癌症预防回肠造口护理中的循证渗漏管理：系统评价与临床专业知识相结合的德尔菲共识

IF 2.8 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing Pub Date : 2025-04-21 DOI:10.1016/j.apjon.2025.100703

Songxian Zhao , Xueling Ma , Yujue Wang , Yan Bai , Chongyu Yan

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引用次数: 0

摘要

目的综合现有的最佳证据，结合临床专业知识，建立一套结构化的、循证的回肠造口预防护理渗漏管理系统。方法采用两相混合法设计。首先，根据PIPOST框架(人群：癌症预防性回肠造口患者；干预措施：泄漏管理策略；专业：造口护理人员；结果：渗漏发生率及皮肤并发症；设置:医院;证据类型：临床决策、指南、证据摘要、最佳实践、系统评价和专家共识)。从开始到2024年6月，检索了数据库和临床知识库，产生了23份高质量的文档。其次，来自中国6个省份的15名造口护理专家参与了德尔菲共识过程，通过两轮反复咨询，将证据细化为可操作的临床方案。共识阈值包括李克特评分≥4和变异系数<；0.25.结果最终确定的泄漏管理体系包括预防、评估和干预三个领域，共分为11个主题和46个可操作项目。关键的组成部分包括预防策略的回肠造口漏，动态造口器具的选择，并处理泄漏相关的皮肤损伤的协议。专家共识强调了个性化护理的重要性，并根据流出物特征和产气量进行调整。德尔菲面板达到了高一致性(Cr = 0.89, Kendall's W = 0.194-0.137, P <；0.05)。本研究提出了一种针对癌症预防性回肠造口幸存者需求的可靠的、循证的泄漏管理系统。通过将高质量的证据与实际的临床见解相结合，该系统为改善患者预后和提高现实环境中造口护理的质量提供了有价值的指导。系统评价注册号：es20245104。

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Evidence-based leakage management in cancer-preventive ileostomy care: A Delphi consensus integrating systematic review and clinical expertise

Objective

This study aimed to synthesize the best available evidence and integrate clinical expertise to develop a structured, evidence-based leakage management system for cancer-preventive ileostomy care.

Methods

A two-phase mixed-methods design was employed. First, a systematic review was conducted following the PIPOST framework (Population: cancer-preventive ileostomy patients; Intervention: leakage management strategies; Professionals: ostomy caregivers; Outcomes: leakage incidence and skin complications; Setting: hospitals; Evidence types: clinical decisions, guidelines, evidence summaries, best practices, systematic reviews, and expert consensus). Databases and clinical repositories were searched from inception to June 2024, yielding 23 high-quality documents. Second, a Delphi consensus process involving 15 ostomy nursing experts across six Chinese provinces refined the evidence into actionable clinical protocols through two iterative consultation rounds. Consensus thresholds included a Likert score ≥ 4 and coefficient of variation < 0.25.

Results

The finalized leakage management system comprises three domains—prevention, assessment, and intervention—organized into 11 themes and 46 actionable items. Key components include preventive strategies for ileostomy leakage, dynamic ostomy appliance selection, and protocols for managing leakage-related skin damage. Expert consensus highlighted the importance of individualized care, with adjustments based on effluent characteristics and gas production. The Delphi panel achieved high agreement (Cr = 0.89, Kendall's W = 0.194–0.137, P < 0.05).

Conclusions

This study presents a robust, evidence-based leakage management system tailored to the needs of cancer-preventive ileostomy survivors. By integrating high-quality evidence with practical clinical insights, the system offers valuable guidance for improving patient outcomes and enhancing the quality of ostomy nursing care in real-world settings.