Partnering with oncology nursing leaders in Latin therapies in cancer

Partnering with oncology nursing leaders in Latin
America to deliver an education program on oral
therapies in cancer
by Tracy Truant, Esther Green and Luz Esperanza Ayala de Calvo
lobal initiatives and partnerships
among nurses between and across
countries are important strategies to
begin to address global inequities in
cancer care (Sheldon, 2010). Cancer
nurse leaders in Latin America, specifically Argentina, Brazil, Colombia,
and Mexico, recently advocated for
enhanced access to high-quality oral
therapies (OT) nursing education and
resources, as well as improved direct
nursing care of people receiving OTs
(Ayala de Calvo, 2010, 2014). Despite
increasing numbers of cancer patients
receiving OTs in those countries, few
receive care by knowledgeable nurses
who can effectively prevent and/or manage the associated toxicities and support patients to maintain adherence
*Tracy Truant, RN, MSN, PhD(c),
Doctoral Candidate, University
of British Columbia School of
Nursing, T201-2211 Wesbrook Mall,
Vancouver, BC V6S 1R6
[email protected]
Esther Green, RN, BScN,
MSc(T), Director, Person Centred
Perspective, Canadian Partnership
Against Cancer, 1 University Avenue,
Toronto, ON M5J 2P1
[email protected]
Luz Esperanza Ayala de Calvo,
MEd, ONS, RN, Especialista
en Enfermería Oncológica- Mg.
Educación e Investigación, Consultora
Independiente de educación en
cáncer, Vicepresidenta Asociación de
Enfermería Oncológica Colombiana
(AEOC), Magistrada Tribunal
Nacional Ético de Enfermería (TNEE
[email protected]
*Preferred author for correspondence
to the treatment plan (Barton, 2011;
Schneider, Hess & Gosselin, 2011). This
gap in OT nursing care may negatively
impact patients’ quality and length of
life (CANO/ACIO, 2010; Neuss et al.,
2013; Oakley, Crowe & Johnson, 2010;
Weingart et al., 2011).
Over the past three years, these
Latin American nursing leaders have
partnered with a Canadian working group under the auspices of
ISNCC’s Philanthropic and Corporate
Committee. Co-led by Esther Green
(Canada) and Luz Esperanza Ayala
de Calvo (Colombia), and supported
by the Executive Director of ISNCC
(Sarah McCarthy), the Canadian working group (Donalda MacDonald, Komal
Patel, Janice Stewart, Tracy Truant) was
tasked with developing a culturally sensitive train-the-trainer OT education
program for nurses in Latin America.
Using a participatory collaborative
approach, the working group met via
web-based technology for more than
a year to understand the OT learning
needs in Latin America and create the
train–the-trainer program, which was
contextualized for the different practice
environments and health care systems
among the four countries. In addition
to a review of the literature for OT nursing care best practices, permission was
obtained to contextualize the de Souza
Institute’s (de Souza Institute, 2015)
OT learning modules for the unique
needs in Latin America. Canadian nurse
educators Simonne Simon and Diana
Incekol were involved in completing
the final pilot version of the OT education program, which included modules
on 1) introduction to OTs, 2) nurse’s
role and responsibilities, 3) teaching
and learning principles of OTs, 4) oral
therapies for cancer therapy, 5) toxicity
assessment and management, and
6) safe handling and disposal of oral
hazardous drugs. Given the minimal
development of nursing roles in OT
care in Latin America, another key document developed by the working group
outlined the role, standards and competencies of the registered nurse in the
care of people receiving oral therapy
and their families. This document was
deemed essential to advocate for OT
nursing resources, revisions to models
of care that align nursing resources to
patients’ OT needs and develop policies
to support professional nursing practice
related to OT care.
To ensure the OT train-the-trainer
program was complete and effective for
the Latin American context, the program was pilot tested in December 2013.
Nurse champions were identified in
each of the four countries to receive and
contextualize the education materials
further and offer the pilot OT program
in their country. With support from the
working group members, nurse champions Silvina Estrella de Ellis, Victoria
Brunelli and Clara Cullen (Argentina),
Patricia Salles and Lailah Nunes (Brazil),
and Luz Esperanza Ayala de Calvo
(Colombia and Mexico) delivered the
one-day educational program to nurses
in each of those countries in a face-to
face format. Seventy-six oncology nurses
from a variety of practice settings, some
travelling more than 1,000 km, attended
one of the four pilot workshops.
Evaluations were conducted at each pilot
workshop, which aided in further revision and refinement of the program.
A final workshop held in May 2014
used the refined program and was delivered in both Spanish and Portuguese.
