Research Guides the Transition of PEP Resources to ONS Guidelines
Jane M. Armer, PhD, RN, FAAN, CLT, is the director of nursing research at the Ellis Fischel Cancer Center, professor emerita for the Sinclair School of Nursing at the University of Missouri, and director of the American Lymphedema Framework Project.

Lymphedema is one of the most common treatment side effects in patients with breast cancer. Estimates suggest that approximately 40% of all breast cancer survivors are at risk to develop lymphedema at some point in their lives. But as far back as 1998 and even before, some healthcare experts were predicting that lymphedema would be eliminated as a side effect from breast cancer treatment. Twenty-one years later, it’s still prevalent among breast cancer survivors, requiring careful management recommendations from oncology nurses to help patients live with this chronic issue.

Nurse scientists and clinicians work with the very latest literature and most rigorous research to examine the issues affecting patients’ care, like chronic lymphedema, and develop recommendations or interventions for nursing practice. But for nurses in a clinical setting, nurse educators, or other healthcare professional less familiar with the research or with limited time, knowledge and evidence must be translated into a useable format for practice, covering a wide spectrum of healthcare settings. The literature and research must be synthesized into shareable resources that put the outcomes into clear terms and formats for all healthcare professionals.

Through rigorous research, literature review, and initiatives to develop practice resources for oncology nurses, the ONS Putting Evidence Into Practice (PEP) team examined the evidence and created practice recommendations for lymphedema care, highlighting interventions that would best improve the care and quality of life for patients. The beauty of resources like PEP is that they present the available evidence for symptom management in an easy-to-use document, detailing different levels of effectiveness for each intervention. Presenting interventions in a stoplight format—red, yellow, and green—was a straightforward way for healthcare professionals to understand what worked best and how to implement research-supported interventions into daily practice.

Now the Lymphedema PEP team and other health professionals and patients are working with ONS to transition the PEP resources to clinical practice guidelines for lymphedema. This in-depth process elevates the recommendations to a level of rigor that oncology nurses and healthcare providers have come to expect from nationally recognized practice guidelines, passing the information through the required guideline development process and systematic review of evidence.

ONS guidelines build on the body of work that exists in the PEP resources and provide guidance that nurses, physicians, therapists, and other healthcare providers can rely on when developing treatment plans for their patients. New ONS guidelines for lymphedema and other symptoms and side effects will help drive future nursing research, allowing scientists to build on established knowledge.

Patients with breast cancer experience lymphedema at an alarming rate, and oncology nurses must work closely with their patients to assess for and manage this complication. Through new ONS guidelines for lymphedema, oncology nurses can practice with the confidence of having the most up-to-date recommendations for practice, knowing the evidence has been expertly examined and reviewed.