The development, implementation and evaluation of guidelines for the management of breast cancer related lymphoedema

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Abstract
A project was funded by the UK's Department of Health to develop national guidelines for breast cancer related lymphoedema using a Consensus Strategy. This involved the organization of a consensus conference with a multidisciplinary panel of experts, an extensive literature review, the production of clinical guidelines and the implementation of the guidelines at three pilot sites (breast unit, hospice and community). The EORTC QLQ-30, MOS SF-36 and a standard assessment form were used to evaluate patient outcome. Diaries and semi-structured interviews were used to elicit data on practitioner compliance and practical issues of implementing change using clinical practice guidelines. Results showed stable or improved scores in all categories of physical, social and emotional functioning and a stable or measured decrease in limb volume for 75% of the sample. Qualitative data obtained from practitioners demonstrated high levels of compliance from practitioners and patients and offers useful recommendations. This project highlights the importance of raising awareness of lymphoedema through the development and utilization of research-based, patient-centred guidelines.