Research priorities in haemato-oncology nursing: Results of a literature review and a Delphi study

Nursing as a balancing act in allogeneic hematopoietic cell transplantation -nurses' experiences through participation in workshops

PURPOSE

Registered nurses have a key role in supporting patients during the trajectory of allogeneic hematopoietic cell transplantation (allo-HCT). However, the circumstances for performing nursing are not previously outlined therefore the purpose of this study was to explore the conditions for nursing care in allo-HCT.

METHOD

An explorative design, inspired by Experienced based co-design was used to gather experiences, thoughts and visions of nursing care in allo-HCT by means of workshops. Thematic analysis was applied to analyse the data.

RESULT

An overarching theme that was defined from the data was nursing as a balancing act and illustrating conditions for performing nursing in a highly medical-technical environment. The theme included three sub-themes: Fragmented care vs holistic care outlining how the holistic approach to care disappeared when the care became fragmented; Proximity vs distance illuminating the balance between seeing the patient as an independent person despite illness and the need for support; Teamwork vs stand-alone demonstrating the difficulties inherent in adapting to both teamwork and independence in nursing.

CONCLUSION

This study shows that the conditions for RNs and nursing care in allo-HCT care is to balance tasks and approach towards the patient and themselves. RNs must weigh and balance what is most important in the moment and where something else often has to be put aside. It is difficult for RNs to find the time to plan each patient's care and to support the patient in the way they see as most optimal to prepare for discharge, self-care and rehabilitation.

Cancer nursing research priorities: A rapid review

PURPOSE

Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019 and 2022.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th^, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality.

RESULTS

Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice.

CONCLUSION

The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.

Psychosocial interventions with art and music during stem cell transplantation: An integrative review

OBJECTIVES

The objective of this study is to systematically review the literature with the following aims: to survey the art and music interventions offered to the stem cell transplant population; to define the interventions' beneficial properties by conceptualising themes; to analyse these themes using behavioural activation principles as a lens and explore their value in alleviating isolation-related distress.

BACKGROUND

Patients undergoing stem cell transplant are at great risk of psychological morbidity, partly on account of prolonged hospital stays in protective isolation. This risk extends beyond discharge and into ambulatory care, negatively affecting quality-of-life and survival rates of the transplant recipients.

DESIGN

Integrative review methodology.

METHODS

A systematic search of 10 bibliographic databases was undertaken using terms relating to art, music and stem cell transplantation for the years 2012 to 2019. Records were assessed for quality and risk-of-bias using a critical appraisal tool and following the PRISMA Systematic Review checklist to guide reporting. Studies were analysed narratively and thematically.

RESULTS

The 16 papers were of mixed quality. Findings and treatment effects differed between and within studies. The beneficial attributes of the treatments were clustered and divided into two groups. The first consisted of intrinsic, patient-focussed factors: (1) Creative outlet or acquisition of a new skill; (2) achievement of normality; (3) mutual or peer-support; (4) relationship-building and (5) meaningful recreation, distraction and diversion. The second group considered extrinsic factors: (6) Improved communication; (7) enhanced spiritual care and (8) better healthcare experience.

CONCLUSIONS

Several art and music interventions have been attempted which were beneficial to patients and generated a sense of achievement, connection and enjoyment. The interventions appear to uphold the principles of person-centred holistic care and have potential to generate a high-quality, supportive healthcare and working environment.

RELEVANCE TO CLINICAL PRACTICE

Psychosocial interventions with art and music have improved the care and experience of patients undergoing stem cell transplant.

The Bachelor's thesis in nursing: Characteristics and students' approach and satisfaction

AIM

The aim of the study was to describe the characteristics of the Bachelor's thesis of fourth-year nursing students at a Spanish public university, the criteria that students used to choose a topic and students' degree of satisfaction after completing the Bachelor's thesis.

DESIGN

Quantitative study.

METHODS

We examined 420 Bachelor's theses carried out from 2013 to 2018 and conducted an online survey among fourth-year students in the 2017-18 and 2018-19 academic years (81 completed questionnaires).

