PuttingEvidEncE

intoPracticE

Edited byLinda H. Eaton, MN, RN, AOCN®

Janelle M. Tipton, MSN, RN, AOCN®

Oncology Nursing SocietyPittsburgh, Pennsylvania

ImprovIng oncology patIent outcomes

ONS Publishing DivisionPublisher: Leonard Mafrica, MBA, CAE

Director, Commercial Publishing: Barbara Sigler, RN, MNEdManaging Editor: Lisa M. George, BA

Staff Editor: Amy Nicoletti, BACopy Editors: Sharon Padezanin, BA, Laura Pinchot, BA

Graphic Designer: Dany Sjoen

Putting Evidence Into Practice: Improving Oncology Patient Outcomes

Copyright © 2009 by the Oncology Nursing Society. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by an information storage and retrieval system, without written permission from the copyright owner. For information, write to the Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275-1214, or visit www .ons.org/publications.

Library of Congress Control Number: 2009926935ISBN: 978-1-890504-84-7

Publisher’s NoteThis book is published by the Oncology Nursing Society (ONS). ONS neither represents nor

guarantees that the practices described herein will, if followed, ensure safe and effective patient care. The recommendations contained in this book reflect ONS’s judgment regarding the state of general knowledge and practice in the field as of the date of publication. The recommendations may not be appropriate for use in all circumstances. Those who use this book should make their own determinations regarding specific safe and appropriate patient-care practices, taking into account the personnel, equipment, and practices available at the hospital or other facility at which they are located. The editors and publisher cannot be held responsible for any liability incurred as a conse-quence from the use or application of any of the contents of this book. Figures and tables are used as examples only. They are not meant to be all-inclusive, nor do they represent endorsement of any particular institution by ONS. Mention of specific products and opinions related to those products do not indicate or imply endorsement by ONS. Web sites mentioned are provided for information only; the hosts are responsible for their own content and availability. Unless otherwise indicated, dollar amounts reflect U.S. dollars.

ONS publications are originally published in English. Publishers wishing to translate ONS publi-cations must contact the ONS Publishing Division about licensing arrangements. ONS publications cannot be translated without obtaining written permission from ONS. (Individual tables and figures that are reprinted or adapted require additional permission from the original source.) Because trans-lations from English may not always be accurate or precise, ONS disclaims any responsibility for inaccuracies in words or meaning that may occur as a result of the translation. Readers relying on precise information should check the original English version.

Oncology Nursing SocietyIntegrity • Innovation • Stewardship • Advocacy • Excellence • Inclusiveness

Printed in the United States of America

i i i

Contributors

EditorsLinda H. Eaton, MN, RN, AOCN®

Research AssociateOncology Nursing SocietyPittsburgh, PennsylvaniaAuthor (Chapters 2, 4, 5, 8, 10, 11, 12, 14,

18, 19)

Janelle M. Tipton, MSN, RN, AOCN®

Oncology Clinical Nurse SpecialistUniversity of Toledo Medical CenterToledo, OhioAuthor (Chapters 1, 2, 3, 6, 7, 9, 13, 15, 16,

17, 19)Chemotherapy-Induced Nausea and Vomit-

ing PEP Resource

AuthorsLinda I. Abbott, RN, MSN, AOCN®, CWONAdvanced Practice NurseHolden Comprehensive Cancer CenterUniversity of Iowa Hospitals & ClinicsIowa City, IowaPeripheral Neuropathy PEP Resource

Lynn A. Adams, RN, MS, ANP, AOCN®

Nurse PractitionerMemorial Sloan-Kettering Regional NetworkCommack, New YorkAnorexia PEP Resource

Lisa B. Aiello-Laws, RN, MSN, APNG, AOCNS®

Knowledge Base ManagerITA PartnersPhiladelphia, PennsylvaniaPain PEP Resource

Suzanne W. Ameringer, PhD, RNAssistant Professor, School of NursingVirginia Commonwealth UniversityRichmond, VirginiaPain PEP Resource

Felicia Andrews, BSNNurse ManagerNational Institutes of HealthBethesda, MarylandPrevention of Infection PEP Resource

Jane M. Armer, RN, PhD, FAANProfessor, Sinclair School of NursingUniversity of Missouri, ColumbiaDirector of Nursing ResearchEllis Fischel Cancer CenterColumbia, MissouriLymphedema PEP Resource; Mucositis PEP

