108 Volume 25, Issue 1, WInter 2015 • CanadIan onCology nursIng Journal reVue CanadIenne de soIns InfIrmIers en onCologIe
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Commentaries on presentations from the 2014 Annual CANO/ACIO Conference
The following commentaries are based on oral presentations given at the 2014 Annual CANO/ACIO Conference. It was held October 26–29 in Quebec City. The authors of these commentaries are members of the Doctoral Student Network, a newly formed group created by
the Research Committee under the auspices of CANO/ACIO.
Presentation authors and title
Lun, Lisa & Persaud, Soma. Is what I need to know what my patient actually want to know? An analysis of oncology nurses’ resources needs compared to oncology patient priority concern and support needs at end of treatment.
(CANO session: VIII-04-C).
Presentation abstract
The Central Local Integrated Health Network (LIHN) Regional Systemic Therapy Nursing Committee (RSTP) participated in a two-part patient edu- cation project aimed to standardize and optimize the provision of informa- tion and education resources for oncol- ogy patients within their geographical region. The first part of the project iden- tified a need to address how patients are supported, as they transition from treat- ment to survivorship. Within phase two of the project a survey was administered to community and chemotherapy clinic nurses (n=69) and patients (n=101).
Survey questions were developed to collect data related to how patients information needs were addressed by oncology nurses including: informa- tion priority areas, what resources are utilized and how those resources are being utilized. The CANO–ACIO 2014 Conference presentation compared and contrasted the perception of infor- mational needs and priorities of both patients and nurses.
Commentary on presentation by Jagbir Kohli
Extensive research has demonstrated that individuals with cancer have an array of psychosocial and supportive care needs. It is recommended these needs are considered in assessment, planning, and intervention when provid- ing oncology care (Howell et al, 2009;
Fitch, 2008). There is an abundance
of evidence in the literature related to the informational needs of oncology patients including: common informa- tional priorities, sources from which information is received, and preferred learning styles. The benefits of sup- porting a patient’s informational needs include increased patient involvement in decision-making; greater satisfaction with treatment choices; and reduced confusion, anxiety, and fear (Rutten, Arora, Bakos, Aziz, & Rowland, 2004).
RSTP’s patient education project’s survey questions incorporated cur- rent understanding based on research related to common informational needs and utilized resources. This project connects the vast amount of research in a pragmatic local context in order to examine the health network’s current practices and potential gaps in sup- porting patients’ informational needs.
Another interesting element to this study is the inclusion of both nurses (from community and chemotherapy clinic) and patients, which compared similarities and differences amongst the two groups.
Survey data related to informa- tion needs regarding symptoms, and psychological and practical concerns, revealed both similarities and differ- ences in what information nurses felt they need to better support patients, and what patients prioritized as con- cerns. The following example illustrates these similarities and differences. Both nurses and patients rated the impor- tance of information about managing fatigue and tiredness as high, whereas other concerns such as fertility issues, body image concerns, and sexual health were rated as high-priority from a nurse perspective, but not from a patient per- spective. Other concerns such as ‘living in a new normal’ and anxiety were rated high-priority information concerns by patients and not by nurses.
Within the regional context, the results of this project support the Central Local Integrated Health Network Regional Systemic Therapy Nursing Committee in providing edu- cation and support to clinicians and in providing oncology care that is a better reflection of patient needs within their region. An example of how this infor- mation is being used to inform practice is through the use of the survey results to help outline the content of a regional oncology nursing education day.
Although the generalizability of the results cannot be determined due to the relatively small sample size of patients and nurses, the project provides a unique view of the components that need to be considered; patient, clini- cian, and organization. At a leadership level, this project highlights a need for organizations to continuously reflect on the appropriateness of current health care practices, and to examine if these practices reflect actual patient needs. At a clinician level, this project acts as a reminder that nurses’ perceived priori- ties, when examined from the patient’s perspective, may well differ.
