1. DiGiulio, Sarah

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ORLANDO, Fla.-The Oncology Nursing Society has provided five cancer-specific recommendations that were included in the American Academy of Nursing's recent 'Choosing Wisely' list. This list is the first from nurses for the American Board of Internal Medicine Foundation initiative, which is intended to identify and reduce practices and procedures that are commonly done, but may not always be necessary or in the best interests of patient health.

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"ONS is proud to be part of this important campaign," ONS President, Margaret Barton-Burke, PhD, RN, FAAN, said in a news release. "The Choosing Wisely campaign is a practical and meaningful approach to facilitate evidence based practice and quality health care."


The AAN list was released in April during the ONS Annual Congress here-and is available on the ABIM's 'Choosing Wisely' website ( and on the AAN's website (


The ONS recommendations were created based on input from a member survey asking for recommendations, and input from members who are contributors to ONS's Putting Evidence into Practice (PEP) resources. The list was written by Marc Irwin, RN, MN, PhD, an ONS Research Associate. The recommendations were reviewed by fellows of the AAN prior to submission to the ABIM.


The items on the list were gleaned from the PEP resources, which identify the level of evidence for interventions used in 20 different topics areas, Irwin explained in an email. "The items [on the 'Choosing Wisely' list] were chosen based on information that these practices may be commonly used, have associated costs or adverse effects, and have evidence that shows they are ineffective."


First Nursing List

Though the first 'Choosing Wisely' lists were released in 2012 with the launch of the campaign and some oncology organizations have already submitted multiple lists-including the American Society of Clinical Oncology (OT 11/25/13 issue), the American Society for Radiation Oncology (OT 10/10/14 issue), and the American Society of Hematology (OT 1/10/15 issue)-this list is the first specifically from nursing organizations.


"ONS has been participating in the AAN initiative to submit nursing items to this ABIM initiative since they began the effort," Irwin noted. "It makes sense for various professions to work together rather than creating their own initiatives. Other nursing organizations [in addition to ONS] have also had items accepted via the AAN."


She noted there were challenges in creating a list for this initiative that was specifically for nursing. The recommendations for this campaign for the AAN list are intended to be solely within the realm of nursing practice and of high costs, Irwin said. These parameters can make it challenging to identify nursing-specific items, as many nursing actions are interdisciplinary in nature and can be influenced by physicians' orders; and many interventions identified by nurses that can have significant effect on patients and caregivers that may not be necessary are not necessarily high cost.


ONS plans to continue to work with the AAN and other organizations using the infrastructure and criteria already established, Irwin said-though she did not specify if and when another list would be released.


The Oncology-Specific Recommendations

The oncology-specific 'Choosing Wisely' recommendations identified for this most recent list by ONS are:


* Don't advise patients to avoid physical activity or exercise during or after treatment for cancer to manage fatigue (OR, Don't neglect to advise patients with cancer to get physical activity and exercise during and after treatment to manage fatigue and other symptoms);


* Don't use L-carnitine/acetyl-L-carnitine supplements to prevent or treat symptoms of peripheral neuropathy in patients receiving chemotherapy for treatment of cancer;


* Don't use mixed medication mouthwash, commonly termed "magic mouthwash," to prevent or manage cancer treatment-induced oral mucositis;


* Don't administer supplemental oxygen to relieve dyspnea in patients with cancer who do not have hypoxia; and


* Don't use aloe vera on skin to prevent or treat radiodermatitis.