Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting

Abstract

Purpose

To examine nurses' roles in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), and to identify their related educational needs.

Methods

This was a descriptive cross-sectional study with a self-reported survey completed by 103 oncology nurses caring for and administering chemotherapy to cancer patients in the department of oncology in three Hong Kong public hospitals. The survey was developed to identify key issues pertinent to the role of nurses in managing CINV. Data were collected from the following areas (a) demographics, (b) assessment of CINV, (c) CINV management and (d) barriers and facilitators to good CINV practice.

Results

Only a third of respondents performed a CINV assessment before starting chemotherapy, and more than 40% reported that the use of a standardised assessment tool was uncommon. Nearly half recognised that they had inadequate knowledge of different aspects of CINV, but the majority could clearly state the most common pharmacological agents used to treat chemotherapy-induced nausea (88.3%) and vomiting (87.4%). The barriers respondents most frequently encountered in CINV prevention and management were lack of time and a heavy workload. Adopting a standardised CINV assessment tool and management protocol together with further professional training were identified as the major facilitators in improving CINV prevention and management.

Conclusions

Respondents perceived their knowledge of CINV prevention and management as inadequate. There is a need to adopt a standardised assessment tool, to develop a management protocol and to introduce further professional training to meet the expanding needs of both patients and nurses.

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:

• How do nurses assess CINV risk?

• How do nurses currently practise CINV management?

• What facilitators and barriers do nurses encounter in the prevention and management of CINV?

• What educational needs do nurses have in seeking to improve prevention and management of CINV?