RESULTS

The Bachelor's thesis took the form of a research proposal. The most frequent proposal type was a qualitative hospital-based study whose objective was to understand the experiences of adult or adolescent patients, close family members, or nurses. Students chose topics for personal reasons. Most participants reported feeling satisfied with the knowledge and skills acquired.

CONCLUSIONS

Students completing a Bachelor's thesis in the form of a research proposal have the potential to transfer their research skills to their nursing practice.

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

Purpose

Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death.

Method

Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach.

Results

Five inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home.

Conclusions

Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.

•

Patients with haematological malignancies are more likely to die in hospital than people with other cancers.

•

No previous research has reported on UK haematology nurses' perspectives of their patients' place of care and place of death.

•

Hospital deaths were largely attributed to disease characteristics, nature of treatment and difficulties with prognostication.

•

However, other modifiable factors were also identified as barriers to death at home.

Research agenda for life-threatening cancer

OBJECTIVES

The aim of this study was to identify future research agendas that reflect the concerns and unexplored areas of interest for patients with life-threatening cancer, their relatives and the clinical specialists during the cancer trajectory.

METHODS

Six focus group discussions were conducted addressing two different cancer trajectories: primary malignant brain tumour and acute leukaemia. For each of the two cancer trajectories, separate FGIs were carried out with patients, relatives and clinical specialists to identify important concerns, challenges and uncertainties. The FGIs were video/audio-recorded, transcribed and thematically analysed within and across FGI groups to construct research topics. Finally, the literature was reviewed for existing evidence concerning the identified research topic(s) to strengthen the suggested research agendas.

RESULTS

New research agendas related to high-grade glioma brain tumour and acute leukaemia with corresponding research questions were formulated within the topics of supportive care/palliation, education/information, rehabilitation, complementary and alternative therapy and organization of health care.

CONCLUSION

User involvement in identifying research agendas has the potential to improve quality of care for patients and caregivers across the cancer trajectory, while minimizing the gap in research between the healthcare user and healthcare provider.

Factors influencing infection prevention self-care behaviors in patients with hematologic cancer after discharge

PURPOSE

The purpose of this study is to investigate the conditions and influencing factors behind infection prevention self-care behaviors performed at home by hematologic cancer patients with a central venous catheter inserted before hospital discharge, and to identify additional external factors influencing these self-care behaviors.

METHODS

This is a descriptive survey study conducted with 147 patients with hematologic cancer who were hospitalized and re-admitted to a university hospital in Korea. Infection prevention self-care behaviors, knowledge, and family support were measured using scales developed through a preliminary survey and validity testing.

RESULTS

The score for infection prevention self-care behaviors was 3.67 ± 0.81 (out of 5), knowledge was 68.8 ± 18.2 (out of 100), and family support was 4.21 ± 2.14 (out of 7). Infection prevention self-care knowledge (β = 0.443, p < 0.001) and economic status (β = 2.102, p = 0.05) both had a significant effect on infection prevention self-care behaviors. The total explanatory power for infection prevention self-care behaviors by two variables was 37.1%.

CONCLUSIONS

Infection prevention self-care behaviors were found to be significantly affected by infection prevention self-care knowledge and economic status. Developing and applying effective educational programs to improve infection prevention self-care knowledge will increase self-care behaviors. Additionally, nursing interventions should assess patients' economic status, their performance of oral care and knowledge of central venous catheter management.

Haemato-oncology patients' perceptions of health-related quality of life after critical illness: A qualitative phenomenological study

INTRODUCTION

Haemato-oncology patients often require critical care support due to side-effects of treatment. Discharge can mark the start of an uncertain journey due to the impact of critical illness on health-related quality of life. Qualitatively establishing needs is a priority as current evidence is limited.

AIMS

To qualitatively explore perceptions of haemato-oncology patients' health-related quality of life after critical illness and explore how healthcare professionals can provide long-term support.

METHODS

Nine in-depth interviews were conducted three to eighteen months post-discharge from critical care. Phenomenology was used to gain deeper understanding of the patients' lived experience.

SETTING

A 19-bedded Intensive Care Unit in a specialist cancer centre.

