A study on the effect of clinical intervention of evidence-based nursing measures on complications in patients after breast-conserving surgery

Abstract

BACKGROUND:

Breast-conserving surgery is an important treatment for breast cancer, which not only eradicates the disease, but also protects the integrity of the breast, however, postoperative nausea and vomiting often bother patients.

OBJECTIVE:

This study examines the effects of evidence-based nursing practices on nausea and vomiting in patients after breast-conserving surgery, with the aim of providing new perspectives for clinical nursing practice.

METHODS:

One hundred and sixty patients who underwent breast-conserving surgery from January 2023 to December 2023 in Fudan University Shanghai Cancer Center were enrolled. The patients were divided into an intervention group (evidence-based nursing group) and a control group (conventional nursing group) using the random number table method, both groups comprised 80 patients. The control group used conventional nursing methods, and the intervention group added evidence-based nursing intervention on this basis. Comparative analysis focused on the incidence of nausea and vomiting, quality of life metrics, and postoperative satisfaction.

RESULTS:

In the intervention group, notably lower incidence rates of postoperative nausea and vomiting were observed compared to the control group within both the 0–24 hour and 24–48-hour postoperative periods ( $P<$ 0.05). Furthermore, the intervention group exhibited significantly higher scores across all five dimensions as well as the overall score of the FACT-B scale in comparison to the control group ( $P<$ 0.05), accompanied by heightened satisfaction with the nursing staff.

CONCLUSION:

This study demonstrated the positive clinical intervention effects of evidence-based nursing measures and emphasized their importance in improving postoperative nausea and vomiting and quality of life. Future studies are expected to incorporate evidence-based nursing practices into nursing care to improve patient recovery and overall quality of care.

Keywords

Breast cancer breast-conserving surgery evidence-based nursing practices nausea and vomiting interventions

1. Introduction

Breast cancer stands out as a prevalent malignancy among women globally [1, 2, 3], involves multiple factors in its pathological development, including genetics, lifestyle, hormone levels, and the environment. Initially, the proliferation of abnormal cells is confined to the breast tissue; however, as the disease evolves, these abnormal cells may spread to the surrounding tissues and other parts of the body. According to WHO data [4], the global age-standardized incidence of breast cancer in women is approximately 48 per 100,000. Additionally, it is estimated that there are 260,000 new diagnoses of breast cancer in women every 2 years [5, 6]. This represents approximately 25% of all cancer cases [7]. The 1-year survival rate of breast cancer patients is 85%, while the 5-year survival rate is only 10% [8]. Its high prevalence and complex pathogenetic characteristics make it a major challenge in women’s health worldwide. Millions of new cases of breast cancer are diagnosed each year, with far-reaching implications for women’s health and public health [9].

Breast-conserving surgery is a common surgical procedure in the treatment of breast cancer [10, 11, 12], aiming at preserving the patient’s breast and completely removing the cancerous tissue [13]. The advantages of the surgery are to ensure the therapeutic effect while maximizing the preservation of the shape and function of the breast, and care is taken to protect the blood vessels, nerves, and other important structures of the breast during the procedure in order to minimize the impact of the surgery on the patient and to improve the patient’s quality of life [14]. This surgical procedure is usually a more conservative and holistic treatment option for patients [15, 16]. Although breast-conserving surgery is a more conservative, relatively safe, and holistic surgical option that is usually performed in the setting of early diagnosis and localized breast cancer [17], however, there are still some common complications that patients may experience after the procedure, with the most common complication being postoperative nausea and vomiting (PONV) [18]. PONV may be caused by a variety of factors such as the use of anesthetic drugs during surgery, physiological stress caused by surgical incisions [19, 20], or postoperative care.