Resource

puttIng evIdence Into practIceiv

Julie A. Aschenbrenner, RN, BSN, OCN®

Assistant Nurse ManagerAdult Leukemia/Bone Marrow TransplantUniversity of Iowa Hospitals & ClinicsIowa City, IowaPeripheral Neuropathy PEP Resource

Terry A. Badger, PhD, PMHCNS-BC, FAANProfessor and Division DirectorUniversity of Arizona, College of NursingTucson, ArizonaAnxiety PEP Resource; Depression PEP

Resource

Kristen Baileys, RN, MSN, CRNP, AOCNP®

Project ManagerONS Education TeamOncology Nursing SocietyPittsburgh, PennsylvaniaDiarrhea PEP Resource; Peripheral Neuropa-

thy PEP Resource

Marie A. Bakitas, DNSc, ARNP, AOCN®, FAANAssistant ProfessorClinical ResearcherAdult Nurse Practitioner, Palliative Care Sec-

tion of Palliative MedicineDartmouth-Hitchcock Medical CenterLebanon, New HampshirePain PEP Resource

Laurel A. Barbour, RN, MSN, APN, AOCN®

Biotherapy Care ManagerAdvocate Lutheran General HospitalPark Ridge, Illinois Chemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Susan L. Beck, APRN, PhD, AOCN®, FAANProfessor and Carter Endowed Chair in

NursingUniversity of Utah, College of NursingSalt Lake City, UtahFatigue PEP Resource

Heather Belansky, RN, MSNProject ManagerONS Education TeamOncology Nursing SocietyPittsburgh, PennsylvaniaAnorexia PEP Resource; Caregiver Strain

and Burden PEP Resource; Depression PEP Resource; Diarrhea PEP Resource; Dyspnea PEP Resource; Lymphedema PEP Resource; Peripheral Neuropathy PEP Resource; Prevention of Bleeding PEP Resource; Prevention of Infection PEP Resource

Ann M. Berger, PhD, RN, AOCN®, FAANProfessor and Dorothy Hodges Olson

Endowed Chair in Nursing, Advanced Practice Nurse

Director, PhD Program, College of NursingUniversity of Nebraska Medical Center, Col-

lege of NursingOmaha, NebraskaSleep-Wake Disturbances PEP Resource

Annette Kay Bisanz, RN, BSN, MPHClinical Nurse SpecialistUniversity of Texas M.D. Anderson Cancer

CenterHouston, TexasConstipation PEP Resource

Jeannine M. Brant, PhD, APRN, AOCN®

Clinical Nurse Specialist and Nurse ScientistBillings ClinicBillings, MontanaPrevention of Bleeding PEP Resource

Ruth Ann Brintnall, RN, PhD, AOCN®, APRN-BC

Associate ProfessorGrand Valley State UniversityKirkhof College of NursingGrand Rapids, MichiganCaregiver Strain and Burden PEP Resource

Annette Parry Bush, RN, BSN, MBA, OCN®

Certification Programs ManagerOncology Nursing Certification CorporationPittsburgh, PennsylvaniaPrevention of Bleeding PEP Resource

Contributors v

Rose Ann Caruso, RN, OCN®

Staff Registered NurseMemorial Sloan-Kettering Cancer CenterCommack, New YorkAnorexia PEP Resource

Barbara J. Cashavelly, MSN, RN, AOCN®

Nurse Director of Clinical PracticesMassachusetts General Hospital Cancer

CenterBoston, MassachusettsMucositis PEP Resource

Deirdre B. Colao, RN, BSN, OCN®

Manager of Clinical OperationsArizona Pulmonary Specialists Ltd.Phoenix, ArizonaCaregiver Strain and Burden PEP Resource

Mary L. Collins, RN, MSN, OCN®

Clinical EducatorCarle Clinic Cancer CenterUrbana, IllinoisPeripheral Neuropathy PEP Resource

Regina S. Cunningham, PhD, RN, AOCN®

Senior Director, OncologyThe Tisch Cancer InstituteMount Sinai Medical CenterNew York, New YorkAnorexia PEP Resource

Ann E. Culkin, RN, OCN®

Clinical NurseMemorial Sloan-Kettering Cancer CenterNew York, New YorkDyspnea PEP Resource

