Archives
Challenges and Choice
An audit of the management of nausea, vomiting and bowel obstruction in metastatic ovarian cancer
Jackie Walker
Clinical Nurse Specialist, Hospice and Palliative Care Service, Nurse Maude Association, Christchurch, New Zealand
Pauline Lane
Clinical Nurse Specialist, Hospice and Palliative Care Service, Nurse Maude Association, Christchurch, New Zealand
Abstract
Women living with metastatic ovarian cancer experience many distressing symptoms, such as vomiting and bowel obstruction, which challenge the expertise of nurses working in Palliative Care to promote quality of life.
These clinical challenges prompted us to audit our management of nausea/vomiting and bowel obstruction in a New Zealand Palliative Care service, with a focus on both pharmaceutical and non-pharmaceutical interventions (eg dietary advice, relaxation strategies). The audit involved a retrospective chart review of 17 patients and identified the current clinical management of these symptoms in comparison with best practice guidelines.
The results indicated many areas of symptom management were in line with current evidence-based practise, however the use of non-pharmaceutical interventions was limited. There were several implications for clinical practice, specifically supporting the use of electronic integrated patient management systems and a greater use of non-pharmaceutical (complementary) interventions.
The audit process provided useful data for the authors to analyse current practice and promote more effective management of these distressing symptoms.
Keywords
Nursing, metastatic ovarian cancer, audit, nausea/vomiting, bowel obstruction
References
Camilleri M (2007) Management of Malignant Bowel Obstruction. Paper: Hospice New Zealand Breakfast Teleconference, 3 May 2007, Palmerston North, NZ.
Cooper R and Gent P (2002) An overview of chemotherapy – induced emesis highlighting the role of lorazepam as adjuvant therapy, International Journal of Palliative Nursing 8(7): 331-335.
EClinic Pty Ltd (2007) PalCare: an introduction Accessed at http://www.eclinic.com.auwww.eclinic.com.au on 30 June 2007.
Ferrell B, Cullinance CA, Ervin K, Melancon C, Uman GC and Juarez G (2005) Perspectives on the impact of ovarian cancer: women’s views on quality of life, Oncology Nursing Forum 32(6): 1143-1149.
Grundy K and Morgan A (2003) Christchurch Hospital Palliative Care service: Clinical Guidelines, Canterbury District Health Board, Christchurch, NZ.
Laval G, Arvieux C, Stefani L, Villard M-L, Mestrallet J-P and Cardin N (2006) Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Centre, Journal of Pain and Symptom Management 31(6): 502-512.
Letizia M and Norton E (2003) Successful management of malignant bowel obstruction, Journal of Hospice and Palliative Nursing 5(3): 152-158.
Levine ME, Gillis M, Yanchis S, Voss AC, Stern RM and Koch KL (2006) Protein and ginger for the treatment of chemotherapy induced delayed nausea and gastric dysrhythmia, Neurogastroenterology and Motility 18(6): 488-486.
Lockwood-Rayermann S (2006) Survivorship issues in ovarian cancer: a review, Oncology Nursing Forum 33(3): 553-562.
MacLeod RD, Vella-Brincat J and Macleod AD (2004) The Palliative Care Handbook 2nd edn, Genesis Oncology Trust, Wellington.
Mangli G, Aletti G, Frigerio L, Franch M, Panacci N, Vigano R, De Marzi P, Zanetto F and Ferrari A (2005) Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis, International Journal of Gynaecological Cancer 5(5): 830-835.
Manusirivithaya S, Sripramote M, Tangjitgamol S, Sheanakul C, Leelakahorn S, Thavarama T and Tangcharoenpanich K (2004) Anti-emetic effects of ginger in gynaecologic oncology patients receiving cisplatin, International Journal of Gynaecological Cancer 14(16): 1063-1069.
Martin GW (1998) Empowerment of dying patients: The strategies and barriers to patient autonomy, Journal of Advanced Nursing 28(4): 737-744.
Martin V (2005) Straight talk about ovarian cancer, Nursing 35(4): 36-42.
New Zealand Ministry of Health (2005) Cancer: New Registrations and Deaths 2001, accessed at http://www.moh.govt.nz on 7 May 2007.
New Zealand Ministry of Health (2006) Toward Clinical Excellence: An Introduction to Clinical Audit, Peer Review and Other Clinical Practice Improvement Activities, accessed at http://www.moh.govt.nz on 10 December 2006.
Ripamonti C and Bruera E (2002) Palliative management of malignant bowel obstruction, International Journal of Gynaecological Cancer 12(2): 135-143.
Thompson I (2004) The management of nausea and vomiting in palliative care, Nursing Standard 19(8): 46-53.
Twycross R and Wilcock A (2001) Symptom Management in Advanced Care 3rd edn, Radcliffe Medical Press, Abingdon.
eContent Home