AONN+ Navigation Metrics That Support the Oncology Navigation Standards of Professional Practice

OBJECTIVES

To offer a comprehensive overview of the critical elements contributing to the achievements of oncology navigation, address challenges in standardized implementation, and examine recent advancements influencing the acknowledgment and reimbursement of navigation services. Lastly, the AONN+ 35 evidence-based navigation metrics will be shared, emphasizing the five core metrics that should be utilized by all navigation models in all settings.

METHODS

Employed in this review involves synthesizing information from established oncology organizations, documenting the development of navigator professional standards of practice and navigation metrics that measure patient experience, clinical outcomes, and return on investment, and analyzing outcomes from national studies and collaborations to present a summary of advancements in oncology navigation.

RESULTS

The key components vital for ensuring the enduring success of programs encompass the core competencies of navigators, adherence to standards of navigation practice set by the Professional Oncology Navigation Taskforce, and the establishment of well-defined metrics specific to oncology navigation.

CONCLUSIONS

Despite these advancements, challenges persist in implementing and recognizing the newly defined standards and metrics. Effective solutions involve aligning navigation programs with leadership, integrating standards into daily practice, defining navigator roles, measuring navigation program outcomes through defined metrics, and leveraging certifications. Standardized measurement and practice are imperative for national policy development and reimbursement models, aligning with the Cancer Moonshot's goal of high-quality, patient-centered, and cost-effective cancer care.

IMPLICATIONS FOR NURSING PRACTICE

To contribute to standardizing measurement and practice in oncology navigation for national policy development and reimbursement models.

Navigating Through Disaster: Application of Oncology Nurse Navigator Competencies to Climate Disaster Preparation and Response

OBJECTIVES

The role of the oncology nurse navigator (ONN) before, during, and after a climate disaster is critical to ensuring that individuals with cancer continue to receive the necessary care and support. The objective of this article is to provide an overview of the essential role of the ONN by highlighting the application of core competencies to climate disasters.

METHODS

Competencies available for ONNs from the Oncology Nursing Society include coordination of care, communication, education, professional role, and expertise. International Council of Nurses (ICN) core competencies for disaster nursing include eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. These competencies are explored for application to climate disaster preparation, mitigation, and response.

RESULTS

The ONN competencies and the domains of the ICN disaster nursing competencies were integrated to outline the role of the ONN in disaster preparedness and response.

CONCLUSION

The ONN is pivotal in maintaining the continuity of cancer care. The ONN's expertise is critical for navigating the difficulties presented by hurricanes, floods, wildfires, and other extreme climate events as well as existing barriers to cancer care. The ONN's adeptness at coordinating care, communicating effectively, and tapping into community resources will transfer to a climate disaster, ensuring minimal treatment interruptions and access to necessary care.

IMPLICATIONS FOR NURSING PRACTICE

The ONN is integral to the cancer care team in preparing and responding to climate disasters. The ONN ensures ongoing access to cancer care and advocates for the specialized care that people with cancer need. The ONS ONN Core Competencies and the ICN Disaster Competencies are applicable for developing processes and procedures to address climate disasters in clinical practice.

Influences Shaping Clinicians' Monoclonal Antibody and Immune Checkpoint Inhibitor Preparation and Administration Management Practices: A Systematic Review

OBJECTIVES

In 30 years, monoclonal antibodies (mAbs) and immune checkpoint inhibitors (ICPIs) have enhanced cancer survival and quality of life. Limited knowledge exists regarding the long-term risks of repeated exposure, especially for cancer nurses, who prepare and administer them. This systematic review aimed to identify influences shaping clinicians' awareness and practices in the safe preparation and administration of mAbs and ICPIs.

DATA SOURCES

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases CINAHL, EMBASE, Joanna Briggs Institute, OVID, MEDLINE, and Cochrane were searched. Eligibility and risk of bias were assessed by four reviewers.

RESULTS

Of 7301 identified studies, 481 duplicates were removed, and 6673 were excluded after title and abstract review. A full-text review was conducted on 147 studies; six studies were included. A narrative synthesis generated two themes: (1) ambiguity contributes to variation in handling practices and (2) continuing professional development (CPD) is vital but hard to implement without evidence.

CONCLUSION

Lack of evidence regarding long-term risks and consensus creates uncertainty about the hazardous nature of unconjugated mAbs and ICPIs. Resulting in varied risk reduction strategies during preparation and administration, and inconsistent CPD. Protecting the long-term health of clinicians necessitates consensus on risk reduction strategies. This will be challenging without compelling evidence or international agreement on their hazardous classification.