In brief
What is already known:
• Patients with cancer can often have informational needs regarding the disease, treatment, prognosis, and side effects
• Supporting informational needs can potentially positively influence the patient’s ability to cope, reduction of anxiety and fear, and enhancing com- munication and decision making What this project adds:
• The identification of the similari- ties and potential differences about perceived and actual information priorities from a patient and nurse perspective
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reFerenCes
Fitch, M. (2008). Supportive care framework.
Canadian Oncology Nursing Journal, 18(1), 6–14.
Howell, D., Currie, S., Mayo, S., Jones, G., Boyle, M., Hack, T., Green, E., … Digout, C. (2009). A pan-canadian clinical practice guideline: assessment
of psychosocial health care needs of the adult cancer patient Toronto. Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology.
Rutten, L., Arora, N., Bakos, A., Aziz, N.,
& Rowland, J. (2005). Information
needs and sources of information among cancer patients: A systemic review of research (1980–2003). Patient Education and Counseling, 57, 250–261.
doi:10.1016/j.pec.2004.06.006
Presentation authors and title
Enders, W., Whiteside, D.J., & Champ, S. (2014). Maintaining competency in specialized rural cancer treatment centres. (CANO session: V-04-A).
Presentation abstract
Although important, practice guide- lines may not be used in rural or remote practice settings because of their unfeasibility in these settings (Kulig, Kilpatrick, Moffitt, & Zimmer, 2013) and/or a lack of practitioner awareness (Bettencourt, Schlegel, Talley, & Molix, 2007). This presentation described the
actions taken by a team of oncology nurses to develop a program for nurses delivering chemotherapy in low-volume environments in order to maintain their competency. Using the results from stakeholder surveys, existing relevant guidelines were adapted to develop a pilot program of competency practice standards that includes staff monitor- ing, structured educational support, fol- low-up, and evaluation. In this program, staff members maintain their compe- tency by working two shifts per month in the chemotherapy administration area, or by administering 12 chemother- apy treatments in a three-month period.
If these criteria are not met, staff are required to conduct a self-assessment of their skills, hold a teleconference with the nurse educator to review policies and documentation resources, as well as ‘buddy’ with a competent RN for a shift in chemotherapy administration.
Other protocols exist for nurses who do not administer chemotherapy for peri- ods longer than three months. Baseline data have been collected and the pro- gram is currently being piloted.
Commentary on presentation by Jacqueline Galica
Between 19–30% of the Canadian population lives in areas that can be defined as rural (Bollman & Clemenson,
2008). Because of the increasing inci- dence of cancer (Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2013), initiatives have been undertaken for rural can- cer patients to receive chemotherapy treatments closer to home (Goldstein
& Margo, 2001; Pong et al., 2000).
However, registered nurses working in these settings may not have sufficient opportunity to maintain their compe- tency in administering these cytotoxic agents. This presentation described the development of a program to ensure the continued competency of regis- tered nurses practicing in rural settings where chemotherapy administration is infrequent. This program was devel- oped to fill a gap identified by front-line oncology nurses in rural settings.
Although it is not clear whether empirical literature was reviewed and/
or available to integrate into the pro- gram, the program was developed by adapting similar practice guidelines to a rural nursing context, where cancer care may not be the only care provided to patients. Furthermore, the program developers assessed the needs of front- line RNs practicing in rural cancer set- tings to incorporate content that would support their chemotherapy administra- tion competency. However, it is unclear whether these RNs had an awareness of current chemotherapy competency guidelines, such as those presented by the Canadian Association of Nurses in Oncology (Burns et al., n.d.). Surveying the needs of nurses who have a detailed understanding about the competen- cies required of them enables program developers to incorporate relevant and appropriate content. Similarly, the demo- graphics of the respondents, the major- ity of whom worked part-time (47%) and had less than two years of oncology nursing experience (43%), may also have
negatively affected the appropriateness of the content included in the program.
This demographic may have provided results not representative of those with greater oncology nursing experience and awareness of practice-related issues.
However, this demographic may provide richer information about what education and resources are needed for oncology nursing practice in low-volume settings.
