Development and Evaluation for the Preoperative Nursing Practice Guidelines in Patients with Colorectal Cancer
DOI:
https://doi.org/10.60099/prijnr.2025.274149Keywords:
Colorectal cancer, Feasibility study, Implementation research, Nursing practice guideline, pre-operative careAbstract
Colorectal cancer is the third most common cancer worldwide, and surgery is the primary treatment. Developing and implementing clinical nursing practice guidelines for preoperative care is essential to enhancing patient outcomes. Evidence supports the effectiveness of clinical nursing practice guidelines in Thailand for colorectal surgery, particularly in reducing hospital stays and enhancing quality of life. However, preoperative components such as individualized education, comprehensive nutritional support, and psychological readiness remain insufficiently addressed in existing studies. This study aimed to: (1) develop and implement a preoperative clinical nursing practice guideline, (2) evaluate its impact on patients' knowledge, anxiety, behavioral adherence, and satisfaction among both nurses and patients, and (3) assess its feasibility and nurses' and patients’ satisfaction. Using Soukup’s evidence-based model, the clinical nursing practice guidelines were designed and evaluated through evidence-triggered, evidence-supported, and evidence-observed approaches. The study included 12 nurses and 24 patients with colorectal cancer scheduled for surgery at a university hospital in Bangkok, Thailand. Patients' knowledge and anxiety were measured before and after the initial visit, one week later, and on admission day. Behavioral adherence was assessed at one week and at admission. Nurses’ and patients’ satisfaction with the guideline was evaluated. Data were analyzed using descriptive statistics, Friedman and Wilcoxon signed-rank tests.
The Preoperative Nursing Practice Guidelines for people with colorectal cancer included four components of recommendations: (1) preadmission information, education, and counseling; (2) preoperative optimization; (3) nutritional assessment; and (4) prehabilitation. Patients demonstrated significantly increased knowledge and showed a trend of anxiety reduction, with good behavioral adherence. Both patients and nurses reported high compliance and satisfaction with this guideline. Nurses can apply this guideline in practice. However, further study should include postoperative follow-up of the outcomes with a larger sample size, multi-center studies and a randomized controlled trial before it can be used widely.
References
Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, et al. Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer. 2024. Available from: https://gco.iarc.who.int/media/globocan/factsheets/cancers/39-all-cancers-factsheet.pdf
National Cancer Institute. CPG colon (020266-final) [Internet]. Ministry of Public Health, Thailand; 2023 [cited 2023 July 17]. Available from: https://www.nci.go.th/th/cpg/CPG%20Colon%20(020266-final).pdf (in Thai).
Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis. 2020;35(7):1265-72. doi: 10.1007/s00384-020-03580-4. DOI: https://doi.org/10.1007/s00384-020-03580-4
Peters EG, Pattamatta M, Smeets BJJ, Brinkman DJ, Evers SMAA, de Jonge WJ, et al. The clinical and economical impact of postoperative ileus in patients undergoing colorectal surgery. Neurogastroenterol Motil. 2020;32(8): e13862. doi: 10.1111/nmo.13862. DOI: https://doi.org/10.1111/nmo.13862
Al-Amry AL OY, Al-Shehari MM, Gailan WM, Bajubair MH, Jowah HM. Early postoperative complications in colorectal cancer patients following colorectal surgery among Yemeni patients: a prospective study. Open Access Surg. 2024(17):81-90. doi: 10.2147/OAS.S465936. DOI: https://doi.org/10.2147/OAS.S465936
Bain CR, Myles PS, Martin C, Wallace S, Shulman MA, Corcoran T, et al. Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes. Anaesthesia. 2023;78(11):1365-75. doi: 10.1111/anae.16104. DOI: https://doi.org/10.1111/anae.16104
Javed H, Olanrewaju OA, Ansah Owusu F, Saleem A, Pavani P, Tariq H, et al. Challenges and solutions in postoperative complications: a narrative review in general surgery. Cureus. 2023;15(12):e50942. doi: 10.7759/cureus.50942. DOI: https://doi.org/10.7759/cureus.50942
Sanaeha N, Toskulkao T, Chanruangvanit W, Chinswangwatanakul V, Predictive factors in colorectal cancer patients’ recovery after laparoscopic colorectal surgery. Thai J Nurs Counc. 2015;30(4):32-44. Available from: https://he02.tci-thaijo.org/index.php/TJONC/article/view/34656/39089 (in Thai).
