Development and Evaluation of Evidence-Informed Clinical Nursing Protocols for Remote Assessment, Triage and Support of Cancer Treatment-Induced Symptoms
The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT？ methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability ( ), just the right amount of information ( ), appropriate terms ( ), fit with clinical work flow ( ), and being self-evident for how to complete ( ). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms. 1. Introduction Adults undergoing cancer treatments often experience distress from treatment-related symptoms [1, 2]. Helping patients manage these symptoms can relieve some distress but more importantly better symptom management may lead to safer care for some symptoms that can progress to be life threatening [3]. Given that most chemotherapy and radiation therapy is provided through ambulatory programs, and patients experience treatment-related symptoms at home, telephone is the easiest way to access oncology health professionals [4, 5]. Thus, an important service for patients is telephone access to healthcare professionals for self-care guidance and triaging symptoms to the appropriate level of care. According to recent surveys, 88% of ambulatory oncology programs in Ontario reported that nurses respond to incoming calls from patients for symptom management and 54% of oncology nurses in Canada provide remote symptom support
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