IMPLICATIONS FOR NURSING PRACTICE

In nursing, policy gaps and inconsistent CPD related to unconjugated mAbs and ICPIs may expose nurses to risks. Understanding the educational needs of nurses and global standardized guidelines are urgently needed.

Knowledge and Practice Behaviors Toward the Care of the Dying Among Chinese Oncology Nurses: A Cross-Sectional Survey

The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.

CE: Chemotherapy-Induced Peripheral Neuropathy

ABSTRACT

Chemotherapy-induced peripheral neuropathy (CIPN) occurs in more than 68% of patients receiving the neurotoxic chemotherapy agents commonly used to treat breast, gastrointestinal, gynecologic, and hematologic malignancies. CIPN, often experienced initially as numbness, tingling, or pain in the upper or lower extremities, may progress to the point where the resultant decline in physical function requires a reduction in the chemotherapy dose. This article provides nurses with strategies to use in assessing, managing, and educating patients who are at risk for or who are already experiencing CIPN. Currently, the American Society of Clinical Oncology endorses only one treatment for CIPN: duloxetine 60 mg/day. Discussing CIPN with patients before chemotherapy is initiated and throughout the course of treatment promotes its early identification and management, which may minimize its impact on physical function and chemotherapy dosing, reducing the patient's risk of experiencing chronic symptoms after chemotherapy ends.

Managing Chemotherapy Extravasation Across Transitions of Care: A Clinical Nurse Specialist Initiative

Chemotherapy extravasation can lead to serious patient harm in patients with cancer. For nurses who administer vesicant chemotherapy, extravasation is a primary concern. Regardless of nurse experience level and despite prevention strategies, extravasations occur. Literature related to nurse management of chemotherapy extravasation beyond initial treatment is lacking, and no descriptors are available for a formalized process. Communication gaps and a lack of standardized follow-up within a 1400-bed, quaternary care academic medical institution contributes to challenges in care continuity when patients transition between hospital and ambulatory settings. With chemotherapy extravasation, the site does not immediately exhibit signs of tissue injury, leading to a false sense of security. As a result, tissue damage can be significant by the time the patient returns for his or her regular appointment. Two oncology clinical nurse specialists (CNSs) recognized an opportunity to bridge the gap and overcome the challenges by addressing patient needs postextravasation. Between 2015 and 2016, a formal consult process was designed, approved, and implemented to observe, manage, and make recommendations for timely care and follow-up. Since implementation of the process, the oncology CNSs have received multiple requests for consultations. Nursing staff report increased comfort levels with this process in place. A formalized process for managing chemotherapy extravasations increases patient safety and patient and nurse satisfaction.

The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development

BACKGROUND

Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education.

METHODS

Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses.

RESULTS

Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05).

DISCUSSION

SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.

Job satisfaction among oncology nurse practitioners

BACKGROUND

One proposed solution to the predicted shortage of oncology nurse practitioners (NPs) is expanding the role of the oncology NP. However, role expansion may lead to an increase in work-related stress and a decrease in job satisfaction. It is important to understand oncology NPs' job satisfaction and stress and their intent to leave their job or profession in order to further develop and potentially expand the role.

PURPOSE

The purpose of this study is to determine the main factors that affect job satisfaction, especially the relationship with stress and the intent to leave the oncology specialty.

METHODS

A convenience sample of responses to a series of surveys administered by the Oncology Nursing Society and residing in the ONS database was used for this analysis. Exploratory data analysis, principal component analysis, and regression models were applied to explore characteristics of the questionnaires, assess the reliability of the Coping Skills Questionnaire, and find out main factors for their intent to leave.

RESULTS

Items in the Coping Skills Questionnaire were internally consistent, and stress had a positive effect on NPs' intent to leave. Satisfaction and coping skills were also significant in some models; higher levels of satisfaction and coping skills resulted in lower levels of intent to leave. Moreover, several demographic factors such as having children, schedule days off, and patient population also affected the response significantly.

IMPLICATIONS FOR PRACTICE

This study provides nursing leaders with information to guide retention of NPs.

STAT: Anaphylaxis

Anaphylaxis is a severe, potentially life-threatening acute allergic reaction that involves more than one system of the body.