Barbara I. Damron, PhD, RNDirector of Oncology Nursing Research and

Government and Community AdvocacyUniversity of New Mexico Cancer CenterAlbuquerque, New MexicoPrevention of Bleeding PEP Resource

Arlene B. Davis, RN, MSN, AOCN®

Oncology Clinical SpecialistGainesville VA Medical CenterGainesville, FloridaDiarrhea PEP Resource

Nancy A. Delzer, MSN, MBA, AOCN®, BC-PCMDirector, Cancer Clinical ServicesColumbia St. Mary’sMilwaukee, WisconsinPain PEP Resource

Wendye M. DiSalvo, MSN, ARNP, AOCN®

Advanced Registered Nurse PractitionerDartmouth-Hitchcock Medical CenterLebanon, New HampshireDyspnea PEP Resource

Amy H. Dolce, RN, APN, MS, AOCN®, CHPNOncology Clinical Nurse SpecialistNorthwest Community HospitalArlington Heights, IllinoisAnxiety PEP Resource

Rachael Christine Drabot, MPH, CNSD, RDClinical Research DietitianNational Institutes of HealthBethesda, MarylandDiarrhea PEP Resource

June G. Eilers, PhD, APRN-CNS, BCClinical Nurse ResearcherOncology Clinical Nurse SpecialistThe Nebraska Medical CenterOmaha, NebraskaMucositis PEP Resource

Patricia J. Friend, PhD, APRN, AOCN®

Assistant ProfessorNiehoff School of NursingLoyola University ChicagoMaywood, IllinoisChemotherapy-Induced Nausea and Vomit-

ing PEP Resource; Prevention of Bleeding PEP Resource

Christopher R. Friese, RN, PhD, AOCN®

Assistant Research ScientistUniversity of Michigan, School of NursingAnn Arbor, MichiganPrevention of Infection PEP Resource

puttIng evIdence Into practIcevi

Caryl D. Fulcher, RN, MSN, CNS-BCClinical Nurse SpecialistDuke University HospitalDurham, North CarolinaDepression PEP Resource

Stephanie Fulton, MSISAssistant Director of the Research Medical

LibraryUniversity of Texas M.D. Anderson Cancer

CenterHouston, TexasConstipation PEP Resource

Lindsay Gaido, MSN, RNClinical Nurse SpecialistUniversity of Texas M.D. Anderson Cancer

CenterHouston, TexasConstipation PEP Resource

Barbara A. Given, PhD, RN, FAANUniversity Distinguished ProfessorAssociate Dean for Research and Doctoral

ProgramMichigan State UniversityEast Lansing, MichiganCaregiver Strain and Burden PEP Resource

Barbara Holmes Gobel, MS, RN, AOCN®

Oncology Clinical Nurse SpecialistNorthwestern Memorial HospitalChicago, IllinoisChapter 1; Prevention of Infection PEP

Resource

Ashley K. Gunter, RN, BSN, OCN®

Clinical Nurse IIIDuke University Medical CenterDurham, North CarolinaDepression PEP Resource

Amber Harriman, RNStaff NurseOregon Health & Science UniversityPortland, OregonMucositis PEP Resource

Debra J. Harris, RN, MSN, OCN®

Nursing Practice and Education CoordinatorOregon Health & Science UniversityPortland, OregonMucositis PEP Resource

Connie Hart, RN, BSN, OCN®

Clinical EducatorCarle Foundation HospitalUrbana, IllinoisPeripheral Neuropathy PEP Resource

Jody Hauser, RN, MS, AOCNP®

Oncology Nurse PractitionerSan Francisco Oncology AssociatesSan Francisco, CaliforniaPrevention of Infection PEP Resource

Norissa J. Honea, PhD(c), MSN, RN, AOCN®, CCRP

Clinical Research NurseArizona Oncology Services FoundationPhoenix, ArizonaCaregiver Strain and Burden PEP Resource

Linda Edwards Hood, RN, MSN, AOCN®

Duke Cancer Palliative Care Research NurseDuke University Medical CenterDurham, North CarolinaFatigue PEP Resource

Lauran B. Johnson, RN, BSN, MSNBone Marrow Transplant CoordinatorUniversity of California at San Francisco

