Lewis Lucy, Williams Anne M, Athifa Mariyam, Brown Deborah, Budgeon Charley A, Bremner Alexandra P
Author 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.
Cancer Nurs. 2015 May-Jun;38(3):E1-8. doi: 10.1097/NCC.0000000000000154.
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.
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.
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.
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.
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.
Providing patients with pathways to information as needed may be preferable to administering multiple EBGs.
尽管已制定了大量循证指南（EBG）来管理与癌症及化疗相关的症状负担，但探索其疗效的研究却很匮乏。
本研究旨在探讨在西澳大利亚一家急性三级护理公立医院实施循证指南对减轻接受门诊化疗的癌症患者症状负担和心理困扰的效果。
本研究分两个群体和阶段进行，采用行动研究促进变革。第1阶段评估患病率；在第2阶段，实施特定的循证指南。在基线、首次化疗后1周和1个月时确定症状患病率、严重程度和困扰程度，以便进行阶段间比较。
第2阶段的参与者在应对情绪低落（优势比，2.33；95%置信区间，1.47 - 3.70；P <.001）和呕吐（优势比，2.37；95%置信区间，1.13 - 4.97；P =.022）方面表现更好。在基线时，第2阶段呕吐（P =.040）、疼痛（P =.017）、感到疲倦（P =.038）、感到焦虑或担忧（P =.001）以及情绪低落（P =.024）的困扰程度更高。到1个月时，只有感到焦虑或担忧（P =.023）和情绪低落（P =.006）存在差异。在基线时，第2阶段疼痛（P =.025）和感到焦虑或担忧（P =.008）的严重程度更高。到1个月时，只有感到焦虑或担忧（P =.010）存在差异。
正如我们的研究结果所示，管理化疗不良反应的有效自我护理策略应以证据为基础，但需个体化；对某些人而言，专注于自身症状可能并不总是有益的。
根据需要为患者提供信息渠道可能比实施多个循证指南更可取。
