Kelly F, Carroll S L, Carley M, Dent S, Shorr R, Hu J, Morash R, Stacey D
1School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada.
2Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada.
Cardiooncology. 2017 Dec 28;3:7. doi: 10.1186/s40959-017-0026-6. eCollection 2017.
Patients with cancer treatment-related cardiotoxicity, which may manifest as heart failure (HF), can present with dyspnea. Nurses frequently assess, triage and offer self-care strategies to patients experiencing dyspnea in both the cardiology and oncology settings. However, there are no known tools available for nurses to manage patients in the setting of cancer treatment-related cardiotoxicity. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity.
The CAN-IMPLEMENT© methodology guided this descriptive study. A systematic search was conducted in four databases to identify cardio-oncology and HF guidelines and systematic reviews. Screening was conducted by two reviewers, with data extracted into a recommendation matrix from eligible guidelines and systematic reviews on: assessment criteria, medications, and/or self-care strategies to manage dyspnea. Healthcare professionals with an expertise in oncology and/or cardiology were recruited using purposeful and snowball sampling. Evaluation of acceptability of the adapted SPG was gathered through semi-structured interviews and a survey with open- and closed-ended questions. Quantitative findings and participant feedback from the interviews and the open-ended survey questions were analyzed descriptively.
Of 490 citations, seven HF guidelines were identified. Evidence from these guidelines was added to the original SPG. Eleven healthcare professionals completed the interview and acceptability survey. The adapted SPG was iteratively revised three times during the interviews. The original SPG was adaptable, and participants indicated the adapted SPG was comprehensive, easy to follow, and would be useful in clinical practice.
This study highlights the lack of knowledge tools and available clinical practice guidelines to guide healthcare professionals to assess, triage and/or offer self-care strategies to patients with cancer treatment-related cardiotoxic dyspnea. Moreover, most nurses require assistance to differentiate among the various causes of dyspnea from oncology treatment in order to triage severity appropriately. Further research should focus on evaluating the validity of the adapted SPG in clinical practice.
癌症治疗相关心脏毒性患者可能会出现心力衰竭（HF），表现为呼吸困难。在心脏病学和肿瘤学环境中，护士经常对出现呼吸困难的患者进行评估、分诊并提供自我护理策略。然而，目前尚无已知工具可供护士用于管理癌症治疗相关心脏毒性患者。本研究的目的是调整并评估一份基于证据的症状实践指南（SPG）对护士通过电话评估、分诊和管理因癌症治疗相关心脏毒性而出现呼吸困难患者的可接受性。
CAN-IMPLEMENT©方法指导了这项描述性研究。在四个数据库中进行系统检索，以识别心脏肿瘤学和心力衰竭指南及系统评价。由两名评审员进行筛选，将符合条件的指南和系统评价中的数据提取到推荐矩阵中，内容包括：评估标准、药物和/或管理呼吸困难的自我护理策略。采用目的抽样和滚雪球抽样方法招募肿瘤学和/或心脏病学专业的医疗保健专业人员。通过半结构化访谈以及开放式和封闭式问题的调查收集对调整后的SPG可接受性的评估。对访谈和开放式调查问题的定量结果及参与者反馈进行描述性分析。
在490条引用文献中，识别出7份心力衰竭指南。这些指南中的证据被添加到原始SPG中。11名医疗保健专业人员完成了访谈和可接受性调查。在访谈过程中，调整后的SPG经过了三次迭代修订。原始SPG具有可适应性，参与者表示调整后的SPG内容全面、易于遵循，并且在临床实践中会很有用。
本研究凸显了缺乏知识工具和可用的临床实践指南来指导医疗保健专业人员对癌症治疗相关心脏毒性呼吸困难患者进行评估、分诊和/或提供自我护理策略。此外，大多数护士需要协助以区分肿瘤治疗导致呼吸困难的各种原因，以便适当地进行严重程度分诊。进一步的研究应侧重于评估调整后的SPG在临床实践中的有效性。