Dajenah M, Ahmed F, Thabet A, Ghaleb K, Nikbakht HA. Early postoperative complications of gastrointestinal surgery and its associated factors in Yemeni patients treated in a teaching hospital: a retrospective monocentric study. Cureus. 2022;14(5):e25215. doi: 10.7759/cureus.25215. DOI: https://doi.org/10.7759/cureus.25215
Ni K, Zhu J, Ma Z. Preoperative anxiety and postoperative adverse events: a narrative overview. Anesthesiol Perioper Sci. 2023;1(3):23. doi: 10.1007/s44254-023-00019-1. DOI: https://doi.org/10.1007/s44254-023-00019-1
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS(®)) society recommendations: 2018. World J Surg. 2019;43(3):659-95. doi: 10.1007/s00268-018-4844-y. DOI: https://doi.org/10.1007/s00268-018-4844-y
Peng YN, Huang ML, Kao CH. Prevalence of depression and anxiety in colorectal cancer patients: a literature review. Int J Environ Res Public Health. 2019;16(3):411. doi: 10.3390/ijerph16030411. DOI: https://doi.org/10.3390/ijerph16030411
Bedaso A, Ayalew M. Preoperative anxiety among adult patients undergoing elective surgery: a prospective survey at a general hospital in Ethiopia. Patient Saf Surg. 2019;13:18. doi: 10.1186/s13037-019-0198-0. DOI: https://doi.org/10.1186/s13037-019-0198-0
Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am. 2011;31(1):81-93. doi: 10.1016/j.iac.2010.09.010. DOI: https://doi.org/10.1016/j.iac.2010.09.010
Venianaki M, Andreou A, Nikolouzakis TK, Chrysos E, Chalkiadakis G, Lasithiotakis K. Factors associated with malnutrition and its impact on postoperative outcomes in older patients. J Clin Med. 2021;10(12):2550. doi:10.3390/jcm10122550. DOI: https://doi.org/10.3390/jcm10122550
Komindrg S, Tangsermwong T, Janepanish P. Simplified malnutrition tool for Thai patients. Asia Pac J Clin Nutr. 2013;22(4):516-21. doi: 10.6133/apjcn.2013.22.4.06.
Yamada T, Endo H, Hasegawa H, Kakeji Y, Yamamoto H, Miyata H, et al. Presurgical mild anemia is a risk factor for severe postoperative complications of rectal cancer surgery: a Japanese nationwide retrospective cohort study. Ann Gastroenterol Surg. 2024;8(3):471-80. doi: 10.1002/ags3.12770. DOI: https://doi.org/10.1002/ags3.12770
van Kooten RT, Bahadoer RR, Peeters KCMJ, Hoeksema JHL, Steyerberg EW, Hartgrink HH, et al. Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: a systematic review. Eur J Surg Oncol 2021;47(12):3049-58. doi: 10.1016/j.ejso.2021.07.021. DOI: https://doi.org/10.1016/j.ejso.2021.07.021
Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg. 2018; 267(1):50-6. doi: 10.1097/SLA.0000000000002293. DOI: https://doi.org/10.1097/SLA.0000000000002293
Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis. World J Gastroenterol. 2018;24(4): 519-36. doi: 10.3748/wjg.v24.i4.519. DOI: https://doi.org/10.3748/wjg.v24.i4.519
Zhang Q, Sun Q, Li J, Fu X, Wu Y, Zhang J, et al. The impact of ERAS and multidisciplinary teams on perioperative management in colorectal cancer. Pain Ther. 2025;14(1): 201-15. doi: 10.1007/s40122-024-00667-6. DOI: https://doi.org/10.1007/s40122-024-00667-6
Soukup SM. The Center for Advanced Nursing Practice evidence-based practice model: promoting the scholarship of practice. Nurs Clin North Am. 2000;35(2):301-9. PMID: 10873242. DOI: https://doi.org/10.1016/S0029-6465(22)02468-9
