Debate, Discuss, Decide

April 2, 2007

n this issue of ONCOLOGY Nurse Edition you'll find a carefully referenced review of cancer pain management using complementary medicine approaches. This is a perfect topic for discussion and debate. We all have our own attitudes toward complementary medicine, but how much of what we think, either for or against, is based on published research evidence and further informed by rigorous discussion? Debunking myths and offering our patients information about and access to evidenced-based therapies, no matter what their origins, is what we all want.

It seems that almost weekly there is a new candidate for the presidency. Accompanying this announcement is extensive debate for and against the individual based on both declared and implied positions on issues of public importance. Public debate is a critical activity in our society and includes the presentation of information based on varying levels of evidence that are discussed, refuted, and revised. All this discourse makes for more informed decision-making. Might this wonderful privilege of open and vigorous debate be a lesson for nurses to apply in our own professional arena? Might our clinical practices be even better if we question and debate the evidence, even as we develop practice guidelines?

For example, in this issue of ONCOLOGY Nurse Edition you'll find a carefully referenced review of cancer pain management using complementary medicine approaches. This is a perfect topic for discussion and debate. We all have our own attitudes toward complementary medicine, but how much of what we think, either for or against, is based on published research evidence and further informed by rigorous discussion? Debunking myths and offering our patients information about and access to evidenced-based therapies, no matter what their origins, is what we all want. Strong "opinions" also substitute for evidence when it comes to guidelines for dietary precautions for patients with neutropenia. Many of our institutions have such guidelines, but upon examination, it is clear that limited, rigorous evidence exists. Then how should one proceed? In the absence of strong evidence, when should expert opinion and consensus guide our practice?

I think we can all agree that our patients would be better served if we developed, reviewed, discussed and revised our practice standards and guidelines using an iterative approach. Granted that oncology nursing, in particular the Oncology Nursing Society, is working diligently toward developing an evidence base for our practice, but this will take time and require much more research than we have currently have. So what do we do in the meantime? We all have institutional practice standards that have evolved from practice traditions. For example, if we took a poll, how many mucositis mouthwash recipes would we discover in use? So for now, we need to sort things out, beginning with reviewing the evidence, debating, and accepting expert consensus where it makes sense, all the while conducting research.

As Editor-in-Chief, I invite you to send in ideas for review papers on topics of particular importance to you and your practice; suggest case studies for presentation where current practices can be reviewed, along with the evidence to date and suggestions for improvements; identify new agents and interventions we should summarize; and identify key topics for the drug information sheets. Together we can make this journal a lively forum for the exchange of professional experiences, information, and evidence. And we can DEBATE, DISCUSS, and DECIDE on ways to raise our professional standards, all with an eye to improving quality care for our patients.

—Mary McCabe, RN, MA

Editor-in-Chief