Use of a theory driven, evidence-based skin-care protocol to teach preventive skin-care during radiation therapy

Purpose: Self-care to prevent radiation dermatitis is imperative. However, patient adherence to recommended skin-care is not always optimal. Poor adherence to skin-care occurs when patients receive instruction that is poorly organized, inconsistent, not evidence-based and contrary to their learning style.  This quality improvement project sought to optimize adherence to skin-care recommendations and decrease skin toxicity among radiation oncology (RT) patients being treated for head and neck cancer.

Objective: To promote adherence to skin-care and minimize skin toxicity among RT head and neck patients by ensuring that

 1.           skin-care recommendations are evidence-based and in accord with ONS PEP  

              guidelines

2.            skin-care education and reinforcement information is standardized and delivered consistently by

nurse educators.

3.            multimedia  instructional materials are theoretically structured to meet the patient’s preferred

learning style

Outcomes:

Adherence to the skin-care protocol was moderate during week one but thereafter 96% or more of the patients used both products at least once a day. Satisfaction with initial teaching was high. On a 4-point scale (1=not satisfied; 4= very satisfied), the average level of satisfaction was 3.79 with a narrow standard deviation (sd = .41) Time to onset of a skin reaction (Grade 1 or greater) was evaluated in consecutive days from the first day of treatment. For the new protocol group the average time to onset was 20.84 days (sd =  12.59) whereas time to onset for the old protocol group was 17.15 days (sd = 11.42).  There was a nearly 4 day delay in onset in the new protocol group. The mean level of skin toxicity for the experimental group was 1.91 whereas the mean level of skin toxicity for the control group was 1.98.  Using independent samples t-test there was no statistically significant difference (t₁₀₉ = -.33, p = .739) in the average severity of skin toxicity between groups.