Oncology Nurse Practitioner Competencies: Defining Best Practices in the Oncology Setting

BACKGROUND

The oncology nurse practitioner (ONP) role has evolved since the first ONP competencies were published by the Oncology Nursing Society in 2007. An update was completed in 2019 to reflect the rapidly expanding role.

OBJECTIVES

The purpose of this article is to describe the process of the ONP competency development and identify potential applications across a variety of oncology settings.

METHODS

The team performed an extensive literature review of the research about ONP practice across the cancer care continuum. Peer and expert review were conducted to ensure the competencies were comprehensive and relevant.

FINDINGS

The ONP competencies provide a solid, evidence-based benchmark to standardize the ONP role and practice, thereby ensuring that patients receive the highest-quality cancer care.

Recommendations for spiritual care in cancer patients: a clinical practice guideline for oncology nurses in Iran

BACKGROUND

In spite of the necessity of implementing spiritual care practices for cancer patients, there is no clear process in this regard in palliative care programs of the health system of countries. The present study was designed with the aim of developing a clinical practice guideline of spiritual care in cancer patients for oncology nurses in the current context.

METHODS

This is a multi-method study which was conducted in five stages within the framework of the National Institute for Health and Care Excellence (NICE) guideline. A research committee consisting of four focal and 16 secondary members was formed. The stages included determining the scope of the study, developing guideline (a qualitative study and a systematic review, triangulation of the data, and producing a preliminary draft), consultation stage (validation of the guideline in three rounds of the Delphi study), as well as revision and publication stages.

RESULTS

The clinical guideline of spiritual care with 84 evidence-based recommendations was developed in three main areas, including the human resources, care settings, and the process of spiritual care.

CONCLUSIONS

We are hoping by applying this clinical guideline in oncology settings to move towards an integrated spiritual care plan for cancer patients in the context of our health system. Healthcare organizations should support to form spiritual care teams under supervision of the oncology nurses with qualified healthcare providers and a trained clergy. Through holistic care, they can constantly examine the spiritual needs of cancer patients alongside their other needs by focusing on the phases of the nursing process.

ONS Staffing Position Statement: Ambulatory Treatment Centers

Appropriate nurse staffing levels contribute to the delivery of safe quality care and optimal patient outcomes. However, developing nurse staffing models, particularly in the ambulatory setting, is an ongoing challenge. Within this position statement, the term ambulatory setting includes infusion centers that provide treatment to patients with cancer, including non-chemotherapy treatment centers (e.g., blood products) and radiation therapy treatment centers. These settings share commonalities, including rapid turnover of patients and the administration of some type of treatment or intervention. Nurse staffing refers to the clinical nurses in the setting and does not include advanced practice nurses or nurses in other roles.

The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting: A Systematic Review

BACKGROUND

Today, cancer care and treatment primarily take place in an outpatient setting where encounters between patients and healthcare professionals are often brief.

OBJECTIVE

The aim of this study was to summarize the literature of adult patients' experiences of and need for relationships and communication with healthcare professionals during chemotherapy in the oncology outpatient setting.

METHODS

The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs Institute Evidence Based Practice Database.

RESULTS

Nine studies were included, qualitative (n = 5) and quantitative (n = 4). The studies identified that the relationship between patients and healthcare professionals was important for the patients' ability to cope with cancer and has an impact on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships.

CONCLUSIONS

The relationship and communication between patients and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer.

IMPLICATIONS FOR PRACTICE

Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More research is needed to investigate the type of interaction and intervention that would be the most effective in supporting adult patients' coping during chemotherapy in an outpatient clinic.

Comorbid Dementia and Cancer in Residents of Nursing Homes: Secondary Analyses of a Cross-Sectional Study

BACKGROUND

Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored.

OBJECTIVES

The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer.

METHODS

This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored.

RESULTS

Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P < .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation.

CONCLUSIONS

Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately.

IMPLICATIONS FOR PRACTICE

The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer.

The impact of two triggered palliative care consultation approaches on consult implementation in oncology

INTRODUCTION

Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital.

METHODS

The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics.

RESULTS

Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001).

CONCLUSION

Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.

Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS - a randomized clinical trial

Background:

The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death.

Aim:

To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival.

Design:

A prospective, single-centre, randomized controlled trial ( Clinicaltrials.gov : NCT01885637).

Setting/participants:

In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options.

Results:

No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups ( p = 0.605). No adverse effects were seen as consequence of the intervention.

