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Lee, Chun, Noh, Song, Kim, and Ha: Development of Lower Extremity Lymphedema Nursing Practice Protocol for Patients Following Gynecologic Cancer Treatment
Original Article

Asian Oncol Nurs 2018;18(3):143-153.

Published online: 5 September 2018

DOI: https://doi.org/10.5388/aon.2018.18.3.143

Development of Lower Extremity Lymphedema Nursing Practice Protocol for Patients Following Gynecologic Cancer Treatment

Hyunjung Lee1, Nami Chun2, Gieok Noh3, Hyunju Song1, Juhyun Kim1, Sumi Ha1

1Department of Nursing, Samsung Medical Center, Seoul, Korea

2College of Nursing, Sungshin Women's University, Seoul, Korea

3College of Nursing, Konyang University, Daejeon, Korea

∗ This study was presented in poster session of 46th Fall conference, Korean Society of Women Health Nursing, 2016.

Address reprint requests to: Chun, Nami Sungshin Women's University, College of Nursing, 55 Dobong-ro, 76ga-gil, Gangbuk-gu, Seoul 01133, Korea Tel: +82-2-920-7523 Fax: +82-2-920-2092 E-mail: nmchun@sungshin.ac.kr

Received 21 Jul 201813 Sep 2018       Accepted 16 Sep 2018

Copyright © 2018 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

초록

Purpose

This study aimed to develop and evaluate the lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment.

Methods

Thirteen web-sites were searched for eligible clinical practice guidelines (CPGs) and eleven databases were searched to identify evidence to develop a lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment.

Results

Based on the inclusion and exclusion criteria, eight CPGs and ninety-six studies, two guidelines and eight studies were identified as evidence. The protocol development group consisted of ten experts who have at least five years’ experience in the related area. A lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment was developed including forty-three recommendations in five domains. Significant differences were found in nurses’ pre and post knowledge and confidence on lower extremity lymphedema prevention and management.

Conclusion

Nurses and other professionals could utilize this evidence based lower extremity lymphedema nursing practice protocol and apply it to patients undergoing gynecologic cancer treatment.

Keywords: Gynecologic Neoplasm, Lymphedema, Nursing Protocols

REFERENCES

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2. Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006; 103:714–8.
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3. Kang SH, Hwang KH, Sim YJ, Jeong HJ, Lee TH, Kim SH. The prevalence and risk factors of lower limb lymphedema in the patients with gynecologic neoplasms. Korean J Obstet Gynecol. 2009; 52:815–20.
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5. Yang HS, Lee K, Kim DS, Sim YJ, Jeong HJ, Kim GC, et al. The association of social support and quality of life in gynecological cancer related of lymphedema in a hospital: a pilot study. Korean J Obstet Gynecol. 2011; 54:355–60.
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9. Ministry of Health & Welfare, Korean Academy of Medical Science. Adaptation process for developing Korean clinical practice guidelines [Internet]. Available from. http://www.guideline.or.kr/contents/index.php?code=148. [Accessed August 20, 2017].
10. Medical Education Partnership Ltd. Best practice for the management of lymphoedema: an international consensus [Internet]. Available from. http://www.woundsinternational.com/media/issues/210/files/con-tent_175.pdf. [Accessed August 20, 2017].
11. Korean Society of Lymphedema. Clinical practice guideline for lymph-edema following cancer treatment [Internet]. Available from. http://www.kslymph.or.kr/file/151204.pdf. [Accessed August 20, 2017].
12. The AGREE Research Trust. Appraisal of guidelines for research & evaluation II, AGREE II instrument [Internet]. Available from. http://www.agreetrust.org. [Accessed August 9, 2018].
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Fig. 1.
Database Search Flow Chart.
aon-18-143f1.tif
Table 1.
Guideline Appraisal Using AGREE Tool
Appraisal criteria No. of item Score (%)
Guideline #1 Guideline #2
Scope and purpose 3 92.4 93.1
Stakeholder involvement 3 84.0 84.7
Rigor of development 8 81.8 82.0
Clarity of presentation 3 93.8 92.4
Applicability 4 82.3 78.1
Editorial independence 2 68.8 75.0
Overall AGREE assessment   Acceptable (n=7) Acceptable after revision (n=1) Acceptable (n=7) Acceptable after revision (n=1)

AGREE= Appraisal of guidelines for research and evaluation collaboration.

