What is the management approach for a patient at the end of a treatment cycle or experiencing a wave of illness?

From the Guidelines

The management approach for a patient at the end of a treatment cycle or experiencing a wave of illness should prioritize comprehensive symptom control, careful monitoring, and appropriate transition planning, with a focus on maintaining quality of life and preventing complications, as recommended by the most recent and highest quality study 1.

Key Considerations

• Patients often experience symptom flares or complications during these vulnerable periods, requiring proactive intervention.
• For symptom management, consider medications tailored to specific complaints, such as:
  • Pain: use a stepwise approach starting with acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours), escalating to low-dose opioids as needed.
  • Nausea: ondansetron 4-8mg every 8 hours or prochlorperazine 5-10mg every 6-8 hours can provide relief.
• Hydration status should be closely monitored, with oral rehydration encouraged when possible or IV fluids (normal saline at 100-125ml/hour) if necessary.
• Regular assessment using validated tools like the Edmonton Symptom Assessment Scale helps track symptom burden.

Transition Planning

• This transition period requires clear communication about next steps, whether that involves surveillance protocols, palliative care integration, or preparation for another treatment cycle.
• Consider increasing the frequency of follow-up visits following treatment changes, as recommended by 1.
• Monitor treatment effects and clinical parameters, as well as side effects at follow-up appointments, and adjust treatment plans accordingly.

Patient Education and Support

• Patients should be educated on self-management strategies, including recognizing signs and symptoms of deterioration in health, following a prescribed treatment plan, and using medical resources appropriately.
• Consider continuing to offer information and support to people and their carers, even if they have declined this previously, as recommended by 1.

Conclusion is not allowed, so the response will continue without one, focusing on the key points and recommendations.

The physiological stress of treatment completion or disease progression often triggers inflammatory responses and metabolic changes that exacerbate symptoms, making this proactive approach essential for maintaining quality of life and preventing complications, as supported by the evidence from 1 and 1.

From the Research

Management Approach for Patients at the End of a Treatment Cycle or Experiencing a Wave of Illness

• The management approach for patients at the end of a treatment cycle or experiencing a wave of illness involves evidence-based decision making and clinical practice guidelines 2.
• Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patients in making healthcare decisions, and they should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient-relevant outcomes 2.
• Evidence-informed practice (EIP) is an alternative to evidence-based practice (EBP) that has been proposed to simplify and apply the concept for nursing students and academics, and it provides a framework to deliver clinically effective care 3.
• EIP involves the integration of evidence into clinical nursing practice, and it requires a systems-based model that takes into account the context of care and the mechanistic nature of EBP 3.
• In the case of patients with chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype, treatment with mepolizumab has been shown to lead to a lower annualized rate of moderate or severe exacerbations when added to background triple inhaled therapy 4.
• The use of mepolizumab in this patient population is an example of evidence-based decision making, and it highlights the importance of considering the latest research and clinical guidelines when making treatment decisions 4.
• Effective communication is also critical in the management of patients at the end of a treatment cycle or experiencing a wave of illness, and it requires a precise description of communication errors and a focused approach to improving process reliability 5.
• The principles of clinical ethics, including beneficence, nonmaleficence, autonomy, and justice, should also be considered in the management of these patients, and they should be integrated into a model of patient care that prioritizes caring and professionalism 6.