Nursing Knowledge, Practice Patterns, and Learning Preferences Regarding Chemotherapy-Induced Peripheral Neuropathy

Ellen M.L. Smith

Grace Campbell

Cindy S. Tofthagen

Lisa A. Kottschade

Mary Collins

Charlene Warton

Bidisha Ghosh

David L. Ronis

Gail A. Mallory

Constance Visovsky

chemotherapy-induced peripheral neuropathy, nurse knowledge, preferences, Assessment, evidence-based practice
ONF 2014, 41(6), 669-679. DOI: 10.1188/14.ONF.669-679

Purpose/Objectives: To explore nurses' practice patterns, knowledge, and barriers related to chemotherapy-induced peripheral neuropathy (CIPN).

Design: Descriptive, cross-sectional.

Setting: The United States.

Sample: 408 oncology nurses.

Methods: A team of eight experts met and developed the CIPN nurse knowledge and preferences survey, which was electronically sent to randomly selected nurses.

Main Research Variables: The survey assessed nurses' knowledge and practice patterns regarding assessment strategies and barriers, evidence-based interventions, preferences for education, and perceived gaps in scientific knowledge.

Findings: Nurses in the survey lacked knowledge regarding neurotoxicity of specific agents and evidence-based treatments. CIPN-focused physical examinations and standardized measurement tools were infrequently used during assessment. The most frequently reported barriers to CIPN assessment included lack of access to measurement tools, lack of specialized skills needed for assessment, lack of confidence, and lack of time. Recommendations for future research included CIPN prevention research, exploration of CIPN-related effects on quality of life, and alternative treatments of CIPN. The majority of participants preferred online educational opportunities.

Conclusions: Nurses do not consistently integrate evaluation and management of CIPN in their practices.

Implications for Nursing: Educational offerings should incorporate web-based CIPN assessment and management content.

