To help improve nurse-focused patient outcomes through evidence-based resources, ONS created its popular Putting Evidence Into Practice (PEP) resources. The print and web-based resources integrate the best evidence from well-designed studies with a clinician’s expertise, including patient assessment and practice data and patients’ preferences and values. The first volume of PEP was released in 2006 and has had several revisions ever since.
Janelle Tipton, MSN, RN, AOCN®, from the infusion center at the University of Toledo Medical Center, Diane Cope, PhD, ARNP-BC, AOCNP®, a nurse practitioner at Florida Cancer Specialists, Ellyn Matthews, PhD, RN, AOCNS®, CBSM, an associate professor at the University of Arkansas for Medical Sciences, and Sandra Mitchell, CRNP, PhD, AOCN®, an oncology nurse practitioner at the National Cancer Institute, discussed these resources and how they can be used in different areas of cancer care and survivorship during a session at the 41st Annual Congress in San Antonio, TX.
The PEP evidence is color coded to help nurses discern the level of evidence available for each intervention.
- Green: The evidence supports the consideration of the interventions in practice.
- Yellow: Evidence is not sufficient to say whether the interventions are effective.
- Red: The evidence indicates that the interventions are either ineffective or may cause harm.
The ONS PEP program offers tools and patient/provider materials to help manage distressing symptoms. Each PEP topic page provides a brief description and lists all of the interventions that have been evaluated and their assigned level of evidence.
The speakers shared some specific areas of patient treatment where the PEP resources can be utilized.
Matthews began with cognitive behavioral therapy (CBT) interventions related to sleep-wake disturbances, depression and anxiety, caregiver burden, and fatigue for patients with cancer.
CBT can be used to
- Identify negative or unhelpful thoughts and beliefs.
- Examine the association among thoughts, feelings, and behaviors.
- Recognize helpful and unhelpful behaviors.
- Establish goals to apply new behaviors that facilitate effective coping.
- Develop and enhance problem-solving skills.
In the literature, CBT is supported for sleep-wake disturbances, caregiver burden, and depression, though there is less evidence to support its use for anxiety and fatigue.
Next, Cope discussed progressive muscle relaxation (PMR), which is a technique that can help patients deal with anxiety by creating awareness of the body and physical sensations through a process of muscle tension and relaxation. The technique involves mental engagement, a quiet environment, a darkened room, and no distractions. Nurses can educate patients on PMR and conduct ongoing anxiety assessments and brief patient and caregiver training sessions to improve engagement.
In the literature, PMR is supported for use in anxiety, chemotherapy-induced nausea and vomiting, and depression. The effectiveness has not yet been established in sleep-wake disturbances.
Lastly, Mitchell discussed the importance of exercise for patients with cancer. National guidelines recommend regular physical activity, aiming for at least 150 minutes of moderate intensity exercise each week for patients with cancer. Research has confirmed the benefit in reducing fatigue, maintaining quality of life, and improving overall prognosis and survival, though less than 40% of survivors meet the recommended physical activity levels, and low levels are associated with the risk of recurrence or secondary cancer.
To encourage engagement in exercise, nurses can help patients establish fitness goals, refer patients to a community-based program, refer rehabilitation programs, and recommend mobile health tracking tools, among others. ONS’s Get Up, Get Moving program can help nurses do just that, with resources including a patient teaching video.
Tipton, J., Cope, D., Matthews, E., & Mitchell, S. (2016). Intervention management: A new approach to ongoing issues. Session presented at the ONS 41st Annual Congress, San Antonio, TX, April 28, 2016.