Medical CenterSan Francisco, CaliforniaSleep-Wake Disturbances PEP Resource

Mary Pat Johnston, RN, MS, AOCN®

Oncology Clinical Nurse SpecialistProHealth Care, Regional Cancer CenterWaukesha Memorial HospitalWaukesha, WisconsinChemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Contributors vi i

Margaret M. Joyce, PhD(c), RN, MSN, AOCN®

Advanced Practice NurseCancer Institute of New JerseyNew Brunswick, New JerseyDyspnea PEP Resource

Marilyn K. Kayne, BSN, RN, OCN®

Staff Nurse, Clinical Nurse IVUniversity of Toledo Medical CenterToledo, OhioChemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Elizabeth S. Kiker, RN, BN, OCN®

Charge Nurse, Chemotherapy ClinicGainesville VA Medical CenterGainesville, FloridaDiarrhea PEP Resource

Michele M. Lacher, RN, OCN®

Clinical Resource NurseHematology-Oncology Centers of the

Northern RockiesBillings, MontanaPrevention of Bleeding PEP Resource

Kristine B. LeFebvre, MSN, RN, AOCN®

Project ManagerONS Education TeamOncology Nursing SocietyPittsburgh, PennsylvaniaPain PEP Resource

Barbara G. Lubejko, RN, MSProject ManagerONS Education TeamOncology Nursing SocietyPittsburgh, PennsylvaniaDyspnea PEP Resource; Lymphedema PEP

Resource; Prevention of Infection PEP Resource

Hannah F. Lyons, RN, MSN, AOCN®, BCOncology Clinical Nurse SpecialistMassachusetts General HospitalBoston, MassachusettsConstipation PEP Resource

Kathleen Mackay, RN, BSN, OCN®

Phase I Research NurseDartmouth-Hitchcock Medical CenterLebanon, New HampshireDyspnea PEP Resource

Gail Mallory, PhD, RN, NEA-BCDirector of ResearchOncology Nursing SocietyPittsburgh, PennsylvaniaCaregiver Strain and Burden PEP Resource;

Chemotherapy-Induced Nausea and Vom-iting PEP Resource

Joyce A. Marrs, MS, FNP-BC, AOCNP®

Nurse PractitionerDayton Physicians, Hematology & OncologyDayton, OhioDepression PEP Resource

Kathy Marsh, BA, RN, OCN®

Staff NurseNorthwest Community HospitalArlington Heights, IllinoisAnxiety PEP Resource

Cathy L. Maxwell, RN, OCN®

Director of Clinical OperationsAdvanced Medical SpecialtiesMiami, FloridaMucositis PEP Resource

Roxanne W. McDaniel, PhD, RNAssociate Dean Sinclair School of NursingUniversity of Missouri, ColumbiaColumbia, MissouriChemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Christine A. Miaskowski, RN, PhD, FAANProfessor and Associate Dean for Academic

AffairsSharon A. Lamb Endowed ChairDepartment of Physiological NursingUniversity of California, San FranciscoSan Francisco, CaliforniaPain PEP Resource

puttIng evIdence Into practIcevi i i

Sandra A. Mitchell, PhD, CRNP, AOCN®

Research and Practice Development ServiceNational Institutes of Health Clinical CenterOncology Nurse Practitioner, National Can-

cer InstituteBethesda, MarylandFatigue PEP Resource; Prevention of Bleed-

ing PEP Resource

Katen Moore, MSN, APN-C, AOCN®

Nurse PractitionerCancer Institute of New JerseyNew Brunswick, New JerseyFatigue PEP Resource

Paula Muehlbauer, RN, MSN, OCN®

Clinical Nurse Specialist/Academic EducatorVA Healthcare San Diego/San Diego State

UniversitySan Diego, CaliforniaDiarrhea PEP Resource

Martha J. Norling, RN, OCN®

Staff NurseCalifornia Cancer CareGreenbrae, CaliforniaAnorexia PEP Resource

Laurel L. Northouse, RN, PhD, FAANMary Lou Willard French Professor of

NursingUniversity of Michigan, School of NursingAnn Arbor, MichiganCaregiver Strain and Burden PEP Resource

Colleen O’Leary, RN, MSN, AOCNS®

Registered Nurse, Staff EducatorNorthwestern Memorial HospitalChicago, IllinoisPrevention of Infection PEP Resource