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    Allet, L., Armand, S., de Bie, R. A., Golay, A., Monnin, D., Aminian, K., … de Bruin, E. D. (2010). The gait and balance of patients with diabetes can be improved: A randomised controlled trial. Diabetologia, 53, 458-466. doi:10.1007/s00125-009-1592-4
    Alreck, P. L., & Settle, R. B. (2004). The survey research handbook (3rd ed.). New York, NY: McGraw Hill.
    Argyriou, A. A., Bruna, J., Marmiroli, P., & Cavaletti, G. (2012). Chemotherapy-induced peripheral neurotoxicity (CIPN): An update. Critical Reviews in Oncology-Hematology, 82(1), 51-77.
    Bakitas, M. A. (2007). Background noise: The experience of chemotherapy-induced peripheral neuropathy. Nursing Research, 56, 323-331.
    Binner, M., Ross, D., & Browner, I. (2011). Chemotherapy-induced peripheral neuropathy: Assessment of oncology nurses' knowledge and practice. Oncology Nursing Forum, 38, 448-454. doi:10.1188/11.ONF.448-454
    Boyle, P. & Levin, B. (2008). World cancer report 2008. Retrieved from
    Cavaletti, G., Frigeni, B., Lanzani, F., Mattavelli, L., Susani, E., Alberti, P., … Bidoli, P. (2010). Chemotherapy-induced peripheral neurotoxicity assessment: A critical revision of the currently available tools. European Journal of Cancer, 46, 479-494. doi:10.1016/j.ejca.2009.12.008
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum and Associate.
    Converse, J. M., & Presser, S. (1986). Survey questions: Handcrafting the standardized questionnaire. Sage university paper on quantitative applications in the social sciences. Beverly Hills, CA: Sage.
    Dillman, D. A. (2007). Mail and internet surveys: The tailored design method (2nd ed.). Hoboken, NJ: John Wiley and Sons.
    Dodd, M. J., Cho, M. H., Cooper, B. A., & Miaskowski, C. (2010). The effect of symptom clusters on functional status and quality of life in women with breast cancer. European Journal of Oncology Nursing, 14, 101-110. doi:10.1016/j.ejon.2009.09.005
    Dworkin, R., O'Connor, A., Backonja, M., Finnerup, N., Kalso, E., Miaskowski, C., … Farrar, J. (2007). Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain, 132, 237.
    Griffith, K., Merkies, I. S. J., Hill, E., & Cornblath, D. (2010). Measures of chemotherapy-induced peripheral neuropathy: A systematic review of psychometric properties. Journal of the Peripheral Nervous System, 15, 314-325.
    Gutierrez-Gutierrez, G., Sereno, M., Miralles, A., Casado-Saenz, E., & Gutierrez-Rivas, E. (2010). Chemotherapy-induced peripheral neuropathy: Clinical features, diagnosis, prevention and treatment strategies. Clinical and Translational Oncology, 12(2), 81-91.
    Hartmann, A., Murer, K., de Bie, R. A., & de Bruin, E. D. (2009). The effect of a foot gymnastic exercise programme on gait performance in older adults: A randomised controlled trial. Disability and Rehabilitation, 31, 2101-2110.
    Hausheer, F. H., Schilsky, R. L., Bain, S., Berghorn, E. J., & Lieberman, F. (2006). Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Seminars in Oncology, 33(1), 15-49.
    Hershman, D. L., Lacchetti, C., Dworkin, R. H., Lavoie Smith, E. M., Bleeker, J., Cavaletti, G., … Loprinzi, C. L. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 32, 1941-1967. doi:10.1200/JCO.2013.54.0914
    Hershman, D. L., Unger, J. M., Crew, K. D., Minasian, L. M., Awad, D., Moinpour, C. M., … Albain, K. S. (2013). Randomized double-blind placebo-controlled trial of acetyl-L-carnitine for the prevention of taxane-induced neuropathy in women undergoing adjuvant breast cancer therapy. Journal of Clinical Oncology, 31, 2627-2633.
    Kautio, A. L., Haanpaa, M., Kautiainen, H., Kalso, E., & Saarto, T. (2011). Burden of chemotherapy-induced neuropathy—A cross-sectional study. Supportive Care in Cancer, 19, 1991-1996.
    Kruse, R. L., Lemaster, J. W., & Madsen, R. W. (2010). Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: "Feet first" randomized controlled trial. Physical Therapy, 90, 1568-1579. doi:10.2522/ptj.20090362
    Loprinzi, C. L., Reeves, B. N., Dakhil, S. R., Sloan, J. A., Wolf, S. L., Burger, K. N., … Lachance, D. H. (2011). Natural history of paclitaxel-associated acute pain syndrome: Prospective cohort study NCCTG N08C1. Journal of Clinical Oncology, 29, 1472-1478. doi:10.1200/JCO.2010.33.0308
    Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35, 382-385.
    Miller, K. L., Magel, J. R., & Hayes, J. G. (2010). The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: A pilot study. Journal of Geriatric Physical Therapy, 33, 85-91.
    Pachman, D. R., Barton, D. L., Watson, J. C., & Loprinzi, C. L. (2011). Chemotherapy-induced peripheral neuropathy: Prevention and treatment. Clinical Pharmacology and Therapeutics, 90, 377-387. doi:10.1038/clpt.2011.115
    Park, S. B., Goldstein, D., Krishnan, A. V., Lin, C. S., Friedlander, M. L., Cassidy, J., … Kiernan, M. C. (2013). Chemotherapy-induced peripheral neurotoxicity: A critical analysis. CA: A Cancer Journal for Clinicians, 63, 419-437.
    Shimozuma, K., Ohashi, Y., Takeuchi, A., Aranishi, T., Morita, S., Kuroi, K., … Hausheer, F. H. (2012). Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial. Supportive Care in Cancer, 20, 3355-3364.
    Smith, E. M., Pang, H., Cirrincione, C., Fleishman, S.,Paskett, E. D., Ahles, T., … Shapiro, C. L. (2013). Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: A randomized clinical trial. JAMA, 309, 1359-1367.
    Smith, E. M. L., Bakitas, M. A., Homel, P., Piehl, M., Kingman, L., Fadul, C. E., & Bookbinder, M. (2011). Preliminary assessment of a neuropathic pain treatment and referral algorithm for patients with cancer. Journal of Pain and Symptom Management, 42, 822-838. doi:10.1016/j.jpainsymman.2011.03.017
    Stubblefield, M. D., Burstein, H. J., Burton, A. W., Custodio, C. M., Deng, G. E., Ho, M., … Von Roenn, J. H. (2009). NCCN task force report: Management of neuropathy in cancer. Journal of the National Comprehensive Cancer Network, 7(Suppl. 5), S1-S26.
    Tofthagen, C. (2010). Surviving chemotherapy for colon cancer and living with the consequences. Journal of Palliative Medicine, 13, 1389-1391.
    Tofthagen, C., Visovsky, C. M., & Hopgood, R. (2013). Chemotherapy-induced peripheral neuropathy: An algorithm to guide nursing management. Clinical Journal of Oncology Nursing, 17, 138-144. doi:10.1188/13.CJON.138-144
    Visovsky, C., Collins, M., Abbott, L., Aschenbrenner, J., & Hart, C. (2007). Putting Evidence Into Practice: Evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clinical Journal of Oncology Nursing, 11, 901-913. doi:10.1188/07.CJON.901-913
    Visovsky, C., & Daly, B. J. (2004). Clinical evaluation and patterns of chemotherapy-induced peripheral neuropathy. Journal of the American Academy of Nurse Practitioners, 16, 353-359.
    Visovsky, C., Haas, M., Faiman, B., Kurtin, S., Schaftic, A. M., Lyden, E., & Rice, J. (2012). Nurse self-evaluation of assessment of chemotherapy-induced peripheral neuropathy in patients with cancer. Journal of the Advanced Practitioner in Oncology, 3, 319-325.
    Windebank, A. J., & Grisold, W. (2008). Chemotherapy-induced neuropathy. Journal of the Peripheral Nervous System, 13, 27-46.
    Wonders, K. K. Y. (2010). Treatment strategies for chemotherapy-induced peripheral neuropathy: Potential role of exercise. Oncology Reviews, 4, 117-125.