Table 4 Revisions to adapted SPG

Chest pain question appears as two separate questions, rather than linked together.

“So it’s not an automatic question if somebody says no I don’t have chest pain, then you’re not gonna ask them that question” RN-onc

Revised to “If you have chest pain, does it go away with rest or medication?”

Language used to assess for patients tachycardia is unclear.

“And then, I’m not sure how I would answer as a patient ‘Do you have a fast heart beat that won’t slow down?’” RN-onc

Revised to “Do you have a fast heartbeat that does not slow down when you rest?”

Self-care strategy for limiting sodium and fluid intake has unfamiliar units (self-care strategies number 11 and 12).

“I would have no idea as a layperson if I, when I see less than 2000 mg a day.” RN-cardiac

“Have you tried limiting your salt intake to, this is a funny number, right? What is 0.4 of a teaspoon of salt?” MD

Revised to “Have you tried limiting your salt intake to under half a teaspoon (under 2000 mg) per day?” and “Are you aiming for a fluid intake of 6 to 8 cups (1.5 to 2 L) per day?”

Lacking an assessment of smoking and drinking prior to offering self-care strategy (self care strategy numbers 13 and 14).

“‘Have you tried to stop, uh, to stop smoking or drinking?’ Well how do you know that I do?” RN-onc

Revised to “If you smoke, have you tried to stop?” and “If you drink more than 1–2 standard alcoholic drinks per day, have you tried to reduce your alcohol intake to 1 drink per day?”

Lacking something in the title to differentiate adapted SPG from original COSTaRS SPG.

“even just reflecting in the title of the practice guide that this one would be related to cardiotoxicity.” RN-cardiac

Revised to “Breathlessness/Dyspnea Practice Guide: Cardiotoxicity”

Missing a way for the nurse to document whether chest pain has gone away with rest and/or medication, and which medication relieved the pain.

“so should the clinician be able to, to uh, document whether the pain does subside with medication or with rest?” RN-cardiac

Revised to

“If you have chest pain, does it go away with:

⃞ Rest or ⃞ Medication?______________”

Missing a way for the nurse to document how many pillows the patient has increased for sleeping.

“is it important to note the number of pillows that they have increased?” RN-cardiac

Revised to “Have you increased the number of pillows you need to sleep? Increase in number of pillows:______”

Missing space for the nurse to document the patient’s description of their dyspnea.

“So is this space intended for the description?” RN-cardiac

Revised to “Does your shortness of breath interfere with your daily activities at home and/or at work? Describe:”

Unclear what the coloured boxes are.

“You might even have a little title that says legend” RN-cardiac

Revised to “Legend: ♥ Cardiology

★ Cardiology and Oncology”

Self-care strategy suggesting exercise requires emphasis on symptom stability.

“And so, perhaps to start the question, uh, state, when breathlessness is stable.” RN-cardiac

Revised to “When breathlessness is stable, have you tried 30 min of exercise at least twice a week?”

Lacking space for the nurse to document.

“I often think of as, the whiteness being paper real-estate” RN-cardiac

Revised to make margins smaller around document.

Unsure if patient would remember how many pillows they have increased from their baseline.

“if there was a baseline I like the idea of that” RN-cardiac

Revised to “Baseline #:______” and “Current #:______”

Lacking space in the self-care strategy for weight management to document the patients’ weight at the time of the call (self-care strategy number 16).

“the last time you called your weight was” RN-cardiac

Revised to “Are you weighing yourself daily (after waking and voiding, before dressing and eating)? Weight______”

Missing assessing for paroxysmal nocturnal dyspnea.

“I notice you don’t ask about, um, PND though in here, right?” MD

Revised to “Are you waking up at night with shortness of breath?”

Lacking space for nurse to document if patient is unsure whether he/she have gained or lost weight at time of the call.

“I find that unless they know about heart failure and you’ve had, they’ve already had teaching on it they’re probably not weighing themselves everyday” MD

Revised to “Have you gained or lost weight in the last week? ⃞ Unsure”

Lacking nitrates to assist with dyspnea.

“nitrates also help heart failure so” MD

Revised to “Nitrates – Benefits Balanced With Harm”

Printer only prints in black-and-white rather then in colour.

“and then I saw the colours because this I thought, my first comment was ‘What’s this?’” RN-onc

Revised to ♥ for cardiology evidence, and ★ for both cardiology and oncology evidence