Currently, nursing measures for nausea and vomiting in patients after breast-conserving mastectomy mainly include medication, psychological support, dietary modification, and physical intervention. For example, in terms of medication, commonly used anti-nausea and vomiting drugs include 5-HT3 receptor antagonists and NK1 receptor antagonists. In terms of psychological support, psychological counseling and behavioral interventions can effectively reduce patients’ anxiety and depression, thus relieving nausea and vomiting symptoms. In terms of dietary regulation, patients are advised to have small and frequent meals after surgery and avoid greasy and spicy foods to reduce the burden on the gastrointestinal tract. Physical interventions, such as acupressure and acupuncture, also help to relieve nausea and vomiting. Although the above nursing measures have achieved certain results in practice, they still have some limitations in practical application. First, although medication can effectively relieve symptoms, it may bring other side effects. Second, measures such as psychological support and dietary regulation depend on the professionalism of the nursing staff and the degree of cooperation of the patient in the implementation process. The effect of physical intervention, on the other hand, varies greatly depending on the individual and requires specialized personnel to operate.

Based on this, this study will use evidence-based care measures to develop and implement a care plan for nausea and vomiting in post-conservative mastectomy patients by systematically evaluating and analyzing the existing high-quality research literature based on scientific evidence, which centers on the integration of the best research evidence, clinical experience, and patient values and preferences, providing a more scientific and systematic guideline for the rehabilitation and postoperative management of breast cancer patients [21]. As a nursing approach based on the latest research evidence, the researcher is able to conduct a comprehensive assessment of the patient’s condition, surgical characteristics and physiological responses [22], and provide a scientific and reasonable rehabilitation program for the patient by taking into account the patient’s individualized characteristics, in order to further improve the postoperative management strategy for breast cancer patients. Through this study, we were not only able to gain an in-depth understanding of the problem of nausea and vomiting in patients after breast-conserving surgery, but also provide a scientific basis for the promotion of evidence-based nursing in breast cancer treatment. This will help to promote the application of evidence-based nursing concepts in actual clinical work and provide more breast cancer patients with better medical care services.

2. Methods

2.1 Trial design

Our trial comprised 160 patients who underwent breast-conserving surgery at Fudan University Shanghai Cancer Center from January 2023 to December 2023. Employing a randomized numerical table method, our trial divided them equally into the intervention group (receiving evidence-based care) and the control group (receiving traditional care), each group comprising 80 cases.

2.2 Participants

The criteria for inclusion and exclusion in this study were as follows: age over 18 years old; meeting the diagnostic criteria of the Chinese Anti-Cancer Association Breast Cancer Diagnostic and Treatment Guidelines and Norms (2017 edition); taking breast-conserving surgery; actively signing the informed consent; have at least one year of breastfeeding experience or desire to breastfeed; no breast surgery or other breast-related surgery affecting breastfeeding in the year before surgery; no pregnancy plan or fertility has been completed. Study subjects with severe mental illness or cognitive impairment, combined malignant tumors or concurrently suffering from other serious systemic diseases, and having undergone other breast surgeries were excluded. This study has been approved by the Ethics Committee of Fudan University Shanghai Cancer Center (No. 1612167-18), adhering to the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study.

2.3 Intervention method

A prospective, randomized controlled study design is used, divided into an intervention group (evidence-based care group) and a control group (traditional care group). To minimize study outcome bias, key outcome assessors will use blinding to assign treatment tasks. Evidence-based care is the process by which caregivers judiciously, explicitly, and judiciously integrate research findings with their clinical experience and the wishes of their patients in planning their care activities to obtain evidence on which to base clinical care decisions.

2.4 Control group

Patients in the control group will be intervened with conventional nursing methods, and health education will be provided to patients, explaining the basic knowledge of the disease, medication methods, dietary guidance, etc.

2.5 Intervention group

Patients in the intervention group were given evidence-based nursing interventions based on conventional nursing interventions, the main contents of which were:

2.6 Intervention group program

2.6.1 Establishing an evidence-based nursing team

The team consists of nurse leaders, responsible nurses, quality control personnel, the main work is to supervise the development and implementation of the nursing plan, timely detection of problems in the nursing process and timely response measures, according to the actual situation of the patient to develop an appropriate nursing plan.

2.6.2 Raise evidence-based questions

Following surgery, patients often experience adverse reactions such as nausea and vomiting, which can lead to negative psychological effects such as pessimism and fear. These reactions may hinder the effectiveness of rehabilitation and subsequent exercise regimens. The evidence-based nursing team, based on previous nursing experience, patient needs, systematically searched relevant databases (including Cochrane, PubMed, Embase, Web Of Science, CNKI, etc.), to understand the factors related to postoperative nausea and vomiting, nursing strategies, and the best practices of evidence-based nursing, for the impact of postoperative nausea and vomiting to analyze the situation, and to develop sound and scientific preventive measures. Frontline researchers then comprehensively evaluated similar studies and care protocols to ensure the effectiveness and feasibility of our evidence-based care strategies.

