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Nursing Research and Practice
Volume 2013, Article ID 171872, 11 pages
Research Article

Development and Evaluation of Evidence-Informed Clinical Nursing Protocols for Remote Assessment, Triage and Support of Cancer Treatment-Induced Symptoms

1University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
2Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1
3Queen’s University, 78 Barrie Street, Kingston, ON, Canada K7L 3N6

Received 6 September 2012; Revised 29 November 2012; Accepted 3 December 2012

Academic Editor: Linda Moneyham

Copyright © 2013 Dawn Stacey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability ( ), just the right amount of information ( ), appropriate terms ( ), fit with clinical work flow ( ), and being self-evident for how to complete ( ). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms.