Bauer, C., Laszewski, P., & Magnan, M. (2015). Promoting adherence to skin care practices among patients receiving radiation therapy. Clinical Journal of Oncology Nursing, 19, 196–203. 

To optimize patient adherence to Oncology Nursing Society's (ONS's) Putting Evidence Into Practice (PEP) recommendations for skin care and to evaluate associated satisfaction and skin condition

A skin care protocol was developed, including cleansing, use of a moisturizer, protection from the sun, and avoidance of skin friction. Patients were given written instruction sheets and videos, skin care kits were provided free of charge and nurses rehearsed to provide consistent verbal information. Outcomes measured included adherence, patient satisfaction, and skin condition. Teaching was reinforced in week 1 and 3. Adherence and skin condition were measured weekly. Results were compared to a cohort of patients who had been managed under a previous protocol. A random selection of patients who had received previous care was selected for comparison.

• N = 86, 30 on the new protocol
• MEAN AGE = 59.2 years
• MALES: 72%, FEMALES: 28%
• KEY DISEASE CHARACTERISTICS: Patients with head and neck cancer

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: Detroit

PHASE OF CARE: Active antitumor treatment

• Observational cohort comparison

• MOSAIQ ONS rating scores 0–4 for skin changes
• Visual analog scale (VAS) for satisfaction
• Structured interview for adherence
• Common Terminology Criteria for Adverse Events (CTCAE)

The onset of skin reactions was later among the new protocol group, but differences from previous care were not significant. By week 5, the proportion of patients with grade 3 and 4 was lower among patients in the current protocol. Adherence to skin cleansing and moisturizing was 93%–95%. Of the patients, 87% were extremely satisfied with the education they received.

The findings suggest that teaching patients to follow a consistent skin care protocol can be beneficial in the prevention of severe radiodermatitis.

• Small sample (< 100)
• Risk of bias (no control group) 
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Skin care provided to the comparison cohort is not described.  
• The dose and fractionization of radiation therapy in both study groups are not described.
• How many patients were also receiving radiation therapy is unclear.

Regular skin cleansing during radiation therapy is a recommended part of care. This study showed that a nursing educational and care protocol could facilitate patient compliance to skin cleansing and other aspects of skin care, and may improve patients' skin condition during radiation therapy.