Prevention and management of radiation dermatitis for patients with nasopharyngeal carcinoma: a best practice implementation project

Radiation dermatitis(RD) is one of the most common acute toxicities of radiotherapy, affecting approximately 85%~95% of patients. Severe RD can substantially impair quality of life and may compromise treatment continuity, thereby reducing the effectiveness of radiotherapy. Despite the availability of clinical guidelines, RD prevention and management in routine practice remain inconsistent. This best practice implementation project aimed to implement an evidence-based strategies for the prevention and management of RD in patients with nasopharyngeal carcinoma (NPC), improve compliance with best-practice recommendations, and reduce severe RD. This was an evidence-based audit and feedback project that used a three-phase approach at a tertiary cancer center in China. We conducted an evidence-based audit-and-feedback project using the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) framework at a tertiary cancer center in China. Phase 1 involved developing 15 evidence-based audit criteria and conducting a baseline audit (22 patients; 26 nurses). Phase 2 identified barriers to best practice and implemented targeted GRiP-informed strategies. Phase 3 conducted a follow-up audit using the same criteria to evaluate changes in compliance and inform sustainability. After implementation, the incidence of severe RD(≥ Grade Ⅲ) decreased from 9.09%(2/22) to 0% (0/22 cases) at follow up. A comparison between the pre-implementation and post-implementation findings showed significant improvements for all audit criteria, and patients’ compliance with RD management protocol increased to between 59.09% and 100%. Notably, compliance increased from 0% to 100% for system-level criteria (protocol availability and multidisciplinary team establishment) and several key practice criteria. Implementing this evidence-based RD prevention and management program improved practice compliance and reduced severe RD among patients with NPC.