Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit

The Value of Renal Clinical Nurse Specialists: Future Potential and Current Challenges in the United Kingdom

OBJECTIVES

The renal clinical nurse specialist (CNS) should be the main source of support and information for people affected by kidney cancer. The CNS is best placed to offer holistic care and often gets to know the patient, especially well as they progress on second- or third-line therapies. We discuss future potential and current challenges in the United Kingdom based on our health professional experiences.

METHODS

This is a discussion paper based on clinical expertise and informed by current literature.

RESULTS

The CNS role for uro-oncology in many centers covers a large patient population and all 5 tumor sites: prostate, bladder, renal, testis, and penile. Urology has a decreasing workforce and increasing difficulty in recruiting to the role in these services. A number of renal CNSs are new to post due to the recruitment crisis without dedicated CNS competencies. Renal CNSs can be proven to reduce costs through managing patients' side-effect profile, ensuring people affected by cancer continue their maintenance therapies.

CONCLUSIONS

Therapies for kidney cancer have revolutionized treatment for patients and improved their overall survival in recent years. With longer prognoses and specialist therapies that include targeted and immunotherapy drugs, people affected by kidney cancer need dedicated renal CNSs to support them throughout the cancer pathway.

IMPLICATIONS FOR NURSING PRACTICE

Educational projects and resources, such as the aspirant cancer career and education (ACCEND) project and RCC4Nurses, will be key to support both new and longer serving CNSs to pursue successful roles in uro-oncology while providing excellent patient care.

Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer

Advances in the multidisciplinary care of early stage resectable NSCLC (rNSCLC) are emerging at an unprecedented pace. Numerous phase 3 trials produced results that have transformed patient outcomes for the better, yet these findings also require important modifications to the patient treatment journey trajectory and reorganization of care pathways. Perhaps, most notably, the need for multispecialty collaboration for this patient population has never been greater. These rapid advances have inevitably left us with important gaps in knowledge for which definitive answers will only become available in several years. To this end, the International Association for the Study of Lung Cancer commissioned a diverse multidisciplinary international expert panel to evaluate the current landscape and provide diagnostic, staging, and therapeutic recommendations for patients with rNSCLC, with particular emphasis on patients with American Joint Committee on Cancer-Union for International Cancer Control TNM eighth edition stages II and III disease. Using a team-based approach, we generated 19 recommendations, of which all but one achieved greater than 85% consensus among panel members. A public voting process was initiated, which successfully validated and provided qualitative nuance to our recommendations. Highlights include the following: (1) the critical importance of a multidisciplinary approach to the evaluation of patients with rNSCLC driven by shared clinical decision-making of a multispecialty team of expert providers; (2) biomarker testing for rNSCLC; (3) a preference for neoadjuvant chemoimmunotherapy for stage III rNSCLC; (4) equipoise regarding the optimal management of patients with stage II between upfront surgery followed by adjuvant therapy and neoadjuvant or perioperative strategies; and (5) the robust preference for adjuvant targeted therapy for patients with rNSCLC and sensitizing EGFR and ALK tumor alterations. Our primary goals were to provide practical recommendations sensitive to the global differences in biology and resources for patients with rNSCLC and to provide expert consensus guidance tailored to the individualized patient needs, goals, and preferences in their cancer care journey as these are areas where physicians must make daily clinical decisions in the absence of definitive data. These recommendations will continue to evolve as the treatment landscape for rNSCLC expands and more knowledge is acquired on the best therapeutic approach in specific patient and disease subgroups.

The role experience of advanced practice nurses in oncology: An interpretative phenomenological study

AIM(S)

To understand the experiences of advanced practice nurses working in cancer care.

DESIGN

Phenomenological qualitative study.

METHODS

Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software.

RESULTS

Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role.

CONCLUSION

Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments.

IMPLICATIONS FOR THE PROFESSION

These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles.

REPORTING METHOD

Reporting complied with COREQ criteria for qualitative research.

PATIENT OR PUBLIC CONTRIBUTIONS

No patient or public contribution.

Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision

Idiopathic pulmonary fibrosis (IPF) is a progressive disease leading to significant morbidity and mortality. In 2017 the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA) published a position statement on the treatment of IPF. Since that time, subsidized anti-fibrotic therapy in the form of pirfenidone and nintedanib is now available in both Australia and New Zealand. More recently, evidence has been published in support of nintedanib for non-IPF progressive pulmonary fibrosis (PPF). Additionally, there have been numerous publications relating to the non-pharmacologic management of IPF and PPF. This 2023 update to the position statement for treatment of IPF summarizes developments since 2017 and reaffirms the importance of a multi-faceted approach to the management of IPF and progressive pulmonary fibrosis.

Telepalliative Care in Home-Based Nursing Care for Older Adults With Metastatic Cancer Post COVID-19: An Ethnoscientific Study

Introduction

The post-COVID-19 pandemic caused the whole world to make several changes to the nursing healthcare system. This sudden shift raised questions about telepalliative care in home-based nursing care in the context of healthcare utilization, including meeting the needs of older adults with metastatic cancer. The evidence suggests that telepalliative care in home-based nursing care is acceptable to most advanced practice nurses, but the extent of their use for metastatic cancer patients has not been defined.

Objectives

To explore the use of telepalliative care in home-based nursing care for older adults with metastatic cancer in central Thailand following the post-COVID-19 pandemic.

Methods

A qualitative approach with an ethnoscientific design was used to collect data from a purposive sample of 15 advanced practice nurses from May to September 2023. The interview transcripts were analyzed using componential analysis (core coding, categorizing, theme, and emerging theory).

Results

The componential analysis revealed two themes of telepalliative care in home-based nursing care for older adults with metastatic cancer in the post COVID-19 pandemic. The first theme is telepalliative care delivery, with subthemes of delivering practice, nurse-mediated feedback and supportive care, remote monitoring of real-time emergencies, and transferring medical data. The second theme is advanced practice nurses' (APN) role in telepalliative nursing care, including the subthemes of virtual monitoring, life-threatening cancer, side effects, caregiving capacity, continuity of care, and long-term care services. The study found that caregiving capacity, continuity of care, and long-term care services were formed of telepalliative care in home-based nursing care for cancer patients following the COVID-19 pandemic.

Conclusion

Telepalliative care in home-based nursing care is effective in delivering services to older adults with metastatic cancer during the post-COVID-19 pandemic. The findings suggested that remote monitoring of real-time emergencies, life-threatening cancer, and long-term care services are part of telepalliative care in home-based nursing care. Adapting the telepalliative competency standards of advanced practice nurses is needed to ensure high-quality healthcare access for older adults with metastatic cancer during the post-COVID-19 pandemic.

The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction

BACKGROUND

To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction.

METHODS

We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction.

RESULTS

Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care.

CONCLUSION

Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

Patients' and professionals' experiences with advanced practice nursing in cancer care: A qualitative study

PURPOSE

The growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by advanced practice nurses (APN).

METHODS

Phenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness.

RESULTS

Interviews were performed with 18 professionals and 11 patients, from high-complexity public hospitals between March-December 2021. The main themes that emerged were: Advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care.

CONCLUSION

Advanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers.

A cross-sectional study on Chinese oncology nurses' knowledge of bone health among cancer patients

OBJECTIVE

To understand the knowledge status, obstacle factors, and management confidence of oncology nurses on the bone health of cancer patients, and in addition to provide reference for establishing bone health knowledge training system for oncology nurses and guiding them to manage bone health of cancer patients.

METHODS

A total of 602 nurses engaged in oncology nursing in 6 hospitals in Hebei Province were selected by cluster sampling, and an online anonymous survey was conducted by sending questionnaires to oncology nurses from the Hebei Cancer Prevention and Control Association. The questionnaire was developed by the study team. There are 4 parts, namely general information, nurses' role and job responsibilities, knowledge of skeletal-related events (SREs) and cancer treatment-induced bone loss (CTIBL), and understanding and confidence in bone health management, for a total of 33 questions.

