Evidence-Based Practice Implementation in the Treatment of Breast Cancer - Research Paper Example

? Evidence-Based Practice Implementation in the Treatment of Breast Cancer Chaminade Evidence-based practice in breast cancer treatment is imperative to making patient care of top quality. This paper contains a summary of an implementation of an EBP guideline for breast cancer patient care and the subsequent evaluation of the effect of its implementation. Various barriers to the complete adaptation of EBP are also examined and some solutions were presented. EBP application towards renal failure was also explored. EBP should become the core of any clinical practice for all treatments of diseases especially breast cancer treatment. Keywords: Evidence-based practice, EBP, Piedmont guideline, breast cancer treatment Evidence-Based Practice Implementation in the Treatment of Breast Cancer Evidence-based practice (EBP) is a way to deliver healthcare to patients that targets problems in the existing system by integrating the practices that yielded the best results through research of relevant studies and accurate patient-care data, along with the expertise of specialists and the input of patients with regards to their preferences and values. The best patient outcomes can be realized when EBP is conducted in the context of care, within a supportive organizational structure and if it is integrated into the organization’s culture (Overholt, Stillwell, Ford, and Melnyk, 2011, p.56). Over the years, many healthcare institutions have adapted EBP in making clinical practice guidelines for the treatment and care of patients afflicted with various diseases. Of the diseases that EBP has been applied to, the most important can arguably be breast cancer. Breast cancer is still the leading cause of cancer-related deaths in women worldwide and it is the most common type of cancer to afflict females with over 1.1 million new cases diagnosed each year. Breast cancer is also considered as the single most prevalent cancer in the world because more than 4.4 million women diagnosed with breast cancer in the last five years are currently alive and are taking in-patient and out-patient care from different healthcare institutions worldwide (Anderson, 2010). It has been theorized that with the aid of EBP to improve clinical practice, 5-year survival after breast cancer treatment could increase by up to 10% (Sainsbury, Haward, Rider, Johnston, and Round, 1995 as cited in Sacerdote et al., 2013). Sacerdote et al. (2013) conducted a study in Piedmont, Italy to evaluate the difference in breast cancer patient care quality before the implementation of an EBP guideline and after the implementation of the EBP guideline. The guideline that Sacerdote et al. evaluated was the Piedmont guideline (PGL) and it constitutes the compliance of 14 quality-of-care indicators in accordance to EBP. The focus of their study is to evaluate the effects of EBP on breast cancer treatment and to determine how well the PGL has been implemented. Summary of the Study Since Sacerdote et al.’s study was concerned with the status of breast cancer care before and after the implementation of the PGL, two patient groups were selected. Breast cancer patients diagnosed and treated during the 1st half of 2002 were the pre-PGL group while patients who were diagnosed and treated after 2004 were the post-PGL group. The practices recommended in the PGL were already being done in the regional hospitals even before the implementation of the PGL. Between 2002 and 2004, 8 indicators out of the 14 moved towards the expected standard, however only 4 of these 8 improvements were statistically significant. It is highly recommended for patients with medium-to-high risk of distant metastasis to undergo chemotherapy or radiation after Breast Conservative Surgery but for patients with low risk of distant metastasis, the exposure to radiation and chemo may actually worsen their condition or hasten the recurrence of cancer. Following the recommendations of nurses and specialists using EBP, the percentage of low risk patients that took chemo- and radiotherapy decreased from 14% in 2002 to 1.4% in 2004. Errors in prescription of hormonal therapy also decreased from 19.6% in 2002 to just 10% in 2004 in with the use of EBP and the PGL. There was a decrease for 5-year survival from 90.4% in 2002 to 90.1% in 2010 however this decrease is not statistically significant therefore the percent risk of mortality stayed the same even after the PGL had been implemented. Discussion The summarized study of Sacerdote et al. (2013) is a good example of the effect of EBP implementation in its early stage. The steps that were taken to develop and implement EBP for breast cancer according to the study were: 1. Review of current and related literature for breast cancer treatment 2. Analysis