Examples of Critiques

In this section you will find articles that have been critiqued by APN work groups during the 2002 ONS APN Retreat. Each group critiqued a review article related to their topic, using Stetler, et al’s (1998) tool, and came to a conclusion as to whether recommendations for practice change could be made based on the evidence in the review. The topic areas reviewed by the participants were:

• Complementary Therapies
• Dyspnea
• Fatigue
• Nutrition
• Pain
• Palliative Care
• Patient Education/Decision Making
• Prevention and Screening

These critiques are listed below by topic. The review article citation, any practice recommendations, if indicated, limitations or strengths of the review and the names of the participants who did the critique are listed.

Published Review:
Jacobson, J.S., Workman, S.B., & Kronenberg, F. (2000). Research on complementary/alternative medicine for patients with breast cancer: A review of the biomedical literature. Journal of Clinical Oncology, 18(3), 668-683.

Limitations of the Review

• Limited to English language literature. Many complementary therapies evolved in Europe and Asia and therefore key articles could be missing
• Research articles dated from 1980 to 1997, none more current
• Concentration for the review was narrow (breast cancer)
• Inclusion/exclusion criteria was unclear

APN Group: Dina A. Faucher, MSN, RN, CS; Jacqueline Redemeer, RN; Judith K. Much, RN, APN-C, AOCN^®; Barbara B.Rogers, MN, RN, CRNP, AOCN^®; Mary Pat Manning, MN, RN, ET; Coordinator: Terri Armstrong, MS, APRN, BC

Published Review:
Ripamonti, C., & Fusco, F. (2002). Respiratory problems in advanced cancer. Supportive Care in Cancer, 10(3), 204-216.

Practice recommendation from the research discussed in the article: No practice change recommendations could be made based on this review due to its limitations.

Limitations of the Review

• Narrow scope of the literature search, did not include nursing, respiratory therapy, or other related disciplines' literature
• No rating system was used for scientific merit or evidence
• No recommendations were made by the authors of the review

APN Group: Ellen M. Smith, MS, RN, ARNP, AOCN^®; Kerry A.Twite, MSN, RN, AOCN^®; Debbie J.Tuttle, MS, RN, AOCN^®; Lynne R. Brophy, MSN, RN, OCN^®; Coordinator: Martha Langhorne, MSN, RN, FNP, AOCN^®

Published Review:
DeJong, N., Courtens, A.M., Abu-Saas, H.H., & Schouten, H.C. (2002). Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature. Cancer Nursing, 25(4), 283-297.

Practice recommendation from the research discussed in the article: No practice change recommendations could be made based on this review due to its limitations.

Limitations of the Review

• Only one medical bibliographic database was searched
• No inclusion/exclusion criteria were stated in the article
• No rating system was used for scientific merit or evidence
• No recommendations were made by the authors of the review

APN Group: Eileen Danaher Hacker, PhD, RN, ARNP-BC AOCN^®; Mary Pat Johnston, MS, RN, AOCN^®; Terry L. Sylvanus, MSN, APRN, BC, AOCN^®; Louise P. Meyer, MS, RN, ARNP, AOCN^®; Coordinator: Gail Mallory, PhD, RN, CNAA

Published Review:
Rock, C.l., & Demark-Wahnefried, W. (2002). Nutrition and survival after the diagnosis of breast cancer: A review of the evidence. Journal of Clinical Oncology, 20(15), 3302-3316.

Practice recommendation from the research discussed in the article: No practice change recommendations could be made based on the evidence presented in this review. ACS nutritional guidelines remain the current best practice recommendations. Review suggests that the results of ongoing randomized clinical trials that are expected to be completed in the next few years should significantly expand our knowledge base in this area.