It was conducted in Bogota, Colombia
with 42 nurses from all four countries,
Volume 25, Issue 4, Fall 2015 • Canadian Oncology Nursing Journal
Revue canadienne de soins infirmiers en oncologie
Ayala de Calvo, L.E. (2010). Working
conditions and professional education in
oncology nursing in countries of Central and
South America. Oral presentation at the
16th Annual International Conference in
Cancer Nursing, Atlanta, Georgia, USA.
Retrieved from http://storage.googleapis.
Ayala de Calvo, L.E. (2014, September).
Cancer issues in Latin America and
oncology nursing in Latin America.
Plenary presentation at the 18th Annual
International Conference in Cancer
Retrieved from http://storage.googleapis.
Barton, D. (2011). Oral agents in cancer
treatment: The context for adherence.
Seminars in Oncology Nursing, 27(2),
problem solve issues unique to their
settings, such as, for example, how to
maintain safety with minimal personal
and protective equipment, or how to
advocate for nursing roles and resources
to meet the standards of practice for OT
nursing care.
An additional evaluation was administered nine months after the completion of the final workshop to determine
the uptake of the OT education program in each of the settings. The final
evaluation results are under review, but
preliminary analysis shows the additional value that the nurses experienced
through the education program, and the
support they experienced to apply the
knowledge in their clinical settings.
This international collaborative initiative has had far-reaching benefits
beyond that of its intended goals. In
addition to sharing expertise to address
a gap in oncology nursing care in Latin
American countries, we have been able
to develop a template for the development, implementation, evaluation and
ongoing monitoring of future collaborative international initiatives. We have
had the good fortune to learn from our
Latin American colleagues about maintaining a passion for oncology nursing
and patient care, despite significant
obstacles. Perhaps most importantly, we
have come to a shared understanding
of what it means to be a global citizen
and to embrace nursing’s social justice
imperative to promote equity in health
for all.
Currently, the OT education program—modular PowerPoint presentations and other resources (e.g., MASCC
oral agent teaching tool; NCIC toxicity assessment tool)—is available
online in Spanish and Portuguese on
the ISNCC website (http://www.isncc.
org/?page=OralChemo) for all to access
for future teaching and/or review.
English versions of the program will be
available on the ISNCC website by the
end of 2015, and available for all to use.
This project was supported by an
unrestricted grant from Pfizer.
Canadian Association of Nurses in
Oncology (CANO/ACIO) (2010). CANO/
ACIO position statement on cancer
chemotherapy administration and care:
Oral chemotherapy supplement. CANO/
ACIO: Vancouver, BC. Retrieved from
de Souza Institute (2015). About de
Souza. Retrieved from http://www.
Neuss, M.N., Polovich, M., McNiff, K.,
Esper, P., Gilmore, T.R., LeFebvre,
K.B., Schulmeister, L., & Jacobson, J.O.
(2013). 2013 Updated American Society
of Clinical Onclogy/Oncology Nursing
Society chemotherapy administration
safety standards including standards for
the safe administration and management
of oral chemotherapy. Journal of Oncology
Practice, 9(2s), 5s–13s.
Oakley, C., Crowe, M., & Johnson, M.
(2010). Introducing the United Kingdom
Oncology Nursing Society’s (UKONS)
position statement on oral chemotherapy.
European Journal of Cancer Care, 19, 1–4.
Schneider, S.M., Hess, K., & Gosselin,
T. (2001). Interventions to promote
adherence with oral agents. Seminars in
Oncology Nursing, 27(2), 133–141.
Sheldon, L.K. (2010). International cancer
care: What is the role of oncology
nursing? Clinical Journal of Oncology
Nursing, 14(5), 539–541. doi:10.1188/10.
Weingart, S.N., Spencer, J., Buia, S.,
Duncombe, D., Singh, P., Gadkari, M. &
Connor, M. (2011). Medication safety of
five oral chemotherapies: A proactive risk
assessment. Journal of Oncology Practice,
7(1), 2–6.
Canadian Oncology Nursing Journal • Volume 25, Issue 4, Fall 2015
Revue canadienne de soins infirmiers en oncologie
and was facilitated by the nurse champions who conducted the pilot workshops.
These final workshop participants were
invited based on their potential to teach
the OT program to other nurses in their
country and/or influence the revision of
models of care and allocation of nursing resources to provide OT nursing
care. At the end of the final workshop
in Bogota, participants returned to their
countries and practice settings with the
expectation that they would use this
new knowledge in their own practice,
as well as teach the OT program to their
peers. Nurse champions who taught the
pilot and final workshops were available
to provide ongoing support and coaching to these nurses, as they taught the
OT program in their own countries and
practice settings.
Evaluation of the pilot and final
workshop revealed high satisfaction and
improved knowledge about the nursing
care of people receiving OTs for their
cancer. Participants felt the face-to-face
format was effective to collaboratively
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