2.6.3 Develop an evidence-based care program

Incorporate the principles of evidence-based care into an individualized care plan that considers each patient’s unique condition, surgical characteristics, and physiological responses. Specific measures are:

Monitoring of vital signs: real-time monitoring of the patient’s vital signs, recording the status of the drainage fluid, and regularly helping the patient to turn over to avoid the occurrence of decubitus ulcers. Observe whether the patient has nausea and vomiting, and report to the attending physician if there is any abnormality.

Compliance Behavioral Guidance: Instruct patients to follow the doctor’s instructions for medication, rehabilitation training, etc., to improve patient compliance.

Dietary care: under the premise of detailed understanding of the patient’s dietary habits, timely adjust to the scientific diet, reduce the intake of fat, increase the intake of vitamins and proteins, maintain a light and easy-to-digest diet, and pay attention to rest in daily life.

Health education: Regular health education for patients, for patients with incomplete knowledge or wrong knowledge of the disease, we can ask famous experts to explain the disease, treatment and prognosis to patients through lectures, so as to let patients strengthen their knowledge of the disease.

Psychological care: for emotionally agitated patients, guide patients to express their own ideas, so that patients can change their bad psychology and actively cooperate with medical care; encourage patients’ family members to give patients a certain amount of care and comfort to reduce their negative emotions.

2.7 Data sources

To ensure the accuracy and reliability of the data, two nurses involved in data collection were professionally trained to ensure that the data collectors had a consistent understanding and standard operating procedures. Data collection included age, marital status, education level, history of nausea and vomiting, history of allergy, and occurrence of nausea and vomiting.

2.8 Outcome

The main observational indexes include postoperative nausea and vomiting and its incidence, survival quality assessment, and patient satisfaction.

2.9 Occurrence of nausea and vomiting

The incidence of postoperative nausea and vomiting was compared between the two groups from 0 to 24 h and from 24 to 48 h. The severity of nausea and vomiting was assessed by using the Verbal Rating Scale (VRS), in which 3 was categorized as severe ( $\geqslant$ 3 times of vomiting), 2 was categorized as moderate (nausea with vomiting twice), 1 was categorized as mild (nausea with vomiting once), and 0 was categorized as no nausea and vomiting.

2.10 Quality of life measurement scale for breast cancer patients (FACT-B)

FACT-B was utilized to evaluate the quality of life among the participants in both groups. This scale encompasses emotional, social/familial, physical, and functional statuses, along with additional concerns. Responses are recorded on a 5-point Likert scale, ranging from 0 to 4, where 0 denotes “not at all”, 1 signifies “a little bit”, 2 represents “some”, 3 indicates “quite”, and 4 corresponds to “a lot”. A higher score reflects a better quality of life.

2.11 Postoperative nursing service satisfaction scale

A self-made nursing satisfaction questionnaire was used to investigate the satisfaction of the two groups of patients with nursing care, which was categorized into very satisfied, basically satisfied and dissatisfied.

2.12 Statistical analysis

Data entry was performed using Excel 2019, while data analysis was conducted using Statistical Package for Social Science (SPSS) 26.0 software (IBM, Armonk, NY, USA). Descriptive statistics for normally distributed measurement data were presented as mean $\pm$ standard deviation, with between-group comparisons conducted using independent samples $t$ -tests. For continuous variables that did not meet the criteria for normal distribution, median and quartiles were utilized, and group comparisons were carried out using the Wilcoxon rank sum test. Frequency and percentage were used to describe count data, with between-group comparisons performed using the $\chi^{2}$ test. A significance level of $P<$ 0.05 was considered statistically significant.