Cassidy CE, Harrison MB, Godfrey C, Nincic V, Khan PA, Oakley P, et al. Use and effects of implementation strategies for practice guidelines in nursing: a systematic review. Implement Sci. 2021;16(1):102. doi: 10.1186/s13012-021-01165-5. DOI: https://doi.org/10.1186/s13012-021-01165-5
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2): 65-76. doi: 10.1007/s10488-010-0319-7. DOI: https://doi.org/10.1007/s10488-010-0319-7
Brouwers MC, Kerkvliet K, Spithoff K; AGREE Next Steps Consortium. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ. 2016;352:i1152. doi: 10.1136/bmj.i1152. Erratum in: BMJ. 2016;354:i4852. doi: 10.1136/bmj.i4852. DOI: https://doi.org/10.1136/bmj.i1152
Moore CG, Carter RE, Nietert PJ, Stewart PW. Recommendations for planning pilot studies in clinical and translational research. Clin Transl Sci. 2011;4(5):332-7. doi: 10.1111/j.1752-8062.2011.00347.x. DOI: https://doi.org/10.1111/j.1752-8062.2011.00347.x
Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4(4):287-91. doi: 10. 1002/pst.185. DOI: https://doi.org/10.1002/pst.185
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. doi: 10.3758/bf03193146. DOI: https://doi.org/10.3758/BF03193146
Soponratana K. The effects of an enhanced recovery program on anxiety and surgical recovery among the patients undergoing abdominal surgery [master’s thesis]. [Bangkok, Thailand]: Thammasat University; 2013 (in Thai).
Aree-Ue S, Youngcharoen P. The 6-item cognitive function test Thai version: psychometric property testing. Rama Nurs J. 2020;26(2):188-202. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/217560 (in Thai).
Subcommittee on Evidence-Based Medicine and Clinical Practice Guidelines, Royal College of Physicians of Thailand. Recommendations for developing clinical practice guidelines. Bull RCPT. 2001;18(6):36-47 (in Thai).
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490. DOI: https://doi.org/10.1136/bmj.328.7454.1490
Alzahrani MM, Alghamdi AA, Alghamdi SA, Alotaibi RK. Knowledge and attitude of dentists towards obstructive sleep apnea. Int Dent J. 2022;72(3):315-21. doi: 10.1016/j.identj.2021.05.004. DOI: https://doi.org/10.1016/j.identj.2021.05.004
Homepan M, Chaiviboontham S, Kanogsunthorntrat N. Developmental and evaluation of the use of nursing practice guideline in patients with total knee arthroplasty. Rama Nurs J. 2022;28(1):75-92. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/250814/175257 (in Thai).
Nakpalad W, Khupantavee N, Sangchan H. The development and evaluation of clinical practice guideline for promoting the recovery of older patients with total knee arthroplasty. JPNHS 2019;11(1):73-85 (in Thai).
Yodkolkij T, Kanogsunthornrat N, Thiengthiantham R. Clinical practice guideline implementation in colorectal disease patients undergoing abdominal surgery. TJNMP. 2018;5(1):94-111 (in Thai).
Ladasoontorn S, Chaiviboontham S, Suwanthanma W. The effects of clinical nursing practice guideline implementation in patients with colorectal cancer receiving stoma creation on quality of life and clinical outcomes. Nurs Res Inno J. 2023;29(2):157-75. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/257733/157-175 (in Thai).
