Chemotherapy-Induced Peripheral Neuropathy Assessment Skills Often Inadequate

Emma Hitt, PhD

March 09, 2010

March 9, 2010 (Atlanta, Georgia) — Nurses consider their assessment of chemotherapy-induced peripheral neuropathy (CIPN) to be essential in oncology nursing, but 75% rate their CIPN assessment skills as only fair to poor, according to a new study.

Madelaine Binner, DNP, CRNP, a nurse practitioner with the Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland, presented the findings at the annual meeting of the 16th International Conference on Cancer Nursing.

Dr. Binner and colleagues designed a questionnaire to determine the information that oncology nurses have specific to CIPN and to evaluate their practice behaviors and CIPN assessment skills. The questionnaire contained 16 knowledge items, 16 practice items, and 9 demographic survey questions related to skills, instruction, and perceptions. The test was administered to 39 oncology nurses in 2 outpatient chemotherapy infusion clinics. Test results were evaluated for reliability.

The mean CIPN knowledge score (12.6), out of a possible maximum of 16, indicated adequate nursing knowledge on this topic.

Although 100% of respondents said that assessment of CIPN is essential in their oncology nursing role, 75% rated their CIPN assessment skills as fair to poor. Only 25% rated their assessment skills as good, and none of the respondents rated their assessment skills as excellent.

Notably, general physical assessment practices did not routinely include neurological physical assessment; 61.5% said they never assessed deep tendon reflexes, and 31% said they never assessed muscle strength. Nearly 70% said they never or only occasionally assessed gross motor function, such as gait.

The content-validity index of the instrument was determined to be 0.95, and the internal consistency reliability was shown to be high, with a Cronbach's alpha score of 0.84.

"Many tools out there measure nurses' knowledge of pain, but not specifically neuropathy or neuropathic pain," Dr. Binner told Medscape Hematology-Oncology at the conference poster session. "This is a very focused study looking specifically at neuropathic pain and neuropathy, as opposed to other studies that look at the umbrella of pain," she said. According to Dr. Binner, nociceptive, or visceral, pain should be assessed differently than neuropathic pain.

"If nurses consider assessment of neuropathy and neurological assessment to be essential in their role, then we haven't done a very good job in terms of their skill development," she said. "I think it will be important to develop some guidelines specifically for assessing CIPN, not just to monitor and treat it. Nurses are not really sure what they should be assessing."

"Distinguishing neuropathic from nociceptive pain is quite important, as it directs selection of intervention approaches targeted to work most effectively for each type of pain," said Keela Herr, PhD, RN, from the University of Iowa College of Nursing in Iowa City.

According to Dr. Herr, there are expectations that nurses assessing and monitoring pain include neuropathic evaluation. However, the findings of this study suggest that knowledge and performance are lacking.

"Nurses play an essential role in evaluating pain and monitoring change over time and in response to treatments," she told Medscape Hematology-Oncology. Improved education on neuropathic pain assessment approaches, reinforced by inclusion in guidelines, policies, and procedures, are needed."

The study was not commercially funded. Dr. Binner and Dr. Herr have disclosed no relevant financial relationships.

16th International Conference on Cancer Nursing (ICCN): Abstract P-50. Presented March 8, 2010.

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