The Effect of Patient Education on Anxiety Levels in Patients Receiving Chemotherapy for the First Time

s to determine significance to the project no relevant articles were found. Careful review of reference lists of the selected evidence yielded two additional practice guidelines (American Society of Clinical Oncology/Oncology Nursing Society [ASCO/ONS], 2012; NCCN, 2013). To ensure adequate evidence was found, a second literature search was performed, using different key words. The terms used for the second search were anxiety as a major concept AND chemotherapy or cancer AND treat or manage or prevent. The same methods, inclusion and exclusion criteria, and limiters for date and language were used in the second search. The second search of JBI, Cochrane, and National Guidelines Clearinghouse did not yield additional relevant evidence. A search in MEDLINE was performed yielding a total of 274 hits. After reviewing titles and abstracts for relevance an additional two were selected based on aforementioned inclusion and THE EFFECTS OF PATIENT EDUCATION 24 exclusion criteria (Jacobsen & Jim, 2008; Traeger, Greer, Fernandez-Robles, Temel & Pirl, 2012). A similar search in CINAHL yielded 157 results. Many articles were repeated from previous searches and many articles were considered irrelevant due to the psychological nature of study. There were no additional articles added from the last search in CINAHL. A total of 10 articles were included in the final review of the literature. Description of Levels of Evidence The hierarchy of evidence rating system developed by Melnyk and FineoutOverholt (2011) was utilized to organize the evidence. Level I, the highest level of evidence, includes systematic reviews and metaanalyses of randomized controlled trials. Level I evidence summarizes the best evidence on a certain topic and is used to develop practice guidelines. A meta-analysis summarizes findings from multiple studies creating a summary statistic that is more valid than results from individual studies. SRs are a scholarly synthesis of the literature that aims to answer a specific clinical question. Level II of the hierarchy consists of results obtained from well-designed randomized controlled trials. A RCT rigorously tests an intervention by careful manipulation of an intervention. Level III and Level IV evidence consists of results obtained from controlled trials without randomization, and casecontrol, or cohort studies. Level V on the hierarchy system contains evidence from systematic reviews of qualitative and descriptive studies, while Level VI is evidence from a single descriptive or qualitative study. The lowest level of evidence, Level VII, comes from expert opinion or opinion of certain authorities (Melnyk & Fineout-Overholt, 2011). Much high-level evidence was found to support the new intervention of this EBP project. One SR (Prouse, 2010) three practice guidelines (ASCO/ONS, 2012; NCCN, 2013; Sheldon, Swanson, Dolce, Marsh & Summers, 2008), and one evidence summary (Jacobsen & Jim, 2008) were among the Level I evidence. One RCT (Williams & Schreier, 2005) and one literature review (Traeger, Greer, Fernandez-Robles, Temel & THE EFFECTS OF PATIENT EDUCATION 25 Pirl, 2012) comprised Level II evidence. Two pilot studies qualified as Level VI evidence (Malone, 2007; Mann, 2011). One piece of evidence was expert opinion (Stephenson, 2006), classified as Level VII on the hierarchy system (see Table 2.1). THE EFFECTS OF PATIENT EDUCATION 26