Assessment and management of radiation-induced trismus in patients with nasopharyngeal carcinoma: a best practice implementation project.

Abstract

Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously impact the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC. This is an evidence-based audit and feedback project implemented using a three-phase approach at a Third-Class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria based on the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit carried out to assess the results of interventions implemented to improve practice. After evidence application, the compliance rate of audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate of audit criterion 2 increased from 0 to 100%. The compliance rate of audit criterion 3 increased from 22 to 62%. The compliance rate of audit criterion 4 increased from 88 to 100%. The compliance rate of audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate of audit criterion 6 increased from 0 to 55%. Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.