MSOR07 Presentation Time: 8:30 AM

Abstract

Purpose

Radiation is an effective therapy for non-melanomatous cutaneous malignancies, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). One of the side effects of radiation for skin cancer is radiation-induced dermatitis (RID), which can negatively affect patients emotionally and physically. This can occur in patients undergoing brachytherapy (BT) or external beam radiation therapy (EBRT). Despite significant advances in radiation treatments, there are gaps in nursing care such as lack of standardized nursing guidelines for managing RID skin care during BT or EBRT. Therefore, establishing a proper nursing guideline is essential as nurses have a key role in monitoring and managing RID. The purpose of this study is to identify the gaps in nursing care, assessment and intervention for RID during BT or EBRT, and assess the effect of a comprehensive guideline to assist nurses in providing efficient skin care.

Materials and Methods

Electronic databases such as PubMed, CINAHL and Embase were used to identify studies from the last decade (2012-2023) related to nursing care regarding RID. A comprehensive skin care guideline was then developed based on peer-reviewed literature and given to nurses working in the radiation oncology department of a large teaching institution with a high volume of both BT and EBRT (N=20). A survey was conducted among these nurses to identify the gaps in nursing care and knowledge before and after the introduction of the skin care guideline. The survey consisted of questions to assess nursing comfort level with skin care, proper documentation of stages of RID and familiarity with wound care products and supplies. The goal of the survey was to compare the nursing team's comfort and competency level before and after the implementation of the nursing guideline.

Results

The review of the literature revealed inconsistency in assessment practices, intervention strategies, and a lack of standardized guidelines. While some nursing recommendations exist through various oncology societies, the guidelines are generalized and do not directly address RID during BT. Furthermore, subjective data from the survey highlighted gaps in nursing care management of RID, such as lack of confidence, lack of standardized training, lack of consistency in products used, and ultimately wide variation in patient care delivery. Nursing staff reported that the guidelines for RID provided to them enhanced the quality of nursing care through multiple methods including the implementation of a standardization framework, utilization of evidence-based practice, risk reduction, optimized patient care, and empowerment of nurses. It also helps to foster interdisciplinary collaboration in the management of RID and improve patient satisfaction in both BT and EBRT.

Conclusions

By implementing standardized guidelines, nurses can follow the same protocols and interventions and deliver evidence-based care consistently. In addition, RID often involves interdisciplinary collaboration among healthcare disciplines including radiation oncologists, dermatologists and wound care specialists. Standardized nursing guidelines can facilitate collaboration between different professionals to ensure patients receive comprehensive care. By using evidence-based practice nurses can identify the risk factors and apply strategies for preventing or minimizing skin breakdown, managing pain and monitoring complications such as infection. Standardization of nursing care by use of a formalized guideline will improve patient safety through the application of evidence-based practice, as well as foster trust between patients and nurses through consistency of care. Advanced knowledge of the management of RID will also help build confidence and competency among nurses involved in the care of patients receiving BT or EBRT.