Despite these shortcomings, the development of this program incorpo- rated available and relevant sources of information. The details of this presen- tation would be of particular interest to administrators and registered nurses in rural settings with low volumes of chemotherapy administration. Of par- ticular interest, will be the results this piloted program, which are being eval- uated in 2015. The program developers are evaluating staff turn-over, staff sat- isfaction, medication errors, the utility of educational materials, and overall cost comparison, which will be useful for potential adopters to consider before implementation.
Rural nurses have been described as generalist nurses requiring spe- cialist knowledge (Zibrik, MacLeod, &
Zimmer, 2010), which can be chal- lenging in light of the continued evo- lution of cancer treatments (Hewitt, Greenfield, & Stovall, 2006). These challenges, compounded with the irreg- ular administration of chemotherapy in rural settings, warrant the incorpo- ration of initiatives such as that pre- sented by Enders and colleagues (2014).
The details of this program, and the results of its evaluation (in-progress), will be useful for executives and clini- cians to ensure that rural and remote cancer patients continue to receive safe and competent registered nursing care with the administration of cytotoxic treatments.
110 Volume 25, Issue 1, WInter 2015 • CanadIan onCology nursIng Journal reVue CanadIenne de soIns InfIrmIers en onCologIe
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In brief
What is already known:
• Oncology nurses need to maintain their competency to administer cyto- toxic agents.
• Practice guidelines are not always fea- sible in rural contexts and/or practi- tioners are unaware of them.
What this presentation showed:
• That rural oncology nurses are con- cerned about their competency in chemotherapy administration in low-volume settings.
• The grey and white literature regarding cancer care in rural contexts is sparse.
• Nurses are ideally situated to plan and implement strategies for contin- ued competency.
Next steps:
• More research is needed to under- stand the experiences of rural can- cer patients, survivors, and oncology nurses.
• Initiatives should be explored about how to facilitate the cancer care pro- vided and received in rural contexts.
reFerenCes
Bettencourt, B.A., Schlegel, R.J., Talley, A.E.,
& Molix, L.A. (2007). The breast cancer experience of rural women: A literature review. Psycho-Oyncolog, 16(July), 875–
887. doi:10.1002/pon
Bollman, R.D., & Clemenson, H.A. (2008).
Structure and change in Canada’s rural demography: An update to 2006. Rural and Small Town Canada Analysis Bulletin, 7(7).
Burns, K., Hartzell, R., Hues, B., Karrei, I., Lejambe, V., Mercer, L., … Truant, T. (n.d.). Standards and competencies for cancer chemotherapy nursing practice.
Vancouver, BC: CANO.
Canadian Cancer Society’s Advisory
Committee on Cancer Statistics. (2013).
Canadian Cancer Statistics 2013. Toronto, Canada. Retrieved from http://www.
cancer.ca/~/media/cancer.ca/CW/
publications/Canadian Cancer Statistics/
canadian-cancer-statistics-2013-EN.pdf Goldstein, D., & Margo, J. (2001). Cancer in
the bush—Optimizing clinical services.
Cancer Forum, 25(2), 121–125. Retrieved from http://www.cancerforum.org.au/
File/2001/July/CF01Jul_121-125.pdf Hewitt, M., Greenfield, S., & Stovall, E.
(2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC. Retrieved from www.nap.edu/
catalog/11468.html
Kulig, J.C., Kilpatrick, K., Moffitt, P., &
Zimmer, L. (2013). Rural and remote nursing practice: An updated documentary analysis. Lethbridge. doi:RRN2-02
Pong, R.W., Irvine, A., McChesney, C., DesRochers, C., Valiquette, A., & Blanco, H. (2000). Chemotherapy closer to home.
Retrieved from http://www.cranhr.ca/
pdf/focus/FOCUS02-A2.pdf
Zibrik, K.J., MacLeod, M.L.P., & Zimmer, L.V.
(2010). Professionalism in rural acute- care nursing. The Canadian Journal of Nursing Research/Revue Canadienne de Recherche En Sciences Infirmières, 42(1), 20–36. Retrieved from http://www.ncbi.
nlm.nih.gov/pubmed/20420090