FINDINGS

Five major themes emerged: Intensive care as a means to an end; Rollercoaster of illness; Reliance on hospital; Having a realistic/sanguine approach; Living in the moment. Haemato-oncology patients who experience critical illness may view it as a small part of a larger treatment pathway, thus health-related quality of life is impacted by this rather than the acute episode.

CONCLUSIONS

Discharge from the intensive care unit can be seen as a positive end-point, allowing personal growth in areas such as relationships and living life to the full. The contribution of health-care professionals and support of significant others is regarded as critical to the recovery experience.

Patient involvement in research priorities (PIRE): a study protocol

INTRODUCTION

Patient involvement in healthcare has expanded from the clinical practice setting to include collaboration during the research process. There has been a growing international interest in patient and public involvement in setting research priorities to reduce the risk of discrepancy between what patients with cancer and their relatives experience as important unanswered questions and those which are actually researched. This study aims to challenge the conventional research process by inviting patients with life-threatening cancer (primary malignant brain tumours or acute leukaemia), relatives and patient organisations to join forces with clinical specialists and researchers to identify, discuss and prioritise supportive care and rehabilitation issues in future research.

METHODS AND ANALYSIS

This is an exploratory qualitative study comprising two sets of three focus group interviews (FGIs): one set for primary malignant brain tumours and the other for acute leukaemia. Separate FGIs will be carried out with patients and relatives including representation from patient organisations and clinical specialists to identify important unanswered questions and research topics within each group. The FGIs will be video/audio recorded, transcribed and thematically analysed. This study will contribute to a patient-centred research agenda that captures issues that patients, their relatives, clinical specialists and researchers consider important.

ETHICS AND DISSEMINATION

The study is registered at the Danish Data Protection Agency (number: 2012-58-0004) and the Scientific Ethics Review Committee of the Capital Region of Denmark (number: H-15001485). Papers will be published describing the methods applied and the supportive care and rehabilitation issues that are identified as important for future research.

TRIAL REGISTRATION NUMBER

ISRCTN57131943; Pre-results.

Developing a research agenda for nursing and midwifery: a modified Delphi study

AIM

We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia.

DESIGN

A modified Delphi technique with two rounds of questionnaires.

METHODS

The first round survey was distributed to 448 nurses and midwives with a 19.2% (n=86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale.

RESULTS

Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues.

CONCLUSION

Priorities were congruent with the organisation's strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives.

[Not Available]

La transition de l’hôpital vers le domicile, après avoir subi une greffe de cellules souches hématopoïétiques, augmente la vulnérabilité des patients relativement aux difficultés thérapeutiques, causant souvent des réhospitalisations imprévues et coûteuses. En 2011, deux lits d’hospitalisation jour/nuit pour patients atteints d’une leucémie aiguë et ayant subi une greffe de moelle osseuse ont été mis en place à un hôpital de soins tertiaires pour favoriser la réussite de la transition de l’hôpital vers le domicile. Cette étude pilote visait à étudier la rétroaction relative à la satisfaction des patients en matière de diffusion de l’information, de traitement et de soutien affectif au sujet de ces soins novateurs. Quatorze anciens patients de l’unité y ont participé. Les réponses au sondage ont indiqué une grande satisfaction en ce qui a trait aux traitements et au soutien affectif, ainsi que des possibilités d’amélioration quant à la diffusion de l’information. Les résultats de cette étude préliminaire sur la satisfaction des patients hospitalisés dans le cadre de cette initiative fournissent des observations importantes au sujet de l’expérience des patients, ce qui orientera les recherches et les pratiques futures.

Evaluating patient satisfaction on an acute leukemia/bone marrow transplant day/night treatment unit: A pilot project

The transition from hospital to home following hematopoietic stem cell transplantation increases the vulnerability for treatment challenges in patients, often resulting in unscheduled and costly hospital re-admissions. Two Acute Leukemia/ Bone Marrow Transplant Day/Night (ALBMT) inpatient beds were established in 2011 at one tertiary care hospital to support successful transition from inpatient cancer treatment to home. This pilot study aimed to investigate patient satisfaction feedback on information provision, treatment, and emotional support on this care innovation. Fourteen former unit patients participated. Survey responses indicated positive satisfaction for treatment and emotional support, and opportunities for information provision enhancement. Findings of this preliminary study exploring satisfaction of this novel inpatient initiative provide important insights into the patient experience, informing future research and practice.