Kim C, Pfeiffer ML, Chang JR, Burnstine MA. Perioperative considerations for antithrombotic therapy in oculofacial surgery: a review of current evidence and practice guidelines. Ophthalmic Plast Reconstr Surg. 2022;38(3):226-33. doi: 10.1097/IOP.0000000000002058. DOI: https://doi.org/10.1097/IOP.0000000000002058
Ernst E. The risk-benefit profile of commonly used herbal therapies: ginkgo, St. John’s wort, ginseng, echinacea, saw palmetto, and kava. Ann Intern Med. 2002;136(1): 42-53. doi: 10.7326/0003-4819-136-1-200201010- 00010. Erratum in: Ann Intern Med. 2003;138(1):79. DOI: https://doi.org/10.7326/0003-4819-136-1-200201010-00010
Ayyadhah Alanazi A. Reducing anxiety in preoperative patients: a systematic review. Br J Nurs. 2014;23(7): 387-93. doi: 10.12968/bjon.2014.23.7.387. DOI: https://doi.org/10.12968/bjon.2014.23.7.387
Tanphiphat C, Watcharapruk T. Textbook of surgery. Bangkok, Thailand: Chulalongkorn University Press; 1998 (in Thai).
Ladasoontorn S, Kanogsunthorntrat N, Chaiviboontham S. The effect of video assisted teaching program on ostomy care knowledge and skills among new ostomate’s caregivers. Rama Nurs J. 2019;25(1):43-57. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/138851/129520 (in Thai).
Plueangklang A, Chaiviboontham S, Sa-ngasoongsong P, Buangam C. Effect of the foot and ankle exercise on blood flow velocity of the common femoral vein in patients with hip fracture. Rama Nurs J. 2021;27(1):92-107. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/242895/170573 (in Thai).
Shabanzadeh DM, Sørensen LT. Alcohol consumption increases post-operative infection but not mortality: a systematic review and meta-analysis. Surg Infect (Larchmt). 2015;16(6):657-68. doi: 10.1089/sur.2015.009. DOI: https://doi.org/10.1089/sur.2015.009
Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268-79. doi: 10.1007/s12630-011-9652-x. DOI: https://doi.org/10.1007/s12630-011-9652-x
Seretis C, Kaisari P, Wanigasooriya K, Shariff U, Youssef H. Malnutrition is associated with adverse postoperative outcome in patients undergoing elective colorectal cancer resections. J BUON. 2018;23(1):36-41. PMID: 29552757.
Kabata P, Jastrzębski T, Kąkol M, Król K, Bobowicz M, Kosowska A, et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition- -prospective randomized controlled trial. Support Care Cancer. 2015;23(2):365-70. doi: 10.1007/s00520-014-2363-4. DOI: https://doi.org/10.1007/s00520-014-2363-4
Kale PM, Mohite VR, Chendake MB, Gholap MC. The effectiveness of pre-operative deep breathing exercise on post-operative patients of abdominal surgery. Asian J Pharm Clin Res. 2017;10(2):157-60. doi: 10.22159/ajpcr.2017.v10i2.14912. DOI: https://doi.org/10.22159/ajpcr.2017.v10i2.14912
Cassidy MR, Rosenkranz P, McCabe K, Rosen JE, McAneny D. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg. 2013;148(8):740-5. doi: 10.1001/jamasurg.2013.358. DOI: https://doi.org/10.1001/jamasurg.2013.358
Arık S, Çevik K. Effect of postural drainage and deep breathing-cough exercises on oxygen saturation, triflo volume and pulmonary function test in patients with COPD. J Clin Exp Invest. 2021;12(4):em00780. doi: 10.29333/jcei/11269. DOI: https://doi.org/10.29333/jcei/11269
Oruç Z, Kaplan MA. Effect of exercise on colorectal cancer prevention and treatment. World J Gastrointest Oncol. 2019;11(5):348-66. doi: 10.4251/wjgo.v11.i5.348. DOI: https://doi.org/10.4251/wjgo.v11.i5.348
Saelao K, Kanungsukkasem V. Effects of arm swing exercise and walking on health-related physical fitness of the elderly women. J Sports Sci Health. 2012;13(1):92- 103 (in Thai).
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Pacific Rim International Journal of Nursing Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
