title: Recommendations for symptom management in women with vulvar neoplasms after surgical treatment: An evidence-based guideline.
abstract: OBJECTIVE
  To develop an evidence-based guideline for nurses and other health care professionals involved in pre- and postsurgical care of women with vulvar cancer (VC) or vulvar intraepithelial neoplasia (VIN).
  
  
  METHODS
  This evidence-based guideline was developed according to six domains of the methodological framework AGREE II. Literature research with focus on cancer care, symptom management and self-management/counselling was conducted from April to August 2013 in the databases CINAHL, Cochrane Library, PsycINFO, PubMed as well as in 14 international guideline databases. Interdisciplinary experts (n = 14) were involved in the development of the guideline from December 2013 to January 2014. This guideline is currently tested in the WOMAN-PRO II RCT (Clinical Trial No: NCT01986725).
  
  
  RESULTS
  For the definition of recommendations, five guidelines, one meta-analysis, two systematic reviews and two randomized controlled trials were included. In total, 24 recommendations were formulated to answer 22 clinical questions based on patients' perspective and experts' opinion. Evidence ranged from 3.5 to 5 (3.5 = weak evidence and/or clinical relevance, 5 = best evidence and/or clinical relevance). The recommendations were subsumed under different themes regarding physical, psychological and psychosocial aspects.
  
  
  CONCLUSIONS
  The clinical practice guideline developed in this study firstly provides recommendations for symptom management issues focusing on self-management interventions for women with VC or VIN. As an interdisciplinary guideline it should be used in addition to the existing medical guideline in the German speaking context.
authors.affiliation: Institute of Applied Nursing Sciences IPW-FHS, FHS St.Gallen, University of Applied Sciences, Switzerland. Electronic address: andrea.kobleder@fhsg.ch.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kobleder
authors.affiliation: Department of Nursing Science, University of Vienna, Austria. Electronic address: silvia.mona.raphaelis@univie.ac.at.
authors.forename: Silvia
authors.initials: S
authors.lastname: Raphaelis
authors.affiliation: Tumor and Breast Center, St. Gallen, Switzerland. Electronic address: aglaus@sg.zetup.ch.
authors.forename: Agnes
authors.initials: A
authors.lastname: Glaus
authors.affiliation: University Center for Palliative Care, Inselspital, University Hospital Berne, Switzerland. Electronic address: monica.fliedner@insel.ch.
authors.forename: Monica
authors.initials: M
authors.lastname: Fliedner
authors.affiliation: Department of Obstetrics and Gynecology, Inselspital, University Hospital Berne, Switzerland. Electronic address: michel.mueller@insel.ch.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
authors.affiliation: Department of Obstetrics and Gynecology, Inselspital, University Hospital Berne, Switzerland. Electronic address: dinah.gafner@insel.ch.
authors.forename: Dinah
authors.initials: D
authors.lastname: Gafner
authors.affiliation: Institute of Applied Nursing Sciences IPW-FHS, FHS St.Gallen, University of Applied Sciences, Switzerland. Electronic address: larissa.gehrig@outlook.com.
authors.forename: Larissa
authors.initials: L
authors.lastname: Gehrig
authors.affiliation: Institute of Applied Nursing Sciences IPW-FHS, FHS St.Gallen, University of Applied Sciences, Switzerland; Sydney Nursing School, University of Sydney, Australia. Electronic address: beate.senn@fhsg.ch.
authors.forename: Beate
authors.initials: B
authors.lastname: Senn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055318:Evidence-Based Nursing / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009859:Oncology Nursing / Q000592:standards*; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D014846:Vulvar Neoplasms / Q000451:nursing* / Q000601:surgery*
keywords: Evidence-based guideline; Self-management; Symptom-management; Symptoms and distress; Vulvar cancer; Vulvar intraepithelial neoplasia