| Objective:To understand the level of cancer-related fatigue,the way of fatigue remission and the status of health literacy of fatigue management in patients with colorectal cancer receiving chemotherapy,and to analyze the influencing factors.Based on the results of the current survey,the best clinical practice guidelines related to cancer-related fatigue were systematically retrieved and evaluated.Recommendations related to the management of symptoms of cancerrelated fatigue with clinical applicability were screened out from the inclusion guidelines by expert letter consultation.Describe and analyze the clinical status of evidence related to the management of symptoms of cancer-related fatigue,understand the gap between clinical practice and the best evidence,and identify the factors that promote and hinder the transformation of evidence.To establish an evidence-based practice plan for the management of symptoms of cancer-related fatigue in patients with chemotherapy for colorectal cancer,in order to unify and standardize the nursing process for the management of symptoms of cancer-related fatigue in patients with chemotherapy for colorectal cancer,improve the quality of nursing,and improve the compliance and quality of life of patients with chemotherapy for colorectal cancer.Methods:In this study,patients receiving chemotherapy for colorectal cancer in the colorectal cancer tumor ward,daytime chemotherapy ward and integrated traditional Chinese and western medicine tumor ward were selected as the investigation objects by convenience sampling method.The level of cancer-related fatigue,the remission of fatigue symptoms and the status of health literacy in the management of fatigue in patients with chemotherapy for colorectal cancer were investigated by using the Cancer Fatigue Scale,the Fatigue Relief Scale-Chinese Version and the Assessment Scale of Health Literacy in the Management of Cancer Fatigue Diseases in patients with chemotherapy for colorectal cancer.Systematic retrieval of domestic and foreign clinical practice guidelines for symptom management of cancer-related fatigue or clinical practice guidelines related to symptom management of colorectal cancer patients undergoing chemotherapy.Apply AGREE II to evaluate the methodological quality of the included guidelines,and screen out the high-quality guidelines that meet the research topic.Translate and integrate the recommendations from the high quality guidelines to form the initial pool of recommendations for this study.The expert letter consultation method was used to evaluate the translation accuracy and the rationality of summarization and integration of the recommendations included in the guidelines for the management of symptoms of cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy.Using investigation method,interview method,assessment of cancer in patients with colorectal cancer chemotherapy for clinical applicability of fatigue management recommendations,determine the present stage can be carried out in pilot clinical ward recommended items,combined with the specific clinical situation,stakeholder interviews,clear recommendations into management solution that may exist in the process of obstacles and promoting factors,formulate corresponding strategies,to construct an evidence-based nursing plan for patients with cancer-related fatigue after chemotherapy in colorectal cancer.Results:Results of an investigation on levels and symptom management of cancer-related fatigue in patients undergoing chemotherapy for colorectal cancer showed:the average score of cancerrelated fatigue scale in patients with colorectal cancer undergoing chemotherapy was 21.39±11.95,with a median of 19,and more than 18 points were taken as the dividing point between cancer-induced fatigue and cancer-induced fatigue.The incidence of cancer-induced fatigue in the study subjects was 51.4%,which was compared with the incidence of cancer-related fatigue reported by other cancer subjects using the same scale.The level of cancer-related fatigue in patients with colorectal cancer treated with chemotherapy was flat or higher.In terms of the choice of relief methods,sleep and rest are helpful to relieve the body fatigue in patients with colorectal cancer undergoing chemotherapy.The average score of the subjects was 85.97±17.60,with a median of 90,and the total score≥104 was defined as having the management literacy of cancer-related fatigue.Only 10.8%of the subjects had the health literacy of the management of cancer-related fatigue.Therefore,the patients undergoing chemotherapy for colorectal cancer had a low health literacy of the management of cancer-related fatigue.Two clinical practice guidelines related to the management of cancer-related fatigue in patients treated with chemotherapy for colorectal cancer,from the National Comprehensive Cancer Network(NCCN)and the European Society for Medical Oncology(ESMO),were included based on a developed screening process and inclusion exclusion criteria.The results of the AGREE Ⅱ evaluation showed that the standardised scores for the four domains of scope and purpose,participants,rigour and clarity of the " Cancer-Related Fatigue(NCCN Clinical Practice Guidelines in Oncology)" were greater than 60%,so the guideline was judged to be a B-level evidence-based guideline,which was revised and used by the research team.The other guideline "Cancer-related fatigue:ESMO Clinical Practice Guidelines for diagnosis and treatment" had a standardised score of more than 60%in six areas:scope and purpose,participants,rigour,clarity,applicability and independence,and was therefore judged to be an A-level evidence-based guideline and could be directly recommended for use.The ICC consistency test results for the two guidelines were 0.81 and 0.76 respectively,all of which were greater than 0.75,suggesting a high level of consistency in the methodological evaluation of the guidelines.In the two guidelines,there were a total of 65 recommendations for symptom management of cancer-related fatigue.Based on the principle of summary and integration of recommendations and expert opinions,researchers and the team finally summarized and integrated 38 recommendations for symptom management of cancer-related fatigue in patients undergoing chemotherapy for colorectal cancer.On this basis,its clinical applicability was evaluated,and the results showed that 10 of the recommended items had been carried out in the pilot wards,and 9 of the recommended items were not suitable to be carried out due to the limitations of the clinical environment.Finally,a total of 19 recommendations related to the management of cancer-related fatigue symptoms of colorectal cancer patients undergoing chemotherapy were screened out for the current clinical pilot wards.After fully considering the promoting and hindering factors in the process of evidencebased practice,the 19 selected recommendations related to the management of symptoms of cancer-related fatigue in patients with chemotherapy for colorectal cancer were transformed into specific nursing measures,and an evidence-based practice plan of nursing care for patients with cancer-related fatigue in chemotherapy for colorectal cancer was constructed.The program includes a nursing procedure for the management of symptoms of cancer-related fatigue in patients undergoing chemotherapy for colorectal cancer and an educational guide for the management of symptoms of cancer-related fatigue in patients undergoing chemotherapy for colorectal cancer.Conclusion:1.Incidence of colorectal cancer chemotherapy in patients with cancer-related fatigue is relatively high,the relief way limited health literacy is low,and the management based on the above situation for the localization of large intestine cancer chemotherapy for patients with cancer fatigue of evidence-based nursing practice,to guide the nurses and patients have effective management of cancer-related fatigue,improve chemotherapy compliance and quality of life of patients.2.At present,the latest clinical practice guidelines for the management of symptoms of cancer-related fatigue in China have not been retrieved.The relevant guidelines for the management of symptoms of cancer-related fatigue in foreign countries are updated in time,with high overall quality and basically consistent recommendations.3.The evidence-based nursing plan for cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy is relatively accepted by clinical nurses.However,due to the low attention to cancer-related fatigue in medical care,the imbalance of nurse-patient ratio and the lack of nurses’ authority,there are still some concerns about the implementation of this plan.4.It is scientifically feasible to construct the best evidence-based practice scheme based on the combination of clinical situation and the opinions of stakeholders,which is conducive to the promotion and implementation of clinical nursing work. |
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