Margaretta S. Page, RN, MSClinical Nurse SpecialistUniversity of California, San FranciscoSan Francisco, CaliforniaSleep-Wake Disturbances PEP Resource

Mary E. Peterson, RN, ANP-BC, OCN®

Nurse PractitionerBone Marrow Transplant ProgramMayo Clinic HospitalPhoenix, ArizonaPain PEP Resource

Ellen Gordon Poage, MSN, ARNP, MPH, CLT-LANA

Certified Lymphedema Therapist and Nurse Practitioner

Rehabilitation Associates of NaplesNaples, FloridaLymphedema PEP Resource

Melanie D. Poundall, RN, OCN®

Infusion NurseY8 Cancer CenterMassachusetts General HospitalBoston, MassachusettsLymphedema PEP Resource

Barbara L. Rawlings, RN, BSNSenior Clinical Research NurseNational Institutes of Health Clinical CenterBethesda, MarylandDiarrhea PEP Resource

Jill M. Reese, RN, BSN, OCN®

Clinical Nurse EducatorDayton Physicians, Hematology & OncologyDayton, OhioDepression PEP Resource

Janice K. Reynolds, RN, BC, OCN®, CHPNStaff NurseMid Coast HospitalBrunswick, MainePain PEP Resource

Marita L. Ripple, RN, OCN®

Staff Nurse ClinicianAdvocate Lutheran General Hospital 8 CenterPark Ridge, IllinoisChemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Contributors ix

Susan M. Samsonow, RN, OCN®

Staff Nurse/Clinical Education SupportDartmouth-Hitchcock Medical CenterLebanon, New HampshirePrevention of Bleeding PEP Resource

Anna D. Schaal, RN, BScN, MS, ARNPHematology Nurse PractitionerDartmouth-Hitchcock Medical CenterLebanon, New HampshirePrevention of Bleeding PEP Resource

Lisa Kennedy Sheldon, PhD, APRN-BC, AOCNP®

Assistant ProfessorUniversity of Massachusetts–BostonOncology Nurse PractitionerSt. Joseph HospitalNashua, New HampshireAnxiety PEP Resource

M. Jeanne Shellabarger, RN, MSNBreast Clinic CoordinatorUniversity of Missouri, ColumbiaEllis Fischel Cancer CenterColumbia, MissouriLymphedema PEP Resource

Nancy Shepard, RN, MS, AOCN®

Oncology Nurse PractitionerCalifornia Cancer Care, Inc.Greenbrae, CaliforniaAnorexia PEP Resource

Paula R. Sherwood, RN, PhD, CNRNAssistant ProfessorSchool of Nursing; School of Medicine,

Department of NeurosurgeryUniversity of PittsburghPittsburgh, PennsylvaniaCaregiver Strain and Burden PEP Resource

Marybeth Singer, MS, APN-BC, AOCN®, ACHPN

Nurse Practitioner, Gillette Center for Breast Oncology

Massachusetts General Hospital Cancer Center

Boston, MassachusettsLymphedema PEP Resource

Susan Claire Somers, RN, BSN, OCN®

Oncology Staff NurseSpectrum HealthGrand Rapids, MichiganCaregiver Strain and Burden PEP Resource

Patricia Starr, RN, MSN, OCN®

Neuro-Oncology/CyberKnife® Care CoordinatorWaukesha Memorial HospitalWaukesha, WisconsinChemotherapy-Induced Nausea and Vomit-

ing PEP Resource

Julie A. Summers, RN, BSNNursing SupervisorTexas Health Harris Methodist Hospital of

Fort WorthFort Worth, TexasAnxiety PEP Resource

Susan A. Swanson, RN, MS, AOCN®

Oncology Clinical Nurse Specialist, Charge Nurse Anschutz Cancer Pavilion

University of Colorado HospitalDenver, ColoradoAnxiety PEP Resource

Ellen R. Tanner, RN, BSN, OCN®

Staff NursePenn State Cancer Institute Milton S.