3. Results

3.1 Patient characteristics

A total of 160 breast-conserving surgery were included in this study, 80 in the control group and 80 in the intervention group. Among them, the age of the control group (42.56 $\pm$ 3.77) years old, 62 cases with reproductive history and 44 cases with family history; the age of the intervention group (42.71 $\pm$ 3.85) years old, 59 cases with reproductive history and 48 cases with family history. The difference between the baseline data of the two groups (Table 1) was not statistically significant ( $P>$ 0.05) and was comparable.

Table 1
Baseline characteristics of the study population

	Intervention group ( $n=$ 80)	Control group ( $n=$ 80)	Statistical value	$P$
Age	42.71 $\pm$ 3.85	42.56 $\pm$ 3.77	$\chi^{2}=$ 3.772	0.54
Educational level			$\chi^{2}=$ 5.573	0.08
Junior high school and below	29	22
High school or junior college	16	19
College	25	32
Bachelor degree or above	10	7
Marital status			$Z=$ 10.17	0.87
Married	42	46
Unmarried	31	29
Divorced	7	5
Childbearing status			$\chi^{2}=$ 7.461	0.37
Children	62	59
No children	18	21
Allergy history			$Z=$ 1.983	0.44
Yes	21	28
No	59	52
Family history			$\chi^{2}=$ 3.659	0.189
No	44	48
No	36	32

3.2 Incidence of nausea and vomiting postoperatively in both groups of patients

In the initial 24 hours post-surgery, patients in the intervention group exhibited a lower incidence of nausea and vomiting at 38.8%, significantly less than the 53.8% observed in the control group. Similarly, during the subsequent 24 to 48 hours post-surgery, the intervention group maintained a lower incidence rate of 23.8%, notably lower than the 42.5% recorded in the control group. Statistical analysis revealed a significant difference between the two timeframes ( $P<$ 0.05), as summarized in Table 2.

Table 2
Occurrence of postoperative nausea and vomiting in the two groups

Groups	Severe	Moderate	Mild	No nausea or vomiting	$\chi^{2}$	$P$
0–24 h					7.881	0.019
Control group	9	6	28	37
Intervention group	6	5	20	49
24–48 h					11.27	$P<$ 0.001
Control group	7	5	22	46
Intervention group	3	1	15	61

3.3 Comparison of survival quality between the two groups of patients

The FACT-B scores and total scores of the two groups were compared after surgery (Table 3), and the scores of the five dimensions of physical status, social and family status, emotional status, functional status, and additional attention status and the total score of quality of survival of the patients in the intervention group were higher than those of the control group ( $P<$ 0.05).

Table 3
Comparison of quality of survival between the two groups

Group	Emotional status	Social and family status	Physical status	Functional status	Additional attention status
Control group	14.86 $\pm$ 4.04	16.32 $\pm$ 4.82	18.45 $\pm$ 4.21	17.53 $\pm$ 3.23	21.55 $\pm$ 4.08
Intervention group	17.09 $\pm$ 4.431	20.18 $\pm$ 4.26	22.38 $\pm$ 4.67	20.65 $\pm$ 3.58	25.62 $\pm$ 4.34
$t$	3.562	5.887	1.616	2.564	1.728
$P$	0.042	0.006	$P<$ 0.001	$P<$ 0.001	0.017

3.4 Comparison of nursing satisfaction between the two groups

In the control group, 46 patients were satisfied, 20 patients were more satisfied, and 14 patients were dissatisfied, with a satisfaction rate of 82.5%; in the intervention group, 54 patients were satisfied, 22 patients were more satisfied, and 4 patients were dissatisfied, with a satisfaction rate of 95%, and the satisfaction rate of patients’ care in the intervention group was higher than that of the control group, and the difference was statistically significant when comparing the two groups ( $\chi^{2}=$ 6.319, $P<$ 0.05).

4. Discussion

Breast cancer, a complex ailment influenced by genetic and environmental factors, ranks as a primary cause of cancer-related fatalities in women, second only to lung cancer [1]. Present medical strategies prioritize personalized and comprehensive treatments tailored to enhance patients’ quality of life, reflecting contemporary healthcare trends.

Mastectomy with breast conservation as a surgical procedure has received much attention in recent years. By preserving as much healthy tissue as possible during surgery, breast-conserving surgery is not only expected to reduce patients’ anxiety about loss of appearance, but also to promote more active integration into the rehabilitation phase [23], and improve their quality of life.