Conclusions:

The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.

The Role of Survivorship Care for Patients with Glioma

OBJECTIVES

To discuss the role of survivorship care and survivorship care plans, including a recently developed neuro-oncology-specific plan care (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx) for adult patients diagnosed with primary glial neoplasms and the necessary educational needs of oncology nurses.

DATA SOURCES

Published peer-reviewed literature and resources from cancer and neuro-oncology professional organizations and patient advocacy organizations.

CONCLUSION

The current Commission on Cancer mandates adult cancer patients treated with curative intent each receive an individualized survivorship care plan. Patients with glioma are likely to benefit from receiving survivorship care, including survivorship care plans aimed at addressing the complex and evolving needs of this unique patient population throughout their illness trajectory.

IMPLICATIONS FOR NURSING PRACTICE

Nurse professionals are critical to the development and implementation of cancer survivorship care. This growing leadership role presents oncology nurses with specific and new educational needs regarding survivorship care.

Patients' characteristics informing practice: improving individualized nursing care in the radiation oncology setting

PURPOSE

A large number of patients attend for radiotherapy daily. Primary nurses in the study settings aim to individualize care for their patients. The individual characteristics of patients may determine their perceptions of nursing care, and provide guidance in tailoring their care. This study aimed to assess patients' personal characteristics on their perceptions of individualized care (IC) provided by nurses during a course of radiotherapy, and to determine predictor variables that may inform nursing practice.

METHODS

This cross-sectional, exploratory study was conducted in three radiotherapy departments in Australia. Patients (n = 250) completed the Individualized Care Scale_Patient (ICS_P). Data were analyzed using descriptive and inferential statistics, univariate analysis, and multiple regression analysis.

RESULTS

Males reported significantly higher perceptions of IC than females in 7/9 subscales. Patients with head and neck and prostate cancer, as well as those requiring hospitalization during radiotherapy, scored significantly higher in 5/9 subscales. Courses > 30 days, those not receiving chemotherapy, and partnered patients reported greater IC across all subscales. Gender and hospitalization were the main predictor variables for IC.

CONCLUSION

Patients reported moderately high levels of IC during their radiotherapy; however, standard demographic information may provide limited insight into improving care for the individual. Patient characteristics routinely chosen, such as age, gender, and education may not predict how patients perceive their care or support the tailoring of interventions to improve IC. Researching a range of related patient characteristics may prove a more useful concept for future nursing studies aiming to predict outcomes to tailor nursing practice.

Role of the Oncology Nurse Navigator Throughout the Cancer Trajectory

Navigation in oncology has demonstrated benefits for people at risk for or diagnosed with cancer, such as shorter time to diagnosis and treatement, increased patient and caregiver knowledge, better adherence to care, and improved quality of life. In addition, benefits to healthcare institutions, such as cost reductions through reduced rates of emergency department visits, and readmission and decreased outmigration of newly diagnosed patients, are being identified.

Palliative and End-of-Life Care Education Needs of Nurses Across Inpatient Care Settings

BACKGROUND

Educating nurses about palliative and end-of-life (EOL) care is a high priority in health care settings. The purpose of this study was to assess nurses' perceived competency regarding the provision of palliative and EOL care to hospitalized patients.

METHOD

This study surveyed nurses from 25 pediatric and adult acute and intensive care units (ICU; N = 583) Quantitative data analysis was descriptive and correlational. Qualitative data analysis identified themes of participant concerns.

RESULTS

Data analysis revealed that perceived competency in palliative and EOL care is significantly higher in the ICU nurses (p <.0001). Mean scores were significantly higher when nurses had more than 10 years of experience (p <.0001). Open-ended responses indicated concerns regarding improved communication behaviors, decision making, and facilitation of continuity of care.

CONCLUSION

The results provide guidance for development of palliative and EOL care nursing education programs tailored to address specific unit needs according to staff characteristics, patient population focus of care, and acuity level of care. J Contin Educ Nurs. 2017;48(7):329-336.

Letters to the Editor

I thoroughly enjoyed reading the article by Tariman et al. (2016) in the October 2016 issue of Clinical Journal of Oncology Nursing. It accurately reflects what is occurring to patients and nurses in clinical practice. I am a clinical nurse educator with seven years of oncology experience in multiple myeloma. Multiple myeloma is incurable; however, in the past decade, significantly more treatment options have become available to patients. With the variety of options, healthcare providers may have a difficult time coming to a consensus about how to best customize care for patients, a decision that is increasingly influenced by patients taking a more proactive role in their care.

Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center

Recent approaches in treating pancreatic adenocarcinoma, an aggressive disease with limited survival, include the use of liposomal irinotecan as an option when first-line therapy has failed. Liposomal irinotecan has been approved in combination with 5-fluorouracil and leucovorin for patients with metastatic pancreatic cancer. Liposomal irinotecan is a newer therapy requiring oncology nurses to obtain knowledge and skills for proper administrating, monitoring of hypersensitivity reactions during infusion, managing side effects, and providing patient education. Nursing considerations when administering this drug include infusion time, premedication, risk for hypersensitivity reactions and adverse events, and side effects.

Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting

OBJECTIVE

To discuss standard-of-care and emerging imaging techniques employed for screening and detection, diagnosis and staging, monitoring response to therapy, and guiding cancer treatments.

DATA SOURCES

Published journal articles indexed in the National Library of Medicine database and relevant websites.

CONCLUSION

Imaging plays a fundamental role in the care of cancer patients and specifically, breast cancer patients in the neoadjuvant setting, providing an excellent opportunity for interprofessional collaboration between oncologists, researchers, radiologists, and oncology nurses. Quantitative imaging strategies to assess cellular, molecular, and vascular characteristics within the tumor is needed to better evaluate initial diagnosis and treatment response.

IMPLICATIONS FOR NURSING PRACTICE

Nurses caring for patients in all settings must continue to seek education on emerging imaging techniques. Oncology nurses provide education about the test, ensure the patient has appropriate pre-testing instructions, and manage patient expectations about timing of results availability.

Newer Strategies for the Management of Low-Grade Gliomas

Low-grade gliomas are infiltrative primary brain tumors that most commonly occur in young adults. They are relatively slow growing compared with high-grade gliomas. The World Health Organization classification system was updated in 2016 to define low-grade gliomas using molecular markers in addition to histology. IDH mutation is an independent marker associated with better outcomes. Management is individualized based on tumor histology, molecular characterization, and patient risk factors. Given the longer course and natural history of low-grade gliomas, the goals of treatment should be to prolong overall survival and minimize neurocognitive decline. Early maximum safe resection is the first line of treatment. While low-risk patients may be followed with observation after surgery, patients with high-risk factors (subtotal resection, age &gt; 40 years, IDH wild-type tumors) should be treated with radiation and chemotherapy. Improved understanding of the molecular characteristics of low-grade gliomas will further guide risk stratification and allow the identification of treatment approaches that are more effective and less toxic.

Creating Quality Online Materials for Specialty Nurse Practitioner Content: Filling a Need for the Graduate Nurse Practitioner

Nurse practitioners are entering specialized areas of practice immediately after graduation from nurse practitioner (NP) education and certification and are finding employment in specialized areas such as oncology. Rapidly achieving a knowledge base in this highly specialized area of medicine coupled with the stress of the new nurse practitioner role can lead to a very difficult orientation and transition period. There are several methods to provide specialized education to NPs during their orientation period. Unfortunately, limitations such as a lack of motivated mentors, limited opportunities to practice the desired skill set or a lack of structure in regards to curriculum quality, and the learning needs of the new nurse hinder the NP's transition to practice. In response to either inadequate or non-standardized orientation to the specialty role of the oncology NP (ONP), a web-enhanced educational tool, funded through the National Cancer Institute, was developed for use in the USA: Oncology Nurse Practitioner Web Education Resource (ONc-PoWER). The development of ONc-PoWER was based upon essential education for NPs new to cancer care, adult learning theory, Bloom's Taxonomy, and foundations of quality online education. The five interactive web-based modules provide specialized education for the nurse practitioner new to oncology along with an on-site mentor to assist the NP in applying the course content to clinical practice.

Quality of nursing care as perceived by cancer patients: A cross-sectional survey in four European countries

PURPOSE

To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries.

METHODS

Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care.

RESULTS

Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p<0.001) as well as in the subscales responsiveness (p<0.001), individualization (p<0.001), coordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care.

CONCLUSION

Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

Next Generation Sequencing and Multi-Gene Panel Testing: Implications for the Oncology Nurse

OBJECTIVES

To review past, current, and future events in genetics and discuss how genetic testing information personalizes cancer screening, detection, and treatment. A case study is presented to illustrate key points.

