Lymphoedema management protocol

Funding body: 2009 Campbell Ballantyne Fellowship funded by the Nurse Maude Foundation.

Project description: This project evaluated the outcomes of a clinical protocol for the management of lymphoedema in patients receiving palliative care or wound management. Lymphoedema is a very distressing chronic condition in some metastatic cancers (e.g. breast and bowel) but with ongoing conservative treatment improvements in function, mobility and patient comfort can be achieved. Currently, the physiotherapist receives abut 60 palliative referrals for treatment annually and treats patients receiving wound care who also have lymphoedema. To achieve best outcomes for patients, a collaborative approach between the physiotherapist and nurses in the management of lymphoedema has been developed. A clinical protocol with clearly identified referral points, key assessment and screening tools, has been developed to ensure patients get appropriate assessment and treatment.  The clinical protocol was designed to develop a team approach where nurses can provide some conservative treatment, resulting in patients receiving earlier treatment and better outcomes.

This project involved two audits to evaluate the outcomes of the clinical protocol.  A baseline audit before the implementation of the clinical protocol, and an audit after 3-6 months usage of the protocol. In addition, an anonymous, voluntary survey was undertaken to obtain nurses’ views on the usefulness of the clinical protocol using a written questionnaire.

Project completion: This project was completed in January 2011 with the implementation of a lymphoedema management protocol, the development of lymphoedema management training for registered nurses and publication of the project report.  The results of the first audit of lymphoedema management was presented by Mary Thomson at the Hospice and Palliative care conference in Wellington, New Zealand.  Two publications have resulted:

Thomson, M. (2012). Working together to improve lymphoedema management in community palliative care. Kai Tiaki Nursing New Zealand,18(1), 18-19.

Thomson, M & Walker, J. (2011). Collaborative Lymphoedema management: developing a clinical protocol. International Journal of Palliative Nursing, 17(5), 231-237

Further information: Lead researcher – Mary Thomson, Physiotherapist, Nurse Maude Hospice Palliative care service

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