Using the best evidence to inform care leads to better patient outcomes and can prevent over- or underuse of healthcare resources. Clinical practice guidelines are an important tool for healthcare providers to ensure they are using informed care in their practice. On Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Pamela Ginex, EdD, RN, discussed ONS’s symptom management guidelines and a new initiative to develop and implement guidelines into clinical care.
From PEP to Guidelines
ONS has a long history of developing evidence-based practice resources to facilitate the translation of evidence to practice. For more than 15 years, ONS member-based project teams have identified and synthesized the research evidence on 20 common cancer side effects and symptoms such as fatigue, dyspnea, depression, pain, sleep/wake disturbance, and more. The teams are comprised of nurse scientists, advanced practice nurses, and staff nurses from around the United States and the world. Although initially released under the label Putting Evidence Into Practice (PEP), those systematic reviews formed the foundation of a practice guideline, and in 2018, ONS started the process to transition the PEP resources to full symptom management guidelines.
A Multiphase Process
The project’s first phase involves transitioning five PEP topics to cancer symptom management guidelines: lymphedema, radiodermatitis, skin toxicities, constipation, and hot flashes. Each can be significant for patients, and clinicians may be uncertain about best practices for management.
The original project teams for each topic have expanded to include other interprofessional subject matter experts. Together, they’ve identified relevant clinical questions that the guideline should address. The teams are following national criteria for the development of trustworthy guidelines from the National Academies of Science, Engineering, and Medicine as well as using GRADE methodology to ensure the guidelines are rigorous, transparent, and relevant to care today.
“Our goal for these guidelines is for them bridge the gap between evidence and practice and facilitate best practices in the care of patients with cancer who are experiencing these side effects,” Ginex said.
Developing the guidelines is just one step in the evidence to practice pathway, Ginex said. Once they are developed, ongoing effort is necessary to get the recommendations into clinical practice. To that end, ONS is embarking on a project to incorporate the constipation guidelines into clinical care.
“We look forward to additional projects similar to this one in the future,” Ginex said. “Working together with our members and interprofessional colleagues, we can change practice and improve outcomes for patients with cancer.”