Completed Research Project

Testing of a near-peer approach to implementing evidence-based mucositis prevention in cancer patients

Investigators: Aranda S, Yates P, & White, K.

Funding: National Institute of Clinical Studies ($62,500).

Abstract: Oral mucositis is a common and distressing side effect of cancer treatment associated with potentially life threatening complications. Evidence suggests that good oral hygiene can reduce the incidence and severity of oral complications in people with cancer but is not routinely used in practice. Following the unsuccessful introduction of evidence-based oral care guidelines for the prevention of oral complications in a cancer setting a multi-site study using a practice change strategy was utilised  to test a near-peer approach to implementing evidence-based guidelines for the prevention of oral mucositis in a cancer population.  Three settings, a day chemotherapy unit, a head and neck radiotherapy outpatient department and an inpatient haematology unit employed a clinical nurse to act as a near-peer facilitator of practice change based on Roger’s (1963) Diffusion of Innovation Theory. The near-peer facilitators engaged with unit staff to facilitate adoption of the guidelines into routine practice. The guidelines consisted of a protocol for oral hygiene, an oral assessment and documentation tool and a patient self-care brochure. Project outcomes were assessed using prospective audit of documentation, oral solution use, oral assessment practice, patient oral assessments and patient self care brochure receipt at baseline, six and 12 months later. Owing to small numbers of patients at two sites, only the inpatient haematology data is presented here. Across time there was a statistically significant reduction in the proportion of patients with severe oral scores. There was also a significant increase in the proportion of patients receiving a self-care brochure and instruction on self-checking of oral status. The appropriateness of oral solution use (topical anaesthetic agents and antifungal agents) also improved. The near-peer facilitators were highly acceptable as change agents in the practice environments. The use of near-peer facilitators can enhance success in the introduction of practice change.