Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting
Introduction
Chemotherapy-induced nausea and vomiting (CINV) is one of the common and distressing side-effects experienced by patients during cancer treatment. In conjunction with anti-emetic treatment, 32.6–59.2% of patients receiving moderate emetogenic chemotherapy (MEC) and 35.3–66.0% undergoing high emetogenic chemotherapy (HEC) still reported acute and delayed CINV (Grunberg et al., 2004; Haiderali et al., 2011; Liau et al., 2005; Molassiotis et al., 2008; Valle et al., 2006). Williams et al. (2010) examined symptom monitoring and self-care strategies among 222 Chinese patients undergoing cancer treatment. Of the 14 therapy-related symptoms reported by patients after at least two weeks' chemotherapy, nausea and vomiting were reported by more than 50%, more than those in radiotherapy alone or a combination of chemotherapy and radiotherapy. Also nausea was one of the most severe symptoms perceived by patients undergoing chemotherapy alone or combined chemotherapy and radiation therapy (Williams et al., 2010). Similar results were reported by 70 patients undergoing chemotherapy for ovarian cancer – nausea and vomiting were considered to be the most severe side-effects (Sun et al., 2005).
In fact, cancer patients had an aversion to CINV not only during chemotherapy, but also after treatment. Hilarius et al. (2012) conducted a study to examine the incidence of CINV among 277 patients undergoing chemotherapy, and their findings showed that 39% and 68% of the participants experienced acute and delayed nausea during the first cycle of treatment, although the incidence of acute and delayed vomiting was 12% and 23% respectively. Of those reporting CINV, one third indicated that the symptoms had an adverse effect on their daily life. Similar findings were reported by Bloechl-Daum et al. (2006), in a study which aimed to examine the effects of CINV on daily life among 298 cancer patients before and after chemotherapy.
Despite evidence that effective anti-emetics and non-pharmaceutical management can reduce the incidence of CINV, the clinical problem still exists (Bender et al., 2002; Hawkins and Grunberg, 2009). Major possible reasons are that symptoms are under-reported by patients and under-documented by healthcare professionals, or that implementation of symptom management strategies is not complying with the anti-emetic guidelines (Bender et al., 2002). Effective communication in relation to the symptoms can help managing them promptly, with positive outcomes. Studies have found that patient outcomes are improved when nurses take a central role in implementing effective CINV management (Aranda et al., 2012; Braud et al., 2003; Lee et al., 2001). Patients consider a nurse's assessment in chemotherapy-induced symptoms to be desirable when it has an impact on their care, with appropriate modifications being made accordingly (Braud et al., 2003). However, studies examining the role of nurses in the prevention and management of CINV have been limited. To improve healthcare services and the quality of life of cancer patients receiving chemotherapy, we need to investigate nurses' roles in CINV prevention and management, and their related educational needs – the principal aims of the present study.
In pursuit of these aims, our key research questions were:
- 1.
How do nurses assess CINV risk?
- 2.
How do nurses currently practise CINV management?
- 3.
What facilitators and barriers do nurses encounter in the prevention and management of CINV?
- 4.
What educational needs do nurses have in seeking to improve prevention and management of CINV?
Section snippets
Sample and setting
A descriptive cross-sectional design was chosen. The data were collected in the department of clinical oncology of three public hospitals in Hong Kong, where all registered or enrolled nurses working in that department at the time of the survey and administering chemotherapy to cancer patients were invited to participate in the study.
Measurements
The survey instrument was developed after a comprehensive review of the literature to identify key issues pertinent to the role of nurses in managing CINV. In this
Recruitment and response
A total of 167 questionnaires were distributed and 103 were returned, a response rate of 61.7%.
Respondents' characteristics
A total of 103 nurses completed the questionnaire. All were working in the public health sector, with over two-thirds (69.9%) in hospital in-patient units. Their years of experience in the nursing profession ranged from less than one to over 20 and so they held different positions, but were mainly staff nurses working on the front line (73.8%). Most (79.6%) had more than two years' experience of
Assessment of CINV risk
Nearly half of the respondents believed that assessment of CINV risk was guided by the clinician's knowledge and experience, and that a standardised assessment tool was not used during CINV assessment. This was consistent with the finding that some respondents felt uncertain and not confident enough in their assessment to distinguish between nausea and vomiting, which may also be related to lack of professional training and thus only one third of respondents performed an assessment before
Conclusion
CINV remains a major clinical problem despite advances in anti-emetic treatment. Oncology nurses, playing a vital role in CINV prevention and management, must be well equipped with a wide knowledge of the area to facilitate their assessment, preventive education and management. However, the nurses in the present study showed some uncertainty and inadequacy in their assessment and knowledge in the absence of a standardised assessment tool, CINV protocol and adequate training in CINV management.
Conflict of interest
None declared.
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