基于循证实践方法改进肿瘤靶向药物皮肤毒性管理模式的研究与实践

Research and practice on improving the skin toxicity management model of tumor targeted drugs based on evidence-based practice method

目的基于循证实践方法改进肿瘤靶向药物皮肤毒性管理模式,并将其应用于临床实践。方法采用乔安娜•布里格斯研究所(JBI)循证实践方法,通过检索国内外相关指南和循证医学文献、开展对护士和患者的访谈调查,形成肿瘤靶向药物皮肤毒性管理的证据;基于证据并咨询循证医学、护理学和临床专家,将证据转化为管理改进方案,制定出皮肤毒性检查表和护理清单等;将改进方案应用于临床实践,加强护士的培训,规范和完善护理流程,为患者提供多种形式的健康教育。收集2023年5月至8月在安徽省肿瘤医院肿瘤内科接受靶向药物治疗的住院肿瘤患者中出现皮肤毒性的患者,比较管理改进前后护士对各种管理指标的执行情况、患者皮肤毒性发生情况和严重程度等,对改进后的效果进行考查。结果共纳入发生靶向药物皮肤毒性的肿瘤患者35例,包括男性26例、女性9例,年龄(60±10)岁。与管理改进前相比,改进后护士应用不良事件通用术语标准5.0版对患者皮肤毒性反应和危险因素进行评估、相关护理文书记录合格情况、对患者进行皮肤护理的健康教育和定期随访等5项指标的执行率均明显提高(0~31.4%提高至80%~100%),差异均有统计学意义(均P<0.001)。管理改进后患者皮疹、皮肤干燥、手足皮肤反应和甲沟炎的发生率和严重程度均明显降低(均P<0.05),皮肤护理知识问卷得分明显提高[6.00(5.00,8.00)分比8.00(7.00,9.00)分,P=0.002],皮肤病生活质量指数明显降低[8.00(6.00,9.00)分比6.00(5.00,8.00)分,P=0.033],焦虑和抑郁评分差异无统计学意义(均P>0.05)。结论基于JBI循证实践方法对靶向药物皮肤毒性管理模式进行改进,可规范护士的临床护理实践流程,减轻肿瘤患者皮肤毒性严重程度,提高患者生活质量。

Objective To improve the skin toxicity management model of tumor targeted drugs based on evidence-based practice method and apply it to clinical practice.Methods Using the evidencebased practice method of Joanna Briggs Institute,evidence of skin toxicity management of tumor targeted drugs was formed by searching relevant guidelines and evidence-based medical literature at home and abroad,and conducting interviews and surveys with nurses and patients.Based on the evidence and in consultation with evidence-based medicine,nursing and clinical experts,the evidence was transformed into management improvement plans,and the skin toxicity checklist and care checklist were developed.The improvement scheme was applied to clinical practice,the training of nurses was strengthened,the nursing process was standardized and improved,and various forms of health education were provided to patients.Patients with skin toxicity who received targeted drug therapy in the Department of Oncology of Anhui Cancer Hospital from May to August 2023 were collected.Implementation of various management indicators by nurses before and after management improvement were compared.The occurrence and severity of skin toxicity in patients were compared to verify the effect of the improvement.Results A total of 35 tumor patients with skin toxicity to targeted drugs were entered,including 26 males and 9 females,with age(60±10)years.Compared with before,the implementation rate of the 5 indicators after the management improvement,including the evaluation of skin toxicity and risk factors by nurses using the common terminology criteria for adverse events version 5.0,the qualified status of related nursing documents,the health education of skin care,and regular follow-up of patients,were significantly increased(from 0-31.4% up to 80%-100%),the differences were statistically significant(all P<0.05).After improvement,the incidence and severity of skin rash,skin dryness,skin reaction of hands and feet,and paronychia were significantly reduced,the score of skin care knowledge questionnaire was significantly increased[6.00(5.00,8.00)vs.8.00(7.00,9.00),P=0.002],and the dermatology life quality index was significantly decreased[8.00(6.00,9.00)vs.6.00(5.00,8.00),P=0.033].The differences in anxiety and depression scores were not statistically significant(both P>0.05).Conclusion The skin toxicity management of targeted drugs based on JBI evidence-based practice method can standardize the clinical nursing practice of nurses,improve the severity of skin toxicity in tumor patients,and improve their quality of life.