Symptoms after hospital discharge following hematopoietic stem cell transplantation

Aims:

The purposes of this study were to assess the symptoms of hematopoietic stem cell transplant patients after hospital discharge, and to determine the needs of transplant patients for symptom management.

Materials and Methods:

The study adopted a descriptive design. The study sample comprised of 66 hematopoietic stem cell transplant patients. The study was conducted in Istanbul. Data were collected using Patient Information Form and Memorial Symptom Assessment Scale (MSAS).

Results:

The frequency of psychological symptoms in hematopoietic stem cell transplant patients after discharge period (PSYCH subscale score 2.11 (standard deviation (SD) = 0.69, range: 0.93-3.80)) was higher in hematopoietic stem cell transplant patients than frequency of physical symptoms (PHYS subscale score: 1.59 (SD = 0.49, range: 1.00-3.38)). Symptom distress caused by psychological and physical symptoms were at moderate level (mean = 1.91, SD = 0.60, range: 0.95-3.63) and most distressing symptoms were problems with sexual interest or activity, difficulty sleeping, and diarrhea. Patients who did not have an additional chronic disease obtained higher MSAS scores. University graduates obtained higher Global Distress Index (GDI) subscale and total MSAS scores with comparison to primary school graduates. Total MSAS, MSAS-PHYS subscale, and MSAS-PSYCH subscale scores were higher in patients with low level of income (P < 0.05). The patients (98.5%) reported to receive education about symptom management after hospital discharge.

Conclusions:

Hematopoietic stem cell transplant patients continue to experience many distressing physical or psychological symptoms after discharge and need to be supported and educated for the symptom management.

Patterns of hospice use in patients dying from hematologic malignancies

BACKGROUND

Hospice brings substantial clinical benefits to dying patients and families but is underutilized by patients dying of hematologic malignancies (HM); nationwide, only 2% of HM patients use hospice. There are 70,000 deaths among U.S. patients with hematologic malignancies yearly.

OBJECTIVE

We measured the use and length of stay (LOS) in hospice among patients with HMs at a large academic cancer center.

DESIGN

This was a single center retrospective review of adult patients (≥18 years) with lymphoma, leukemia, myelodysplastic syndrome, aplastic anemia, and multiple myeloma referred for hospice.

MEASUREMENTS

Information included demographics, transplant, hospice type, LOS, and use of "expanded access" services.

RESULTS

Fifty-nine patients were referred to hospice, and 53 utilized hospice services, 25% of 209 HM decedents. Thirty-five received home hospice and 18 used inpatient hospice. The median home hospice LOS was nine days (SD 13) and inpatient hospice six days (SD 10). Nine patients with "expanded access" hospice received only a few blood transfusions, and none received radiation.

CONCLUSIONS

HM patients are referred late or never for hospice services. Studies evaluating earlier integration of palliative and hospice care with usual HM care are warranted. We present a one-page negotiation form that we have found useful in negotiations among HM physicians, hospice medical directors, and payers.

Supportive care needs of hematological cancer survivors: a critical review of the literature

The purpose of this review was to determine the perceived supportive care needs of hematological cancer survivors, and the patient characteristics associated with higher levels of need. Medline, PsychInfo, CINAHL, EMBASE and PsycEXTRA, were searched for eligible articles published between 1979 and 2011. Ten full-text articles were identified. Extensive variation among study populations, methodologies and needs assessment measures used, made it difficult to synthesize results. Consequently, we could not confidently determine the most prevalent perceived needs of hematological cancer survivors. However, the limited data loosely suggests that concerns surrounding cancer recurrence and survival may be predominant needs experienced by hematological cancer survivors. Younger survivors were also identified by several studies as reporting higher levels of several areas of need. Future research is needed to assess the supportive care needs of large heterogeneous, population-based samples of hematological cancer survivors, utilizing valid, reliable and standardized measures of supportive care needs.