RESULTS

Thirty-seven percent of oncology nurses received training on bone health and other related contents; 40.48% of oncology nurses used domestic and foreign guidelines when managing patients with bone metastases or CTIBL. Only approximately one-third of oncology nurses had confidence in managing the side effects of bone metastases and bone modification drugs and identifying patients at risk of CTIBL and fracture; only 33.04% of oncology nurses believed that weight-bearing exercise can prevent bone loss; less than 50% of oncology nurses believed that aromatase inhibitor therapy, ovarian suppression therapy, androgen deprivation therapy, and low body weight were risk factors for pathological fractures. The reasons that hindered oncology nurses from optimizing the management of patients with bone metastases and understanding the preventive measures and risk factors for bone loss mainly included lack of relevant knowledge training, lack of understanding of effective intervention measures, and lack of training and professionalism of specialized nurses, including insufficient development time and guidelines for clinical nursing practice.

CONCLUSION

Managers must continuously improve the training system of oncology nurses, enrich the content of training pertaining to bone health for cancer patients, formulate clinical nursing practice guidelines, and give oncology nurses more time for professional development.

A first census of skin cancer specialist nurses across UK secondary care trusts

BACKGROUND

Skin cancer specialist nurses (SCSNs) support patients and work alongside healthcare professionals throughout the care pathway. Skin cancer management is rapidly evolving, with increasing and more complex treatment options now available, so the need for patient support is growing. While SCSNs are a major source of that support, the provision of SCSN resource across the UK has never previously been assessed. We therefore undertook a first SCSN census on 1st June 2021.

METHODS

An electronic survey was disseminated to UK hospital trusts and registered skin cancer healthcare professionals. Responses were identifiable only by the respective trust name.

RESULTS

112 responses from 87 different secondary care trusts were received; 92% of trusts reporting having at least 1 established SCSN post. Average SCSN staffing per trust was 2.4 (range 0-7) whole time equivalents, managing an average caseload of 83 (range 6-400) patients per week. SCSN workload had increased in 82% hospitals in the previous year and 30% of trusts reported being under-resourced. Most SCSN time was spent managing melanoma (as opposed to non-melanoma skin cancer) patients linked to surgical services. Regional variations existed, particularly associated with provision of lymphoedema services, nurse prescribing skills and patient access to clinical trials. The COVID-19 pandemic was associated with a marked increase in SCSN-led telemedicine clinics, but loss of training and education opportunities.

CONCLUSIONS

SCSNs based in secondary care hospitals play a major role supporting both clinicians and patients throughout the care pathway. This first UK census confirmed that SCSN workload is increasing and in one third of hospital trusts, the work was reported to outstrip the staffing available to manage the volume of work. Regional variations in SCSN resource, workload and job role, as well as availability of certain skin cancer services were identified, providing valuable information to healthcare commissioners concerned with service improvement.

Roles and practices of specialist lung cancer nurses: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the available literature on the role of specialist lung cancer nurses.

INTRODUCTION

The international literature acknowledges the importance of specialist cancer nurses who provide supportive care to patients. Historically, however, there has been a lack of consistent evidence to inform development and implementation of the role.

INCLUSION CRITERIA

This review will consider quantitative and qualitative studies of any design or methodology that report on role characteristics or behaviors, practices, or activities, or other aspects of specialist lung cancer nurses in the acute care setting. Systematic reviews, professional body reports, as well as unpublished or published studies and reports will also be considered for inclusion. Textual or opinion papers will be excluded.

METHODS

This review will follow the JBI methodology for scoping reviews. Relevant papers from 2006 to 2022, in any language, will be searched for in the following databases and registries: MEDLINE (PubMed), CINAHL (EBSCO), Web of Science, Embase, and the Cochrane Register of Controlled Trials. Websites to be searched will include the World Health Organization, International Council of Nurses, and Agency for Healthcare Research and Quality. ProQuest Dissertations and Theses (ProQuest) and Grey Matters (CADTH) will be searched for unpublished literature. Results will be presented in tabular and narrative format and mapped according to the specified concepts of interest, as well as to the domains of practice for specialist nursing roles.