Hershey Medical CenterHershey, PennsylvaniaFatigue PEP Resource

Robi Thomas, PhD, RNAssociate Professor of Nursing, Chair of

Grand Rapids CampusMcAuley School of NursingUniversity of Detroit MercyGrand Rapids, Michigan

Deborah Thorpe, PhD, APRN, AOCNS®, ACHPN

Pain Medicine and Palliative CareHuntsman Cancer InstituteUniversity of UtahSalt Lake City, UtahDiarrhea PEP Resource

puttIng evIdence Into practIcex

Leslie B. Tyson, MS, APRN-BC, OCN®

Nurse PractitionerMemorial Sloan-Kettering Cancer CenterNew York, New YorkDyspnea PEP Resource

Constance Visovsky, RN, PhD, ACNPAssociate Professor, College of NursingUniversity of Nebraska Medical CenterOmaha, NebraskaPeripheral Neuropathy PEP Resource

Myra J. Woolery, MN, RN, CPON®

Pediatric Clinical Nurse SpecialistNational Institutes of HealthBethesda, MarylandConstipation PEP ResourcePrevention of Infection PEP Resource

Mary Yenulevich, RN, BSN, OCN®

Charge NurseDana-Farber Cancer InstituteBoston, MassachusettsConstipation PEP Resource

Laura Zitella, RN, MS, NP, AOCN®

Nurse PractitionerStanford Hospital and ClinicsStanford, CaliforniaPrevention of Infection PEP Resource

ReviewersLinda Lillington, DNSc, RN, CCRCResearch Program DirectorDivision of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research InstituteHarbor-UCLA Medical CenterTorrance, California

Gail Mallory, PhD, RN, NEA-BCDirector of Research Oncology Nursing SocietyPittsburgh, Pennsylvania

Dana N. Rutledge, PhD, RNProfessor of NursingCalifornia State University, FullertonFullerton, California

DisclosureEditors and authors of books and guidelines provided by the Oncology Nursing Society are

expected to disclose to the participants any significant financial interest or other relationships with the manufacturer(s) of any commercial products.

A vested interest may be considered to exist if a faculty member is affiliated with or has a financial interest in commercial organizations that may have a direct or indirect interest in the subject matter. A “financial interest” may include, but is not limited to, being a shareholder in the organization; being an employee of the commercial organization; serving on an organization’s speakers bureau; or receiving research from the organization. An “affiliation” may be holding a position on an advisory board or some other role of benefit to the commercial organization. Vested interest statements appear in the front matter for each publication.

Contributors xi

Contributors are expected to disclose any unlabeled or investigational use of products discussed in their content. This information is acknowledged solely for the information of the readers.

The contributors provided the following disclosure and vested interest information:Kristen Baileys, RN, MSN, CRNP, AOCNP®, Oncology Nursing Society, employeeHeather Belansky, RN, MSN, Oncology Nursing Society, employeeJeannine M. Brant, PhD, APRN, AOCN®, IMER, M-K Medical Communications, speakerAnnette Parry Bush, RN, BSN, MBA, OCN®, Oncology Nursing Society, employeeAnn E. Culkin, RN, OCN®, Lilly, Genentech, Inc., speakers bureausNancy A. Delzer, MSN, MBA, AOCN®, BC-PCM, Roche Pharmaceuticals, Sanofi-Aventis, speak-

ers bureausLinda H. Eaton, MN, RN, AOCN®, Oncology Nursing Society, employeeJune G. Eilers, PhD, APRN-CNS, BC, Cytogen, Amgen Inc., Endo, advisory board and speakers

bureaus; EUSA Pharma, speakers bureauChristopher R. Friese, RN, PhD, AOCN®, Amgen Inc., speakers bureau, consultantKristine B. LeFebvre, MSN, RN, AOCN®, Oncology Nursing Society, employeeBarbara G. Lubejko, RN, MS, Oncology Nursing Society, employeeJoyce A. Marrs, MS, FNP-BC, AOCNP®, Genentech, Inc., Pfizer Inc., speakers bureausCathy L. Maxwell, RN, OCN®, Novartis, Amgen Inc., Merck, Roche Pharmaceuticals, Sanofi-Aventis,

Pfizer Inc., MGI, AstraZeneca, nurse speaker, nurse adviser, researchChristine A. Miaskowski, RN, PhD, FAAN, Endo, Cephalon, PriCara, consultantJanice K. Reynolds, RN, BC, OCN®, CHPN, MEDA Pharmaceuticals, advisory board for new drug

not yet on the marketDeborah Thorpe, PhD, APRN, AOCNS®, ACHPN, Wyeth Pharmaceuticals, speakers bureauJanelle M. Tipton, MSN, RN, AOCN®, Amgen Inc., ProStrakan, speakers bureausLaura Zitella, RN, MS, NP, AOCN®, ProStrakan, Schering-Plough, consultant

xi i i

Contents

Chapter 1. PEP Up Your Practice: An Introduction to the Oncology Nursing Society Putting Evidence Into Practice Resources ........................................................ 1