Competencies for practice in renal care: a national Delphi study

The aim of this study was to describe essential competencies relevant for professional renal nursing in Sweden. A Delphi study with four rounds was conducted from November 2008 to April 2009. A national sample of renal nurses was used to achieve consensus about the core competencies required. The 43 competencies were reviewed for face validity by external experts representing general nursing, renal nursing, stakeholders and nephrologists. The core competencies were categorised in nine areas according to their structure; nursing and medical science, information and teaching, examinations and therapies, promoting health and preventing ill health, palliative care, safety and quality, care environment, research and development and management and cooperation in the patient care pathway. Altogether these categories represent a national description of competence in renal nursing.

A survey of NAPNAP members' clinical and professional research priorities

INTRODUCTION

The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age.

METHOD

A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90 statements in two domains: Clinical Priorities and Professional Role Priorities.

RESULTS

Survey respondents strongly supported the top priorities with an average overall mean score of 4.0 or above on a 5-point Likert scale. Only three of the top 10 clinical and professional priorities differed by area of practice. No clinical priorities and only three professional priorities differed by age.

DISCUSSION

The survey results were used to develop the NAPNAP Research Agenda. Both the survey results and the agenda can provide guidance for the NAPNAP Board, committees and interests groups as they develop initiatives and programs.

Compassionate presence: The meaning of hematopoietic stem cell transplant nursing

PURPOSE

Within oncology, working with patients who are suffering or at end-of-life has been recognized repeatedly as stress-inducing, yet there is little agreement on what specifically nurses may experience as a result of their work. Further, research focused on caring work within the context of hematopoietic stem cell transplant (HSCT) nursing is almost non-existent. In light of the gap, this interpretative phenomenological study focused on enhancing the knowledge and understanding of the effect(s) of nursing work on the psychosocial health and well being of HSCT nurses.

METHOD

An interpretative phenomenological design grounded in the work of Heidegger and van Manen was used to explore nursing work among HSCT nurses. Twelve nurses from three Canadian tertiary healthcare facilities participated in multiple interviews and focus groups.

FINDINGS

Thematic analysis resulted in the emergence of four core themes and one overarching novel theme, compassionate presence. The discussion provides an overview of the novel finding, compassionate presence, which challenges the notion that working with individuals who are suffering or at end-of-life inevitably leads to adverse psychosocial effects. Implications for practice, education and research are also provided.

CONCLUSION

Compassionate presence emerged to suggest a potential buffering effect against adverse consequences of HSCT nursing work. This finding underscored the value of the relationship as an integral component of nursing work.

Determining research priorities for young people with haematological cancer: a value-weighting approach

INTRODUCTION

Haematological malignancies account for a third of all cancers affecting adolescents and young adults (AYAs). Funding agencies are regularly faced with the dilemma of how to deploy resources in order to provide the greatest possible benefit to this patient group. This study used a value-weighting approach to quantify the stakeholders' perceptions about how resources should be allocated to best improve outcomes for AYA patients and their families.

METHODS

One hundred and fifty seven participants (112 health care providers, researchers and other professionals and 45 patients and carers) were invited to complete a web-based value-weighting questionnaire and indicate how they would allocate 100 units of funding among various research approaches, areas and populations.

RESULTS

Eighty participants (51%) completed the questionnaire. Strategic research was allocated a significantly higher proportion of funding than investigator-driven research. For research areas, clinical medicine and psychosocial research were allocated the highest proportion of funding. Within research populations, AYAs who were newly diagnosed, relapsed or finished treatment were allocated the largest proportion of funds. Psychosocial research which focussed on identifying risk and resilience, developing psychosocial measures, translating research into practice and improving the treatment centre was allocated funding slightly above other items, however the difference was not significant.

DISCUSSION

To improve potential congruence between the views of stakeholders and funding agencies, research funding for AYA haematological cancer patients and their families could be targeted towards newly diagnosed patients and those who have relapsed. Research in the areas of clinical medicine and psychosocial care is perceived to be of utmost value.