Table 2.
SIGN Classification of Reviewed Studies
No. Author Title Article Study design n Evidence level
3 Oremus M Diagnosis and treatment of secondary lymphedema. McMaster University Evidence- based Practice Center. 2010 SR 1++
4 Finnane A Review of evidence of lymphedema treatment effect. American Journal of Physical Medicine & Rehabilitation 2015;94:483-98 SR 1++
5 Leyng EYL The management of secondary lower limb lymphoedema in cancer patients: systematic review Palliative Medicine 2015;29:112-9 SR 1+
6 Iuchi T Associations between the treatments and outcomes of patients with upper and lower lymphoedema in Japan: a cross- sectional observational study. International Journal of Nursing Studies. 2015;52:913-9 Cohort study y 2-
7 Kerchner K Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines American Academy of Dermatol- ogy. 2008;59:324-31 Journal Review  
8 National Breast and Ovarian Cancer Centre The management of Secondary lymphoe dema: a guide for health professionals. National Breast and Ovarian Cancer Centre. 2008 Journal Review  
9 National Lymphedema Network Position statement of the national lymph- edema network. National Lymphedema Network. 2011 Journal Review  
10 Marrs J Lymphedema and implications for oncol ogy nursing practice. Clinical Journal of Oncology Nursing. 2007;11:19-21 − Journal Review  

SIGN=Scottish Intercollegiate Guidlines Network.

Table 3.
Protocol Contents, Strength and Level of Recommendation
Protocol contents n (%) Recommendation strength/level
    I/A II/B III/C
I. Preventive care-assessment 2 (4.7)      
I-1. Assess lymphedema for potential patients and assess patient and caregiver's perception and knowledge on potential risk of lymphedema 1     1/1
 I-2. Assess patient's awareness on sign and symptom of lymphedema 1     1/1
II. Preventive care-intervention 6 (13.9)      
 II-1. Recognize importance of providing information, early detection and treatment 1     1/1
 II-2. Lower extremity lymphedema self-assessment education 1   1/1  
 II-3. Self-management method education 1   1/1  
 II-4. Recommend wearing therapeutic compression stocking 1   1/ /1
 II-5. Provide contact information of institution and clinic 1     1/1
 II-6. Report to physician and follow-up referral 1     1/1
III. Preventive care and lymphedema management-evaluation 3 (7.0)      
 III-1. Evaluate level of understanding on lymphedema preventive care education for potential patient and caregiver 1     1/1
 III-2. Evaluate patient's compliance on lymphedema risk reduction care instruction 1     1/1
 III-3. Evaluate pre post operative lymphedema care and follow-up care instruction 1     1/1
IV. Lower extremity lymphedema management-assessment 7 (16.3)      
 IV-1. Lymphedema assessment 1     1/1
 IV-2. Skin assessment 1     1/1
 IV-3. Measure lymphedema site circumference 1     1/1
 IV-4. Pain assessment 1     1/1
 IV-5. Nutrition assessment 1   1/ /1
 IV-6. Psychosocial status assessment 1     1/1
 IV-7. Mobility and functionality assessment 1     1/1
V. Lower extremity lymphedema management-intervention 2 25 (58.1)      
 V-1. Early and active involvement of patient and family 1     1/1
 V-2. Multi desciplinary approach, consultation to lymphedema clinic 1     1/1
 V-3. Complete decongestive therapy (CDT) 1 1/1    
 V-4. Exercise 1 1/1    
 V-5. Ambulation and activity 1 1/ /1  
 V-6. Sleep 1     1/1
 V-7. Skin care 4   2/1 2/3
 V-8. Lymph massage 4 1/1   3/3
 V-9. Intermittent pneumatic compression (IPC) 1     1/1
 V-10. Multi-layer inelastic lymphedema bandaging (MLLB) 2 1/1   1/1
 V-11. Compression-therapeutic compression stocking 3     3/3
 V-12. Psychosocial Management 1     1/1
 V-13. Midline lymphedema management 1     1/1
 V-14. Lymphedema management for palliative patient 1     1/1
 V-15. Drug treatment 2   1/ 1/2
Total 43 (100.0) 5/4 7/4 31/35
Table 4.
Effect of Nurses’ Knowledge and Confidence on Lymphedema Prevention and Management for Patients after Gynecologic Cancer Treatment
Variables Pre
 Post
 t p
M ± SD M ± SD
Knowledge on lymphedema prevention and management 26.70 ± 2.77 33.42 ± 3.62 −9.52 ＜.001
Confidence on lymphedema prevention and management 2.84 ± 0.56 3.65 ± 0.56 −7.68 ＜.001
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