On the Move Toward Evidence-Based Symptom Management Guidelines

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Key words: evidence-based, Future of Nursing, guidelines, HIV, symptoms

The advent of health care reform and the release of The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2010) have placed a heavy emphasis on implementing evidence-based practice in health care settings in order to increase patient safety and improve care quality and effectiveness (Murphy, 2010, Newhouse and Spring, 2010). Many practices around symptom management in HIV have been tested and proven to be highly successful while others still lack sufficient evidence. When we know that a certain strategy is effective and safe, it needs to be implemented into clinical practice in order to enhance quality and improve the safety and efficacy of patient care. Nurse researchers have established a solid knowledge base in HIV symptom management over the last 25 years and it is time to formalize this knowledge into a scope of practice and a set of guidelines for clinical and advanced nursing practices.

During last year’s ANAC conference I thought about developing an evidence-based practice guideline (EBPG) for symptom management in HIV and wrote a short proposal to the national board for their feedback. This January the board met and supported the idea with great enthusiasm. Adele Webb, the executive director of ANAC, and I had a telephone conference and decided we needed to get input from the members, so we sent out a brief online questionnaire. We asked members their opinions as to whether such a guideline would be of use, whether the results should be published as a book or in another format, and whether they were willing to participate in developing the project. A total of 266 members responded and 255 (96%) said that they would find an EBPG a helpful tool in their practices. The majority (163; 65%) wanted the results to be available in book and PDF format, while 99 (37%) wanted it to be in PDF format only, and 7 (3%) in book format only. While 171 (65%) did not want to be an author on a specific topic of the EBPG, a total of 93 (35%) respondents expressed interest in being an author for at least one set of guidelines. We were thrilled to see that 10% of all members responded and determined that this was a good enough response rate to move forward with the project.

The next step was to identify the 16 most important symptoms to cover and another email went out to those members who had expressed interest in becoming contributors. We asked them to prioritize the three most important HIV-related symptoms and identify those to which they wanted to contribute. The intention was to identify strength in knowledge and interest around certain symptoms. While the top contenders are easy to identify (fatigue, neuropathic pain, nausea, diarrhea, depressive symptoms, anxiety), the second set of symptoms was less clear as there were many. We are still waiting for the responses and will report in a later editorial on our progress. In the meantime, Adele Webb, Lucy Bradley-Springer, the editor of JANAC, and I talked about publication opportunities. Lucy Bradley-Springer was able to suggest multiple opportunities, but, after discussion, we decided the best option was to publish two supplemental issues of JANAC with symptom management articles. All of the articles would then be made available online. This approach has a number of advantages:

In a time when information is readily available through so many electronic options, selecting the most accessible medium makes the most sense. This way ANAC chapters, hospital units, and community clinics can use the articles for patient teaching, for implementation of evidence-based practices, or for evaluation projects.

We have consulted with members from the Oncology Nursing Society and the American Association of Neuroscience Nurses on their approaches to developing and publishing evidence-based practice guidelines and they provided us with extensive lessons learned. Both professional organizations agreed that publishing the guidelines in their professional journals has made the greatest difference to their members. As a member organization, providing added value to the members of ANAC is our main focus.

Next steps include confirmation from JANAC that we can move forward with two supplemental issues in 2012 and confirmation from ANAC that the finances are in place to do so. A telephone conference for potential contributors is in development to define what each article will look like. Each article will have a manuscript-development leader and we anticipate that as many as four co-authors will work on a single chapter. The telephone conference will provide detailed information on the length, required subsections, number of references, evaluation criteria for the evidence, and due dates for each manuscript.

This is an exciting project for ANAC, and the process we have chosen suits ANAC and its members; also, it is in line with what our colleagues used in other organizations. Watch for more information on this important project.

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Disclosures 

The author reports no real or perceived vested interests that relate to this article (including relationships with pharmaceutical companies, biomedical device manufacturers, grantors, or other entities whose products or services are related to topics covered in this manuscript) that could be construed as a conflict of interest.

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References 

1. Institute of Medicine. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press; 2010;
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2. Murphy J. The future of nursing. How HIT fits in IOM/RWJF initiative. Journal of Healthcare Information Management. 2010;24(2):8–12
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3. Newhouse RP, Spring B. Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook. 2010;58(6):309–317
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