema by conducting application study,pilot study and reviewing the guideline to provide the scientific and effective clinical guideline for medical staff and breast cancer patients.Moreover,constructing this guideline to reduce the incidence of lymphedema and improve the quality of life of breast cancer patients.Methods1.Application study: We used questionnaires to investigate the 20 doctors,20 nurses and 20 patients' s suggestions from ten tertiary hospitals in Anhui province to evaluate the 22 aspects with 44 recommendations.2.Pilot study: We conducted a pilot randomized control trial was used to evaluate the feasibility and effectiveness of this guideline.We recruited 80 breast cancer patients who were randomly assigned to intervention group(40)and control group(42).The patients in intervention group received healthy education including the draft guideline and usual healthy education.The patients in control group just received the usual healthy education.After 12 months,we evaluated the feasibility and effectiveness of this draft guideline in clinic,and understood the receptivity and compliance.At last,we revised and improved it to provide evidence for expert reviewing.3.Review and finalize the guideline.We invited 4 experts for written review,and 7experts and 2 breast cancer patients for external review to evaluate the draft guideline by using the Appraisal of Guidelines for Research & Evaluation II.Finally,the guideline developmental team held a meeting to discuss and finalize the guideline according to the results of application study,pilot study and guideline reviewing.Results1.Application study: After investigating the doctors and nurses in An Hui province,we recovered 37 questionnaires,we found that the doctors and nurses believed the most of the recommendations were good.However,they gave some suggestions to revise the some of the recommendation.For example,revising the “lymphedema hygienist” and making the recommendations more scientifically and scrupulously.Meanwhile,we found the breast cancer patients could evaluate the recommendations effectively and give suggestions.2.Pilot study: We recruited 82 breast cancer patients who underwent axillary lymph node dissection to conduct a pilot randomized control trial.The intervention group(40patients)received intervention program involving this guideline and routine health education.Meanwhile,the control group received the routine health education.12 months after intervention,the incidence of lymphedema,the risk of lymphedema in intervention group was lower than control group,the scores of lymphedema risk-reduction behavior and quality of life in intervetion group were higher than control group.The incidence of lymphedema,the risk of lymphedema and the lymphedema risk-reduction and quality of life between the two groups were different significantly(Ps<0.05).3.Review and finalize the guideline: The reviewers believed this guideline was good.three experts for written review recommended this guideline and one for written review agreed to recommend this guideline after revising.Besides,the 4 reviewers gave some suggestions to improve this guideline including using plain language,integrating the similar recommendations,changing the “lymphedema hygienist” to“lymphedema hygienist,doctors,and nurses,providing the updated methods of this gudeline,supplementing the methods of functional training.In the external review,six reviewers recommended this guideline and three reviews agreed to recommend this guideline after revising.invited seven experts and two breast cancer patients to review and evaluate this guideline.And they thought the quality of this guideline was high and most of them chose to recommend this guideline,or recommend it after revising.After that,the guideline developmental team hold a meeting to discuss and give resolution according to the results of application study,pilot study and guideline reviewing.Conclusion We finalized this clinical nursing practical guideline based on the evidenced approach and the steps of constructing clinical nursing practical guideline including a application study,a pilot study and guideline review.Finally,this guideline was feasible,adaptive and scientific,which could help clinical staff and breast cancer patients make the appropriated decisions. |
PDF Full Text Request