Commentaries on presentations from the 2014 Annual CANO/ACIO Conference

108 Volume 25, Issue 1, WInter 2015 • CanadIan onCology nursIng Journal
reVue CanadIenne de soIns InfIrmIers en onCologIe
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 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 rst part of the project iden-
tied 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 benets 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 dierences amongst
the two groups.
Survey data related to informa-
tion needs regarding symptoms, and
psychological and practical concerns,
revealed both similarities and dier-
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 dierences. 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
reection 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 reect on
the appropriateness of current health
care practices, and to examine if these
practices reect 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 dier.
In brief
What is already known:
• Patients with cancer can often have
informational needs regarding the
disease, treatment, prognosis, and
side eects
• Supporting informational needs can
potentially positively inuence the
patient’s ability to cope, reduction of
anxiety and fear, and enhancing com-
munication and decision making
What this project adds:
• The identication of the similari-
ties and potential dierences about
perceived and actual information
priorities from a patient and nurse
perspective

109
Canadian OnCOlOgy nursing JOurnal • VOlume 25, issue 1, Winter 2015
reVue Canadienne de sOins infirmiers en OnCOlOgie
Communiqué
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, Mott, & 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 sta monitor-
ing, structured educational support, fol-
low-up, and evaluation. In this program,
sta 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, sta 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
dened 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 sucient
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 ll a gap identied 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 aected 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 sta turn-over, sta 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,
Greeneld, & 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
Communiqué
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., Greeneld, 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., Mott, 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 Inrmières, 42(1),
20–36. Retrieved from http://www.ncbi.
nlm.nih.gov/pubmed/20420090