Yet, individuals undergoing breast-conserving surgery frequently encounter various gastrointestinal side effects, among which nausea and vomiting, along with symptoms like constipation and loss of appetite, stand out as prevalent occurrences [24, 25]. Reactions occurring within 24 h are characterized as acute nausea and vomiting, and reactions occurring after 24 h are characterized as delayed nausea and vomiting, and studies have shown [26] that the incidence of nausea and vomiting in patients after drug treatment is still high, so controlling the incidence of nausea and vomiting in the postoperative period is still the focus of clinical research [27]. In the present study, evidence-based nursing measures showed a significant reduction in the incidence of nausea and vomiting at 0–24 and 24–48 hours postoperatively, but even more profound was its overall improvement in all dimensions of quality of survival. This may reflect the fact that evidence-based care focuses not only on the immediate relief of symptoms, but also on the overall needs of the patient in postoperative recovery. The lower satisfaction and relatively lower quality of survival scores in the control group, on the other hand, may imply the inadequacy of conventional care in meeting patients’ expectations and needs, and laterally reflect the comprehensive and individualized nature of evidence-based care, which plays a positive role in improving the overall quality of patient survival [28].

The mechanisms of evidence-based care are complex and multifaceted, and its effectiveness may stem from the accurate application of the latest research evidence and a deep understanding of individual patient differences [29, 30]. Patients’ physiological conditions may change due to factors such as surgical trauma and anesthesia, which may trigger uncomfortable symptoms such as nausea and vomiting [31]. Evidence-based nursing reduces the occurrence of postoperative nausea and vomiting by regulating physiological processes such as neuroendocrine, immune, and metabolic processes through the rational use of medications, attention to the postoperative recovery environment, positive psychological interventions, and improvement of self-management abilities through patient education [32]. In addition, Breastfeeding plays a crucial role in the recovery process after breast cancer treatment. It has a profound impact on the patient’s physical and mental health and quality of life that cannot be ignored. By carefully evaluating a patient’s breastfeeding history, a more comprehensive understanding of her recovery process and individual needs can be gained, thus providing an important basis for the development of a personalized recovery plan. The individualized nature of evidence-based care and the comprehensive intervention of psychosocial factors [18, 33], including emotional support and patient education, are expected to improve patients’ psychological coping with postoperative discomfort, not only the single management of symptoms, but also comprehensive care focusing on the overall needs of patients [34, 35].

In future studies, we expect to dig deeper into the applicability of evidence-based care in different surgical procedures and patient groups. With the continuous development of science and technology, evidence-based nursing can provide personalized nursing intervention plans for each patient more accurately with the help of big data, artificial intelligence and other advanced technologies. Driven by both research and practice, evidence-based care is expected to become an engine of nursing innovation, providing patients with a more efficient, warm and personalized care experience.

5. Conclusion

Through individualization, application of the latest scientific evidence and comprehensive nursing care, the incidence of nausea and vomiting in patients at 24 $\sim$ 48 h after surgery was only 23.8%, which was significantly lower than that of 42.5% in the control group, alleviating the psychological barriers of patients and improving their quality of life, and the patient satisfaction was as high as 95%, which indicated that the evidence-based nursing intervention program provided patients with a more accurate, effective, and humanized care The evidence-based nursing intervention program provides patients with more precise, effective and humanized nursing care. Therefore, it is worth to be promoted in future clinical nursing practice.

Ethical approval

This study was approved by the ethics committee of Fudan University Shanghai Cancer Center (Approval no. 1612167-18). Signed written informed consents were obtained from the patients and/or guardians.

Author contributions

Die Ren, Fei Cai: Conceptualization, methodology, writing original draft preparation. Mengqi Zhu, Yijun Zheng: Investigation, software, statistical analysis. Wei Chen: Reviewing and editing, funding acquisition, supervision. All authors read and approved the final manuscript.

Funding

This work was supported by the Science and Technology Commission of Shanghai, Science and Technology Innovation Action Plan (NO. 21ZR1414000).

Footnotes

Conflict of interest

The authors have no potential conflicts of interest to report relevant to this article.

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