Educational interventions that promote self-care in the person at risk of chemotherapy-associated venous thromboembolism
DOI:
https://doi.org/10.31877/on.2026.53.04Keywords:
Cancer, Nursing care, Primary and secondary prevention, Antineoplastic agents, Venous thrombosisAbstract
Introduction: Venous thromboembolism represents a frequent and serious complication in the person with oncologic disease under chemotherapy, increasing morbidity, mortality and overall impact on quality of life.
Objective: To understand whether the educational interventions identified and implemented for the person at risk of chemotherapy-associated venous thromboembolism promote self-care in the prevention and management of this complication.
Methodology: Descriptive and exploratory study, which includes a nursing intervention structured in two nursing consultations (in-person at Day 1, and non-in-person at Day 8), risk assessment, education about signs and symptoms of venous thromboembolism, healthy lifestyle and therapeutic regimen adherence. The sample consists of 16 participants undergoing ambulatory treatment.
Results: Improvement of the self-care behaviour in the maintenance, monitoring, management and confidence in the self-care.
Conclusion: Improvement in the health literacy and absence of venous thromboembolic event. Data suggest that the educational intervention constitutes an effective strategy in the prevention and management of venous thromboembolism.
Downloads
References
1. Mahajan A, Brunson A, Adesina O, Keegan T, Wun T. The incidence of cancer-associated thrombosis is increasing over time. Blood Adv. 2022;6(1):307–20. doi:10.1182/bloodadvances.2021005590.
2. Noble S, Prout H, Nelson A. Patients' experiences of living with cancer-associated thrombosis: the PELICAN study. Patient Prefer Adherence. 2015;9:337–45. doi:10.2147/PPA.S79373.
3. Bayadinova J, Sardo L, Penton L, Jenkins S. "Spot the CLOT": awareness of cancer-associated thrombosis in healthcare providers. Can Oncol Nurs J. 2022;32(2):325–30. doi:10.5737/23688076322325330.
4. Streiff MB, Holmstrom B, Angelini D, Ashrani A, Elshoury A, Fanikos J, et al. Cancer-associated venous thromboembolic disease, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;19(10):1181–201. doi:10.6004/jnccn.2021.0047.
5. Gramaça J, Lopes A, Ganhão M, Gonçalves J, Gameiro R, Fernandes I, et al. Practical model for implementation of cancer-associated thrombosis prevention in the outpatient setting. Thromb Update. 2024;16:100179.
6. Razak NBA, Jones G, Bhandari M, Berndt MC, Metharom P. Cancer-associated thrombosis: an overview of mechanisms, risk factors, and treatment. Cancers (Basel). 2018;10(10):380. doi:10.3390/cancers10100380.
7. Grover SP, Hisada Y, Kasthuri RS, Reeves BN, Mackman N. Cancer therapy-associated thrombosis. Arterioscler Thromb Vasc Biol. 2021;41(4):1291–305. doi:10.1161/ATVBAHA.120.314378.
8. Mulder FI, Horváth-Puhó E, van Es N, van Laarhoven HWM, Pedersen L, Moik F, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood. 2021;137(14):1959–69. doi:10.1182/blood.2020007338.
9. Bayadinova J, Sardo L, Higgins-Nogareda V, Scott J, MacKinnon B. "Spot the CLOT": what cancer patients want to know. Can Oncol Nurs J. 2022;32(1):145–50. doi:10.5737/23688076321145150.
10. Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021;5(4):927–74. doi:10.1182/bloodadvances.2020003442.
11. Biagioli V, Drury A, Wells M, Eicher M, Kelly D. Self-care and cancer: comment on Riegel et al. (2020) "Characteristics of self-care interventions for patients with a chronic condition: a scoping review". Int J Nurs Stud. 2021;115:103861. doi:10.1016/j.ijnurstu.2021.103861.
12. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. Adv Nurs Sci. 2012;35(3):194–204. doi:10.1097/ANS.0b013e318261b1ba.
13. Riegel B, Matarese M, Barbaranelli C, Luciani M, Ausili D, Dickson VV, et al. Measuring self-care: a description of the family of disease-specific and generic instruments based on the Theory of Self-Care of Chronic Illness. J Cardiovasc Nurs. 2025;40(5)–88. doi:10.1097/JCN.0000000000001146.
14. Massouh A, Skouri H, Cook P, Huijer HAS, Khoury M, Meek P. Self-care confidence mediates self-care maintenance and management in patients with heart failure. Heart Lung. 2020;49(1):30–5. doi:10.1016/j.hrtlng.2019.07.008.
15. Hunter DJ, McCallum J, Howes D. Defining exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare. J Nurs Health Care. 2019;4(1).
16. Marcelino A, Martins P, Frade A, Miguel S, Costa M. Nursing interventions for people at risk of venous thromboembolism associated with chemotherapy: scoping review. OncoNews. 2025;(50)–95.