Introduction ..........................................................................................................................1Overview of the PEP Resources ............................................................................................1History of the ONS PEP Project ............................................................................................2ONS PEP Resource Development .........................................................................................4Applying ONS PEP Resources to Practice.............................................................................6Summary ..............................................................................................................................7References ............................................................................................................................7

Chapter 2. Assessment and Measurement .......................................................... 9Integration of the Putting Evidence Into Practice Resources With the Nursing Process .......9Nursing Assessment ...........................................................................................................10Selection of Interventions ...................................................................................................10Why Should Nurses Be Concerned About Measurement? .................................................10Measurement Issues .........................................................................................................12Symptom Dimensions ........................................................................................................12Symptom Clusters ..............................................................................................................13Clinical Utility ......................................................................................................................13Barriers to Effective Symptom Measurement .....................................................................17Survey of Clinical Measurement Tools Used to Evaluate Oncology Patient Problems .........17Characteristics and Work Settings of Advanced Practice Nurses Surveyed ........................17Clinical Measurement Tools ...............................................................................................18Reasons for Not Using a Clinical Measurement Tool ..........................................................18Selection of Tools for This Book ........................................................................................18References ..........................................................................................................................22

Chapter 3. Anorexia ....................................................................................25Problem ..............................................................................................................................25Incidence ............................................................................................................................25Assessment ........................................................................................................................26Clinical Assessment and Measurement Tools .....................................................................26References ..........................................................................................................................27Case Study ..........................................................................................................................28

puttIng evIdence Into practIcexiv

ONS PEP Resource: Anorexia .........................................................................31References ..........................................................................................................................35

Chapter 4. Anxiety ......................................................................................37Problem .............................................................................................................................37Incidence ............................................................................................................................37Assessment ........................................................................................................................37Clinical Measurement Tools ................................................................................................39References ..........................................................................................................................41Case Study .........................................................................................................................41

ONS PEP Resource: Anxiety ...........................................................................43References ..........................................................................................................................48

Chapter 5. Caregiver Strain and Burden ............................................................51Problem .............................................................................................................................51Incidence ...........................................................................................................................51Assessment ........................................................................................................................51Clinical Measurement Tools ................................................................................................52References ..........................................................................................................................54Case Study .........................................................................................................................54

ONS PEP Resource: Caregiver Strain and Burden .................................................57References ..........................................................................................................................61

Chapter 6. Chemotherapy-Induced Nausea and Vomiting ........................................63Problem ..............................................................................................................................63Incidence ............................................................................................................................63Assessment ........................................................................................................................64Clinical Measurement Tools ................................................................................................64References ..........................................................................................................................67Case Study ..........................................................................................................................68

ONS PEP Resource: Chemotherapy-Induced Nausea and Vomiting.............................71References ..........................................................................................................................80

Chapter 7. Constipation ................................................................................85Problem ..............................................................................................................................85Incidence ............................................................................................................................85Assessment ........................................................................................................................85Clinical Measurement Tools ................................................................................................88References ..........................................................................................................................90Case Study ..........................................................................................................................90

ONS PEP Resource: Constipation ....................................................................93References ........................................................................................................................100

Chapter 8. Depression ............................................................................... 105Problem ............................................................................................................................105

Contents xv

Incidence ..........................................................................................................................105Assessment .....................................................................................................................105Clinical Measurement Tools ..............................................................................................106References ........................................................................................................................106Case Study ........................................................................................................................109

ONS PEP Resource: Depression .................................................................... 111References ........................................................................................................................116

Chapter 9. Diarrhea .................................................................................. 119Problem ............................................................................................................................119Incidence ..........................................................................................................................119Assessment ......................................................................................................................119Clinical Measurement Tools ..............................................................................................121References ........................................................................................................................122Case Study ........................................................................................................................123

ONS PEP Resource: Diarrhea ....................................................................... 125References ........................................................................................................................132

