Cancer-related diarrhea: selected findings of a national survey of oncology nurse experiences.

PURPOSE/OBJECTIVES: To describe oncology nurse experiences with disease- and treatment-related diarrhea in patients with cancer, including assessment methods and pharmacologic/supportive care.

DESIGN

Descriptive.

SAMPLE/SETTING: 1,288 (26%) of 5,000 randomly selected Oncology Nursing Society members employed full-time in adult clinical settings in the United States.

METHODS

Mailed survey with scannable booklets.

MAIN RESEARCH VARIABLES

Nurse perceptions of disease and treatment-related issues associated with diarrhea in patients with cancer, along with currently used assessment criteria and nursing care.

FINDINGS

Nurses in this sample routinely encounter diarrhea in their patients with cancer. They commonly assess/document diarrhea by noting its presence or absence, with a minority of nurses using a rating tool. When indicated, most nurses prepare patients for probable diarrhea. This preparation includes both verbal and written instructions about diet, skin care, drug therapy, and treatment of severe diarrhea. Nurses report that primary drug therapy for diarrhea consists of over-the-counter agents. Supportive care consists of fluid/electrolyte replacement, skin care and diet modifications, and also bowel rest and parenteral nutrition for severe diarrhea. For these nurses, the most important factors influencing choice of management strategies are symptom relief and physician and patient preference.

CONCLUSIONS

Although the majority of nurses in this study report providing anticipatory guidance, patient education, and supportive diarrhea management, they are not assessing diarrhea systematically. They report common use of nonprescription medications, with pharmacologic interventions varying with severity of diarrhea.

IMPLICATIONS FOR NURSING PRACTICE

Targeted education is needed to help nurses implement systematic assessment and documentation. Efficacy of diarrhea-management strategies and protocols must be tested-specifically, optimal timing and types of skin care, dietary changes, and bowel rest.