Abstract
There is a unifying theory that cancer results from abnormal cellular proliferation, but its main cause remains idiopathic; however, researchers have developed innovative ways to improve its management (Majérus, 2022). Effective cancer management starts with oncology screening and early diagnosis (Shah et al., 2019) and often leads to palliative care (Hui and Bruera, 2016). Unfortunately, not all cancers are diagnosed early, making chemotherapy an essential element of cancer management (Hellmann et al., 2016). Chemotherapy, though effective, can leave patients with side effects such as biological, psychological, physical, emotional and pharmacodynamic-related but, despite these effects, patients should be supported to maintain a good level of self-care efficacy (Abu El-Kass, et al., 2021).
Self-management education (SME) is a proven self-care phenomenon useful in managing long-term conditions (LTCs) in person-centred ways (Howell et al., 2021). Integration on the other hand remains popular in promoting effective health outcomes for patients with LTCs (Bosun-Arije et al., 2020). With optimism, I reviewed the paper titled ‘Effects of Self-management Education Integrated Nursing on Cancer Patients with peripherally inserted central catheter (PICC) Placement: A Systematic Review and Meta-analysis’. I found the research findings convincing in contributing to the body of knowledge that targets improving person-centred care (PCN) for people living with cancer. Using a researcher and practitioner lens, this commentary entails my opinion on the research whose outcome targets improving the approaches to PICC insertion for oncology patients undergoing chemotherapy.
As part of the chemotherapy process, the insertion of PICC becomes a necessity and a desirable alternative to Peripheral Venipuncture (PV) (American Cancer Society, 2015) because repeated PV causes irritation, inflammation and damage to the vascular endothelium, phlebitis and extravasation of the cytotoxic medication to the subcutaneous tissue (Kreidieh et al., 2016). Research evidence shows that patients requiring a PICC insertion may encounter various shades of anxiety, discomfort and restrictions in daily life (Källenius et al., 2016) and fears: fears of prognosis, and fear of the unknown (Song and Oh, 2016) and those with repeated PICC insertion have the risk for PICC-related symptomatic thrombus (Meyer, 2017) and PICC-associated bloodstream infection (BSI; Kim et al., 2020). However, with the risks associated with PICC and the unwanted feelings, oncology patients who were interviewed in a Norwegian study claimed they would choose to have PICC again (Leonardsen et al., 2020).
The readiness to have PICC is positive, but it is paramount that patients who require PICC insertion receive support before, during and after its insertion to enhance effective PICC practice, care and safety. The authors used a quality appraisal process, Cochrane’s ROB 1.0 as an assessment tool during the screening process for the total of 12 quantitative papers (9 Chinese and 3 English papers included in the project). Cochrane’s ROB 1.0 is a valid tool because its development involved stakeholders from different disciplines; methodologists, statisticians and clinicians (Higgins et al., 2019). With meta-analysis, they highlighted how SME could reduce PICC insertion complications.
Their research outcome shows statistically significant benefits of SME-integrated nursing to oncology patients requiring a PICC placement. Total catheter-related complications (95% CI (0.17, 0.32), p < 0.00001); catheter dislodgement (95% CI (0.07, 0.40), p < 0.0001); catheter-associated infections (95% CI (0.11, 0.41), p < 0.00001); catheter obstruction (95% CI (0.14, 0.53), p = 0.0002]; phlebitis (95% CI (0.11, 0.47), p < 0.0001) and thrombosis (95% CI (0.07, 0.57), p < 0.0001) in patients with PICC placement. In addition, the authors conducted a systematic review. They provided clear and textual perspectives on the effects of SME-integrated nursing such as online and offline education for oncology patients with PICC placement.
In conclusion, the authors have adopted a rigorous and evidence-based approach to improving the support services provided to oncology patients who require PICC placement. The approach is practicable, it is about blending SME-integrated nursing to promote patient PICC care and safety, which is an important part of person-centred oncology care. I recommend that healthcare professionals, families and carers of people receiving PICC placement continually seek SME-integrated nursing pathways to oncology care.