DATA SOURCES

National guidelines, evidence-based summaries, peer-reviewed studies, editorials, and web sites.

CONCLUSION

Multi-gene testing using next-generation sequencing has changed the landscape for hereditary cancer syndromes.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have key roles in personalizing health care including recognizing the complexities of genetic testing, assessing family history, understanding gene/environment factors, referring for genetics consultations, and promoting registry studies. In order to be effective, nurses must stay current with the rapidly-changing technology and guidelines for genetic evaluations and testing.

Charity calls for training framework

A Macmillan Cancer Support investigation has revealed that some healthcare professionals lack confidence, knowledge and skills in caring for older people with cancer.

Development of the LaComm 1.0, A French medical communication analysis software: A study assessing its sensitivity to change

OBJECTIVE

To test and compare the sensitivity to change of a communication analysis software, the LaComm 1.0, to the CRCWEM's using data from a randomized study assessing the efficacy of a communication skills training program designed for nurses.

METHODS

The program assessment included the recording of two-person simulated interviews at baseline and after training or 3 months later. Interview transcripts were analyzed using the CRCWEM and the LaComm 1.0 tools.

RESULTS

One hundred and nine oncology nurses (mainly graduated or certified) were included in the study. The CRCWEM detected 5 changes out of 13 expected changes (38%) (e.g., more open directive questions after training) and the LaComm 1.0, 4 changes out of 7 expected changes (57%) (e.g., more empathic statements after training). For open directive question, the effect sizes of the group-by-time changes were slightly different between tools (CRCWEM: Cohen's d=0.97; LaComm 1.0: Cohen's d=0.67).

CONCLUSIONS

This study shows that the LaComm 1.0 is sensitive to change.

PRACTICE IMPLICATIONS

The LaComm 1.0 is a valid method to assess training effectiveness in French. The use of the Lacomm 1.0 in future French communication skills training programs will allow comparisons of studies.

The Impact of Comorbidity on Surgical Outcomes in Older Adults with Cancer

OBJECTIVES

To provide an overview of the impact of comorbidity on surgical outcomes and postoperative geriatric events in older adults with cancer, and review key components of quality perioperative nursing care of older adults with cancer.

DATA SOURCES

Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations.

CONCLUSION

The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults after cancer surgery have a substantial impact on surgical outcomes, quality of life, and health care costs. Practical and efficient models of comprehensive assessment, prevention, and management of postoperative geriatric events and comorbid conditions are needed to improve surgical outcomes for this vulnerable cancer population.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses practicing in clinical and research settings have a responsibility to arm themselves with evidence-based knowledge and resources to improve the perioperative care of older adults with cancer.

A Home-based Exercise Intervention for Non-Small Cell Lung Cancer Patients Post-Thoracotomy

OBJECTIVES

There are no evidenced-based rehabilitative guidelines for postsurgical non-small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap.

DATA SOURCES

Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC.

CONCLUSION

Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise.

IMPLICATION FOR NURSING PRACTICE

A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.

Representational Approach: A Conceptual Framework to Guide Patient Education Research and Practice

Illness representations are cognitive structures that individuals rely on to understand and explain their illnesses and associated symptoms. The Representational Approach (RA) to patient education offers a theoretically based, clinically useful model that can support oncology nurses to develop a shared understanding of patients' illness representations to collaboratively develop highly personalized plans for symptom management and other important self-management behaviors. This article discusses theoretical underpinnings, practical applications, challenges, and future directions for incorporating illness representations and the RA in clinical and research endeavors.

Informed Consent: A Clinical Trials Perspective

The primary goal of the thousands of registered trials in cancer research is to extend survival. With evaluation of efficacy, safety, and tolerability, healthcare providers must ensure that the principles described in the Belmont Report are upheld and that patients are truly informed when signing a consent form. In this article, two cases are highlighted, and reasons for participating in clinical trials are discussed. Challenges, such as healthcare literacy, patients' dedication to their healthcare providers, and choosing between multiple trials, are also explored.