Chapter 10. Dyspnea ................................................................................. 135Problem ............................................................................................................................135Incidence .........................................................................................................................135Assessment ......................................................................................................................135Clinical Measurement Tools ..............................................................................................135References ........................................................................................................................136Case Study ........................................................................................................................138

ONS PEP Resource: Dyspnea ....................................................................... 141References ........................................................................................................................146

Chapter 11. Fatigue .................................................................................. 149Problem ...........................................................................................................................149Incidence ..........................................................................................................................149Assessment ......................................................................................................................149Clinical Measurement Tools ..............................................................................................149References ........................................................................................................................150Case Study ........................................................................................................................153

ONS PEP Resource: Fatigue ......................................................................... 155References ........................................................................................................................166

Chapter 12. Lymphedema ........................................................................... 175Problem ............................................................................................................................175Incidence ..........................................................................................................................175Assessment ......................................................................................................................175Clinical Measurement Tools ..............................................................................................176References ........................................................................................................................178Case Study ........................................................................................................................179

puttIng evIdence Into practIcexvi

ONS PEP Resource: Lymphedema ................................................................. 183References ........................................................................................................................190

Chapter 13. Mucositis ................................................................................ 193Problem ............................................................................................................................193Incidence ..........................................................................................................................193Assessment ......................................................................................................................193Clinical Measurement Tools ..............................................................................................194References ........................................................................................................................198Case Study ........................................................................................................................199

ONS PEP Resource: Mucositis ...................................................................... 201References ........................................................................................................................209

Chapter 14. Pain ...................................................................................... 215Problem ............................................................................................................................215Incidence ..........................................................................................................................215Assessment ......................................................................................................................215Clinical Measurement Tools ..............................................................................................215References ........................................................................................................................216Case Study ........................................................................................................................220

ONS PEP Resource: Pain ............................................................................ 223References ........................................................................................................................230

Chapter 15. Peripheral Neuropathy ................................................................ 235Problem ............................................................................................................................235Incidence ..........................................................................................................................235Assessment ......................................................................................................................235Clinical Measurement Tools ..............................................................................................235References ........................................................................................................................236Case Study ........................................................................................................................240

ONS PEP Resource: Peripheral Neuropathy ...................................................... 243References ........................................................................................................................249

Chapter 16. Prevention of Bleeding ................................................................ 253Problem ............................................................................................................................253Incidence .........................................................................................................................253Assessment ......................................................................................................................253Clinical Measurement Tools ..............................................................................................254References ........................................................................................................................255Case Study ........................................................................................................................255

ONS PEP Resource: Prevention of Bleeding ...................................................... 257References ........................................................................................................................263

Chapter 17. Prevention of Infection ................................................................ 267Problem ............................................................................................................................267

Contents xvi i

Incidence ..........................................................................................................................267Assessment ......................................................................................................................267Clinical Measurement Tools ..............................................................................................269References ........................................................................................................................270Clinical Example ................................................................................................................271

ONS PEP Resource: Prevention of Infection ...................................................... 273References ........................................................................................................................280

Chapter 18. Sleep-Wake Disturbances ............................................................ 285Problem ............................................................................................................................285Incidence ..........................................................................................................................286Assessment ......................................................................................................................286Clinical Measurement Tools ..............................................................................................287References ........................................................................................................................289Case Study ........................................................................................................................289

ONS PEP Resource: Sleep-Wake Disturbances .................................................. 291References ........................................................................................................................295

Chapter 19. Evidence-Based Practice: Its Role in Quality Improvement ..................... 299Creating an Evidence-Based Practice Environment Through Education ............................300Clinical Example: “Spreading the PEP” Through Unit Bulletin Boards and Staff

Team Huddles ..............................................................................................................300Creating an Evidence-Based Practice Environment Through a System Change ................302Clinical Example: Putting PEP Into Practice: Formation of a Neutropenia

Improvement Project Team in a Community-Based Hospital .......................................303Creating an Evidence-Based Practice Environment Through Performance Evaluation ......304Clinical Example: Competency Testing of the ONS PEP Resource Information .................305Clinical Example: Using the ONS PEP Process for Other Clinical Problems ......................306Promoting Evidence-Based Practice in the Workplace ......................................................307References ........................................................................................................................307

Epilogue ................................................................................................ 309

Index .................................................................................................... 311