17. Vilelas J. Investigação: o processo de construção do conhecimento. 3ª ed. Lisboa: Edições Sílabo; 2020.
18. Pereira RDM, Alvim NAT. Delphi technique in dialogue with nurses on acupuncture as a proposed nursing intervention. Esc Anna Nery. 2015;19(1):174–80. doi:10.5935/1414-8145.20150024.
19. Holmes CE, Ades S, Gilchrist S, Douce D, Libby K, Rogala B, et al. Successful model for guideline implementation to prevent cancer-associated thrombosis: venous thromboembolism prevention in the ambulatory cancer clinic. JCO Oncol Pract. 2020;16(9)–74. doi:10.1200/JOP.19.00697.
20. Sevestre MA, Gaboreau Y, Douriez E, Bichon V, Bozec C, Gendron P, et al. Care pathways for patients with cancer-associated thrombosis: from diagnosis to long-term follow-up. Arch Cardiovasc Dis. 2024;117(1):6–15. doi:10.1016/j.acvd.2023.11.003.
21. Khorana AA. Cancer and thrombosis: implications of published guidelines for clinical practice. Ann Oncol. 2009;20(10):1619–30. doi:10.1093/annonc/mdp068.
22. Rakhshani T, Najafi S, Javady F, Taghian A, Mohammadkhah F, Jeihooni AK. The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial. BMC Cancer. 2022;22:770. doi:10.1186/s12885-022-09881-x.
23. Falanga A, Russo L, Milesi V, Vignoli A. Mechanisms and risk factors of thrombosis in cancer. Crit Rev Oncol Hematol. 2017;118:79–83. doi:10.1016/j.critrevonc.2017.08.003.
24. Wang R, Liu R, Zhao L, Xu D, Hu L. Influence of type 2 diabetes mellitus on Khorana venous thromboembolism risk in colorectal cancer patients. Rev Esp Enferm Dig. 2017;109(7):503–9. doi:10.17235/reed.2017.5037/2017.
25. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol. 2023;41(16):3063–71. doi:10.1200/JCO.23.00294.
26. Cardeira A, Amorim A, Silva C, Valério E, Penaforte M. Guia orientador de boas práticas na administração de terapêuticas antineoplásicas sistémicas à pessoa com doença oncológica [Internet]. Lisboa: Ordem dos Enfermeiros; 2023 [cited 2024 Apr 13]. Available from: https://www.ordemenfermeiros.pt/media/29937/gobp_doncologica_ok.pdf
27. Associação de Enfermagem Oncológica Portuguesa. Noções básicas de oncologia para jovens enfermeiros [Internet]. Domingues B, Cardoso F, Araújo J, Frade I, Ferreira M, Costa S, et al., editors. Porto: Associação de Enfermagem Oncológica Portuguesa; 2020 [cited 2023 Nov 13]. Available from: https://www.aeop.pt/ficheiros/NocoesBasicasOncologia.pdf
28. Noble S, Nelson A, Scott J, Berger A, Schmidt K, Swarnkar P, et al. Patient experience of living with cancer-associated thrombosis in Canada (PELICANADA). Res Pract Thromb Haemost. 2020;4(1):154–60. doi:10.1002/rth2.12274.
29. Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Elkind MSV, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol. 2017;70(8):926–38. doi:10.1016/j.jacc.2017.06.047.
30. Haggstrom L, Parmar G, Brungs D. Central venous catheter thrombosis in cancer: a multi-centre retrospective study investigating risk factors and contemporary trends in management. Clin Med Insights Oncol. 2020;14:1179554920953097. doi:10.1177/1179554920953097.
31. Liz-Pimenta J, Tavares V, Neto B, Santos J, Guedes C, Araújo A, et al. Thrombosis and cachexia in cancer: two partners in crime? Crit Rev Oncol Hematol. 2023;186:103996. doi:10.1016/j.critrevonc.2023.103996.
32. Paulsen B, Gran OV, Severinsen MT, Hammerstrøm J, Kristensen SR, Cannegieter SC, et al. Association of smoking and cancer with the risk of venous thromboembolism: the Scandinavian Thrombosis and Cancer cohort. Sci Rep. 2021;11(1):18752. doi:10.1038/s41598-021-98062-0.
33. Feng Y, Feng X, Wan R, Luo Z, Qu L, Wang Q. Impact of exercise on cancer: mechanistic perspectives and new insights. Front Immunol. 2024;15:1438348. doi:10.3389/fimmu.2024.1438348.
34. Silva SP, Santos JMO, Silva MP, Costa RMG, Medeiros R. Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia. J Cachexia Sarcopenia Muscle. 2020;11(3):619–35. doi:10.1002/jcsm.12528.
35. Riegel B, Jaarsma T, Lee CS, Strömberg A. Integrating symptoms into the Middle-Range Theory of Self-Care of Chronic Illness. Adv Nurs Sci. 2019;42(3):206–15. doi:10.1097/ANS.0000000000000237.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ana Lopes Marcelino, Patrícia Matos Martins, Inês Frade, Alexandra Pinto Santos
This work is licensed under a Creative Commons Attribution 4.0 International License.
