Construction Of An Evidence-based Nursing Practice Program For Breast Cancer-related Lymphedema

Objective:To formulate clinical questions and select outcomes related to evaluation and intervention of breast cancer-related lymphedema(BCRL),evaluate and synthesize the evidence of Chinese and Western medicine related to BCRL,form recommendations,and construct evidence-based nursing practice protocol for BCRL,so as to guide the clinical practice of evaluation and intervention of BCRL.Methods:Based on the WHO handbook for guideline development,this study mainly included four steps:formulating clinical questions,evaluating and synthesizing evidence,developing recommendations and forming protocol.The specific methods were as follows:?formulated clinical questions through literature review and clinical investigation,and evaluated the importance of clinical questions and outcomes;?systematically and comprehensively collected clinical practice guidelines and evidence summaries related to BCRL,the included clinical practice guidelines and evidence summaries were appraised by AGREE ? and Caseworksheet,extracted,translated and synthesized the recommendations from guidelines and evidence summaries,the recommendations retained their classification;?systematic reviewed of different traditional Chinese medicine nursing technique,determined the quality of primary studies by GRADE,referred to GRADE EtD framework to determine the recommendations;?synthesized recommendations from guidelines,evidence summaries and primary studies,formed an evidence-based practice protocol of BCRL finally.Results:?through literature review and clinical investigation,17 clinical questions and 7 outcomes were obtained;?through roundly and systematically searched,5 clinical practice guidelines and 14 evidence summaries were included.Quality of the included guidelines was assessed by AGREE?,two guidelines were grade A,three guidelines were grade B,and the standardized scores of six fields were 81.11%,63.33%,80.10%,85.83%,62.98%and 82.92%,respectively.The quality of evidence summaries was high.A total of 67 recommendations were extracted from the guidelines and evidence summaries,and 17 recommendations and 33 practical guides were obtained through synthesis.After expert review,1 recommendation and 4 practical guides were deleted,and some contents were revised,and finally 16 recommendations and 29 practical guides were obtained.?34 randomized controlled trials were included,but the overall quality was low,mainly due to insufficient reporting of such as randomization process,approaches to sequence generation and blinding.The systematic review showed that traditional Chinese medicine nursing techniques were effective and safe,but the quality of evidence was low or very low,formed recommendations by expert meetings,and the strength of recommendations was weak.?finally,an evidence-based nursing practice protocol of BCRL was formed,including 21 recommendations and 31 practical guides.Conclusion:Based on clinical questions and outcomes,the evidence-based nursing practice protocol of BCRL was formed through evidence collection,evaluation and synthesis.The protocol included 21 recommendations and 31 practical guides,which was highly operable and conducive to promoting the scientific and normative evaluation and intervention practice of BCRL.