The Development of Clinical Nursing Practice Guideline on Preventing and Reducing Mucositis in Breast Cancer Patients Receiving Chemotherapy
Abstract
Adjuvant chemotherapy is an effective treatment. However, patients receiving adjuvant chemotherapy is treatment for metastatic breast cancer. Patients on adjuvant chemotherapy may develop oral mucositis as a serious complication. The sequence of oral pain lowers the patients' appetite and results in reduced food intake. The development of the best practice for nursing role is to prevent and decrease oral mucositis.
The objective in this research is the prevention and decreasing of oral mucositis in breast cancer patients receiving chemotherapy by using the IOWA model as a conceptual framework. Analysis of 20 relevant studies were selected for developing the CNPG. It consisted of 2 meta-analysis, 2 randomized controlled trial studies, 1 quasi experimental study, 1 qualitative study, 13 expert's opinions and 1 textbook. The summary recommendations for development of CNPG cover 3 periods. They were pre-chemotherapy, during chemotherapy and post chemotherapy. The CNPG was validated by 5 experts by using criteria for Appraisal of Guideline for Research & Evaluation (AGREE). The appraisal result was 76% in the domain score, which indicated that the CNPG could help prevent and decrease mucositis in breast cancer patients receiving chemotherapy.
Therefore, the important recommendations in CNPG comprised 3 periods. First, evaluation of risk factors of cancer patients was made in the pre-chemotherapy phase, oral cryotherapy in the high risk group was made during the chemotherapy phase, advice concerning oral care was provided during the post-chemotherapy phase, and evaluation of outcomes were made in this follow-up time.
The recommendations for the development of breast cancer patient care are divided into 3 categories. The first category is making pilot studies in nursing practice using two model of work instructions for nurses and patients. The second category is regarding on work shop for new nurse and health care providers in Nakhon Pathom Hospital and health care services under the control of this hospital. The third category is to conduct further research to evaluate the effectiveness of the outcomes of using CNPG.
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