Commentaries on presentations from the 2014 Annual CANO/ACIO Conference

Communiqué
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 education project aimed to standardize
and optimize the provision of information and education resources for oncology patients within their geographical
region. The first part of the project identified a need to address how patients are
supported, as they transition from treatment 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: information 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 informational 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 providing oncology care (Howell et al, 2009;
Fitch, 2008). There is an abundance
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of evidence in the literature related to
the informational needs of oncology
patients including: common informational priorities, sources from which
information is received, and preferred
learning styles. The benefits of supporting 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 current 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 supporting 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 information needs regarding symptoms, and
psychological and practical concerns,
revealed both similarities and differences in what information nurses felt
they need to better support patients,
and what patients prioritized as concerns. The following example illustrates
these similarities and differences. Both
nurses and patients rated the importance 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 perspective. 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 education 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 information 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, clinician, 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 priorities, 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 communication and decision making
What this project adds:
• The identification of the similarities and potential differences about
perceived and actual information
priorities from a patient and nurse
perspective
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Revue canadienne de soins infirmiers en oncologie
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 guidelines 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 monitoring, structured educational support, follow-up, and evaluation. In this program,
staff members maintain their competency by working two shifts per month
in the chemotherapy administration
area, or by administering 12 chemotherapy 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 periods longer than three months. Baseline
data have been collected and the program 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 incidence of cancer (Canadian Cancer
Society’s Advisory Committee on
Cancer Statistics, 2013), initiatives
have been undertaken for rural cancer 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 competency in administering these cytotoxic
agents. This presentation described the
development of a program to ensure
the continued competency of registered nurses practicing in rural settings
where chemotherapy administration
is infrequent. This program was developed 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 program, 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 frontline RNs practicing in rural cancer settings to incorporate content that would
support their chemotherapy administration 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 competencies required of them enables program
developers to incorporate relevant and
appropriate content. Similarly, the demographics of the respondents, the majority of whom worked part-time (47%)
and had less than two years of oncology
nursing experience (43%), may also have
Canadian Oncology Nursing Journal • Volume 25, Issue 1, Winter 2015
Revue canadienne de soins infirmiers en oncologie
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 incorporated available and relevant sources of
information. The details of this presentation would be of particular interest to
administrators and registered nurses
in rural settings with low volumes of
chemotherapy administration. Of particular interest, will be the results this
piloted program, which are being evaluated in 2015. The program developers
are evaluating staff turn-over, staff satisfaction, 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 specialist knowledge (Zibrik, MacLeod, &
Zimmer, 2010), which can be challenging in light of the continued evolution of cancer treatments (Hewitt,
Greenfield, & Stovall, 2006). These
challenges, compounded with the irregular administration of chemotherapy
in rural settings, warrant the incorporation of initiatives such as that presented by Enders and colleagues (2014).
The details of this program, and the
results of its evaluation (in-progress),
will be useful for executives and clinicians to ensure that rural and remote
cancer patients continue to receive safe
and competent registered nursing care
with the administration of cytotoxic
treatments.
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Communiqué
REFERENCES
Communiqué
In brief
What is already known:
• Oncology nurses need to maintain
their competency to administer cytotoxic agents.
• Practice guidelines are not always feasible in rural contexts and/or practitioners are unaware of them.
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
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What this presentation showed:
• That rural oncology nurses are concerned 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 continued competency.
Next steps:
• More research is needed to understand the experiences of rural cancer patients, survivors, and oncology
nurses.
• Initiatives should be explored about
how to facilitate the cancer care provided and received in rural contexts.
Committee on Cancer Statistics. (2013).
Canadian Cancer Statistics 2013. Toronto,
Canada. Retrieved from http://www.
c a n c e r. c a / ~ / m e d i a / c a n c e r. c a / C W/
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 acutecare 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
Volume 25, Issue 1, Winter 2015 • Canadian Oncology Nursing Journal
Revue canadienne de soins infirmiers en oncologie