Clinical Translation Of The Management Program Of Patients With Breast Cancer-Related Lymphedema Based On JBI Model

BackgroundBreast cancer-related lymphedema(BCRL),as one of the common complications after breast cancer treatments,may brings multiple lymphedema-associated symptoms such as swelling,heaviness and pain,leading to a restriction of normal activities and an infection in affected limb.BCRL has an adverse impact on patients’ quality of life.It is necessary to provide patients with optimal management to alleviate lymphedema symptoms and prevent the progression of the lymphedema.However,at present,the BCRL management in China were suboptimal and many of them were not evidence-based.Therefore,it is urgent to improve the lymphedema management based on the best evidence.Objective1.To understand the current situation of BCRL management and patients’requirements for BCRL management.2.To summarize the best evidence for the management of patients with BCRL.3.To conduct the clinical translation of the best evidence for BCRL management to optimize the lymphedema management.Methods1.Qualitative research method was used in this study,medical staff and patients with BCRL from the Breast Surgery Department of a large tertiary hospital in Guangzhou were selected as the objects of the study.2.According to the methodology of Evidence-Based Nursing,systematic retrieval,screen and evaluation of literatures that were related to BCRL management,and summarize the best evidence for the management of patients with BCRL.3.The Joanna Briggs Institute’s Practical Application of Clinical Evidence System was employed,including baseline audit,getting research into practice and follow-up audit,to promote the clinical translation of the evidence of BCRL management.Results1.Qualitative research of medical staff showed that medical staff have relatively insufficient knowledge of BCRL.The content and form of health education need to be improved and current BCRL management lacks of evidence-based guidelines.While findings were obtained form patients’ interviews,the requirements of patients were:knowledge guidance need,the need for optimizing the disease treatment,psychological support need,need for the access to medical resources and the need for self-worth.2.Through literature search,a total of 27 articles were incorporated,including 4 clinical decisions,2 clinical practice recommendations,6 guidelines,1 evidence summary,4 expert consensuses and 10 systematic reviews.A total of 63 pieces of evidence including 4 dimensions were summarized,namely assessment,treatment/nursing,health education and follow-up.3.During baseline cycle,follow-up cycle 1 and follow-up cycle 2,the compliance of the four audit criteria were improved from 25%to 55%and 60%,50%to 90%and 90%,0%to 90%and 90%,75%to 100%and 95%,respectively.The average scores of the 10-item questionnaire which was used for assessing patients’exercise knowledge increased from 4.3 to 7.4 and 7.5.Before and after the evidence application,there was no significant difference in the total scores of Lym-ICF(P>0.05),whereas significant difference was found in the physical functions subscales and mental functions subscales(P<0.05).There was no significant difference in the both total scores and subscales scores of quality of life(P>0.05).Conclusions1.It is necessary for medical staff to construct evidence-based BCRL management program to optimize clinical nursing behaviors.Targeted interventions should be provided to patients with BCRL to improve the quality of nursing services.2.Through using evidence-based methods,the relevant evidence of BCRL management was summarized,which may be used to guide the clinical practice to manage BCRL better.3.Following the clinical translation of the evidence,significant improvements were achieved in the four audit criteria in the two cycle follow-up audit compared with those in the baseline audit.However,further studies with controlled barriers and evaluated sustainability of the audit criteria are needed to improve patient outcomes.