An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy.
OBJECTIVE
To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy.


BACKGROUND
It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway.


METHODS
An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process.


CONCLUSIONS
There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity.


CONCLUSIONS
The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment skin framework into their daily routine. Such validated tools may add value to postradiotherapy patient care by providing a consistency of management and accordingly refining best practice.
Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tas., Australia.|La Trobe University, Melbourne, Vic., Australia.
Carol R
CR
Baines
La Trobe University, Melbourne, Vic., Australia.
William
W
McGuiness
Nursing and Midwifery, Hobart, Tas., Australia.|Department of Health & Human Services, Hobart, Tas., Australia.|University Tasmania, Hobart, Tas., Australia.
Geraldine A
GA
O'Rourke
D006801:Humans; D058958:Organs at Risk / Q000528:radiation effects; D005791:Patient Care / Q000379:methods; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology*; D011879:Radiotherapy Dosage; D012867:Skin / Q000293:injuries / Q000528:radiation effects*
epidermal breakdown; radiotherapy; skin