of existing breast cancer patient care data 3. Formulation of a standardized guideline that includes all the practices recommended for proper treatment of Breast cancer according to the review of literature and patient data 4. Implementation of the standardized guideline following EBP 5. Evaluation of the effect of the standardized guideline and the extent of its implementation 6. Revision of guideline to include finding from the evaluations and changes in patient care data The use of EBP for improving treatment and care for breast cancer patients can be very helpful to all of the sectors involved (patient, medical staff i.e. nurses, specialists, etc., and healthcare institutions); however, there are a number of barriers identified that makes EBP hard to implement and adapt according to the study of Majid et al. (2011, p.230). The top two barriers as they have identified in their study is (1) the lack or insufficient authority to modify patient care procedures and (2) the lack of time on the job to implement new ideas. Laura Wallis, in her article in the American Journal of Nursing (2012, p.15) also identified the unwillingness of medical practitioners to convert from the traditional course of treatment to EBP just because the traditional method is “how they’ve always done it”. These barriers can be conquered with persistence from the hospital administrators and consistent follow-up on the implementation of the procedures and guidelines laid down to promote EBP. Application One area where EBP can be applied is treatment of patients afflicted with renal failure. The kidneys can fail due to many causes and there are also many ways to help restore renal function aside from traditional dialysis. There are many studies about the paradigms of renal function and the predisposing factors to loss of kidney function. EBP should be done for the course of treatment for these patients so that all options can be given to them. An evidence-based guideline has already been published by the National Kidney Foundation called the Kidney Disease Outcomes Quality Initiative (KDOQI) but its adaptation and implementation has yet to reach majority of primary care physicians and nurses (Fox, Voleti, Khan, Murray, and Vassalotti, 2008, p.2). EBP can be applied for better diagnosis, prevention efforts against, and managing complications of renal diseases. Conclusion EBP does not only benefit breast cancer patients but all other patients because the chances of error in diagnosis and administering treatments are lowered. When nurses and other medical practitioners become up-to-date with the technologies and methods in treating breast cancer and other diseases, then they can better make appropriations for the individual needs and preference of their patients. Making EBP as a guideline or a checklist makes it easier to implement and evaluate, however, for it to be truly EBP, the guideline or checklist must be constantly evaluated and checked against current patient data and current research on patient care. It is the responsibility of the medical professional – may they be nurses, specialist, doctors, and other professionals involved in healthcare, to update themselves with the latest information about patient care and they should check these against actual patient data so as to make the best procedure for following EBP for implementation in breast cancer treatment as well as treatment of other diseases. References Anderson, B. O. (2010). The breast health global initiative: why it matters to all of us. Oncology, Vol. 24, No. 13. Retrieved from www.cancernetwork.com Fox, C. H., Voleti, V., Khan, L. S., Murray, B. and Vassalotti, J. (2008). A quick guide to evidence-based chronic kidney disease care for the primary care physician. Clinical features. Postgraduate Medicine. Vol. 120, No. 2, p. 2 Majid, S., Foo, S. Luyt, B., Zhang, X., Theng, Y. L., Chang, Y. K., Mohktar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, Vol. 99, No. 3, p. 230 Overholt, E. F., Ford, L. G., Melnyk, M., Stillwell, S. B. (2011). Evaluating and disseminating the impact of evidence-based intervention: Show and tell. Evidence-based practice step-by-step. American Journal of Nursing, Vol. 111, No. 7, p. 56 Sacerdote, C., Bordon, R., Pitarella, S., Mano, M. P., Baldi, I., Casella, D., Di Counzo, D., Frigerio, A., Milanesio, L., Merletti, F., Pagano, E., Ricceri, F., Rosso, S., Segnan, N., Tomatis, M., Ciccone, M., Vineis, P., Ponti, A. (2013). Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy. BMC Health Services Research. BioMed Central Journal, Vol. 13, No. 28. Retrieved from www.biomedcentral.com Wallis, L. (2012). Barriers to implementing Evidence-based practice remain high for U.S. nurses – Getting past “We’ve always done it this way” is crucial. American Journal of Nursing. 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