Limitations of the Review

• Only one medical bibliographic database was searched
• No rating system was used for scientific merit or evidence
• Limited number of studies that found a significant association between weight gain and factors related to breast cancer
• Limited number of intervention studies

APN Group: Pamela L. Stephenson, MSN, RN, AOCN^®; Sharon L. Baley, MSN, RNC, CNS, AOCN^®; Coordinator: Diane G. Cope, PhD, RN, ARNP-BC, AOCN^®

Published Review:
Cairns, R. (2001). The use of oxycodone in cancer-related pain: A literature review. International Journal of Palliative Nursing, 7(11), 522, 524-527.

Practice recommendation from the research discussed in the article: No practice change recommendations could be made based on the evidence presented in this review.

Limitations of the Review

• Insufficient evidence presented
• Initial question on which the review was based was unclear.
• No search strategy was discussed in the article
• No inclusion/exclusion criteria was stated in the article
• No rating system was used for scientific merit or evidence
• No study design was described or compared in the studies reviewed

APN Group: Deborah L. Kirk, MSN, RN, CRNP, AOCN^®; Janice Maienza, RN, AOCN^®; Patricia M. Collins, MSN, RN, AOCN^®; Katherine Roth, MSN, RN, ANP, APNP; Coordinator: Mary Cunningham, MS, RN, AOCN^®

Published Review:
Hearn, J., & Higginson, I.J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317-332.

Practice Recommendation from the research discussed in the article: Two recommendations can be made from this review:

1. In hospital, hospice, and community settings, a multi-professional approach with specialist input is beneficial for providing palliative care to cancer patients. Such interdisciplinary care teams improve patient outcomes and should be feasible in most settings.
2. Specialist palliative care teams can affect cost by reducing the number of hospital inpatient days and time spent in out-of-home services. If implemented the detailed methods for calculating costs in the reviewed studies would need to be looked at in detail for appropriateness and feasibility in the practice setting.

APN Group: Kathleen A. Allen, MSN, RN, FNP, AOCN^®; Patricia B. Herman, MSN, RN, AOCN^®; Cindy L. Shobbrock, MN, RN; Caryl Fulcher, MSN, RN, CS; Wendy Miller, MSN, RN, AOCN^®; Coordinator: Marilyn Bookbinder, PhD, RN

Published Review:
McPherson, C.J., Higginson, I.J., & Hearn, J. (2001). Effective methods of giving information in cancer: A systematic literature review of randomized controlled trials. Journal of Public Health Medicine, 23(3), 227-234.

Practice Recommendation from the research discussed in the article: Evidence in the review article was judged by the group to be weak, but the following recommendation is made: In an acute care setting the preferred method of providing information is to create an interdisciplinary team that develops structure and standard to provide written and taped patient education material which:

• Allows patient choice in type of material/media
• Can be provided prior to patient/provider encounter
• Increases retention of oral information given to patient during the encounter.

Team should be led by an APN and group membership should change based on type of patient education material being developed.

APN Group: Jean A. Dell, MN, RN, AOCN^®; Kerry Harwood, MSN, RN; Sharon K. Steingass, MSN, RN, AOCN^®; Coordinator: Dana N. Rutledge, PhD, RN

Published Review:
George, S.A., (2000). Barriers to breast cancer screening: An integrated review. Health Care for Women International, 21(1), 53-65.

Practice recommendation from the evidence in the article: Evidence presented did not provide a basis for recommending any prevention and screening methods different or beyond the current standard practice for breast cancer screening of:

• Clinical breast examinations every three years from ages 20-39, then every year thereafter.
• Monthly breast self-examinations beginning at age 20. Look for any changes in your breasts.
• Baseline mammogram by the age of 40.
• Mammogram every one to two years for women 40-49, depending on previous findings and family history.
• Mammogram every year for women 50 and older.

Limitations of the Review

• Studies reviewed were from 1989-1996, none more current
• Lack of statistical significance in some studies
• No table included to compare the levels of evidence across studies

Strengths of the Review

• Relevant, broad population served as sample in most studies
• Inclusion/exclusion criteria was clearly defined
• Results relevant for varied practice settings.