Protective Isolation in Hemopoietic Stem Cell Transplants: A Review of the Literature and Single Institution Experience

Princess Margaret Hospital for Children, Perth, Western Australia, is a pediatric bone marrow transplant center. This center has both laminar flow and HEPA- (high-efficiency particulate air-)filtered rooms for children under-going allogeneic and autologous transplantation. HEPA-filtered rooms on negative pressure are used to nurse oncology children with infectious diseases. Over the winter months of 2001, there was an increased demand for single rooms for children with infectious diseases. Over the same period, a number of transplants were planned. Consequently, to guide practice decisions, a review of the literature and a survey of nursing practice in Australian and North American pediatric oncology units were undertaken. Findings showed that protective isolation measures such as positive-pressure single rooms, low microbial diets, and strict hand washing should be used only for children requiring allogeneic transplants. Use of other isolation measures were found to be of no added value for transplantation. As autologous transplants are increasingly performed in outpatient clinics, these children should not require the same level of protective isolation.

Improving Cancer Care Through Nursing Research

Nursing research and nurse researchers have been an integral and significant part of the Oncology Nursing Society's (ONS's) history, as evidenced by the development of the Nursing Research Committee within a few years of ONS's establishment. Ruth McCorkle, PhD, RN, FAAN, was the committee's first chairperson in 1979. This was followed by the creation of the Advanced Nursing Research Special Interest Group in 1989 under the leadership of Jean Brown, PhD, RN, FAAN. ONS also began to recognize nurse researchers in 1994 by creating the annual ONS Distinguished Researcher Award to recognize the contributions of a member who has conducted or promoted research that has enhanced the science and practice of oncology nursing. The list of recipients and of their work is impressive and reflects the wide range of our practice areas (see http://bit.ly/1MTC5cp for the recipient list). In addition, the ONS Foundation began funding research in 1981 and has distributed more than $24 million in research grants, research fellowships, and other scholarships, lectures, public education projects, and career development awards (ONS Foundation, 2015). And, in 2006, the Putting Evidence Into Practice resource was unveiled, which provides evidence-based intervention reviews for the 20 most common problems experienced by patients with cancer and their caregivers (www.ons
.org/practice-resources/pep)
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Factors Influencing Nurses' Use of Hazardous Drug Safe-Handling Precautions

PURPOSE/OBJECTIVES

To identify factors associated with oncology nurses' use of hazardous drug (HD) safe-handling precautions in inpatient clinical research units.
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DESIGN

Descriptive, cross-sectional.
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SETTING

The National Institutes of Health Clinical Center in Bethesda, Maryland.
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SAMPLE

115 RNs working on high-volume HD administration units. 
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METHODS

Survey data were collected online using the Hazardous Drug Handling Questionnaire. Data were analyzed using descriptive statistics and multiple regression analysis.
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MAIN RESEARCH VARIABLES

Exposure knowledge, self-efficacy, barriers to personal protective equipment use, perceived risk, conflict of interest, interpersonal influences, workplace safety climate, and total mean HD precaution use.
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FINDINGS

Participants demonstrated high exposure knowledge, self-efficacy, perceived risk, interpersonal influences, and workplace safety climate. Participants demonstrated moderate barriers and conflict of interest. Total mean HD precaution use proved highest during HD administration and lowest for handling excreta at 48 hours. Average patients per day significantly influenced total HD precaution.

CONCLUSIONS

Despite high exposure knowledge, barriers to personal protective equipment use and conflict of interest may contribute to reduced adoption of personal protective practices among oncology nurses.
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IMPLICATIONS FOR NURSING

Hospital and unit-specific factors captured by the predictor variables could contribute to institutional HD policy.

Oncology Nurse Navigation Role and Qualifications

In the early 1990s, women living in a medically underserved community acted as lay navigators to help other women overcome barriers to breast cancer screening and follow-up (Freeman, Muth, & Kerner, 1995). At that time, treatment for cancer was straightforward. Today, cancer treatment is complex, and understanding the diagnosis, treatment, and healthcare system requires the skill of an oncology nurse navigator (ONN). Navigation includes the entire healthcare continuum-from prevention, screening, diagnosis, treatment, and survivorship to end of life. The goal of navigation is to reduce cancer morbidity and mortality by eliminating barriers to timely access to cancer care, which may be financial, psychological, logistic, or related to communication or the healthcare delivery system.

NI Macmillan nurse wins RCN accolade

Macmillan cancer nurse specialist Cherith Semple has been named RCN Northern Ireland Nurse of the Year.

Raising the standard of brain cancer care

Survival rates for people with brain cancer are poor, and some patients do not receive the specialist support they need. Nurse specialist Ingela Oberg calls for earlier diagnosis and improved access to nurse-led clinics and rehabilitation services.