European Respiratory Society guideline on various aspects of quality in lung cancer care

This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.

Exploring the availability of specialist health workforce education in East and Southern Africa: a document analysis

BACKGROUND

Specialist health professionals improve health outcomes. Most low-income and middle-income countries do not have the capacity to educate and retain all types of specialists across various health professions. This study sought to explore and describe the opportunities available for specialist health professions education and the pathways to becoming a specialist health professional in East and Southern Africa (ESA). Understanding the regional capacity for specialist education provides opportunities for countries to apply transnational education models to create prospects for specialist education.

METHODS

A document analysis on specialist training programmes for health professionals was conducted in twenty countries in ESA to establish the capacity of specialist education for health professionals. Data were collected from policy documents, grey literature and websites at the country and institution levels.

FINDINGS

We found 288 specialist health professions education programmes across ten professional categories in 157 health professions education institutions from 18 countries in the ESA are reported. Medical and Nursing specialist programmes dominate the list of available specialist programmes in the region, while Kenya, South Africa and Ethiopia have the highest number of specialist programmes. Most included specialist programmes were offered at the Master's level or as postgraduate diplomas. There is a general uneven distribution of specialist health professions education programmes within the ESA region despite sharing almost similar sociogeographical context and disease patterns. Current national priorities may be antecedent to the diversity and skewed distribution of specialist health professions programmes.

CONCLUSION

Attention must be paid to countries with limited capacity for specialist education and to professions that are severely under-represented. Establishing regional policies and platforms that nurture collaborations towards specialist health professions education may be a proximal solution for increased regional capacity for specialist education.

Clinical nurse specialists and survival in patients with cancer: the UK National Cancer Experience Survey

OBJECTIVE

To examine whether having a better care experience with a clinical nurse specialist (CNS) is associated with better overall survival of patients with cancer in England.

METHODS

We identified 99 371 patients with colorectal, lung, breast and prostate cancer who reported their care experience with CNS from the National Cancer Patient Experience Survey (2010-2014) and English cancer registration linked dataset. We categorised patients' experiences into three groups (excellent, non-excellent and no CNS name was given), across three aspects of CNS care: the ease of contacting their CNS, feeling that a CNS had listened to them and the degree to which explanations given by a CNS were understandable. We used univariable and multivariable Cox proportional hazards regression analyses to estimate HRs with 95% CIs by patient experience for each cancer adjusting for patients' sociodemographic and disease stage at diagnosis.

RESULTS

Among the three compared groups, patients who reported not being given a CNS name had the lowest survival. In the adjusted Cox regression analysis, the results show that among those who reported not being given a CNS name, the highest risk of death was in those with colorectal, breast and prostate cancers only (colorectal HR: 1.40; 95% CI: 1.32 to 1.84; breast HR: 1.34; 95% CI: 1.25 to 1.44; prostate HR: 1.09; 95% CI: 0.99 to 1.13). However, this association seemed reversed among patients with lung cancer, although attenuated when accounting for potential confounders.

CONCLUSION

These findings provide new evidence of the vital contribution CNS may make to cancer survival and suggest CNS input and support should be available to all patients after the diagnosis.

The mediating role of job satisfaction between psychological capital and work engagement among Chinese nurses during COVID-19 outbreak: A comparative study between nurse specialists and general nurses

BACKGROUND

The outbreak of COVID-19 has become a global public health emergency, causing great psychological distress to nurses. It is unknown whether the pandemic will affect the work engagement of nurses, the relationship between psychological capital, job satisfaction, and work engagement among nurses, and whether there are differences between nurse specialists and general nurses during the pandemic.

OBJECTIVES

The purpose of this study was to compare psychological capital, job satisfaction, and work engagement among nurse specialists and general nurses during the pandemic, as well as to test the role of job satisfaction as a mediator in the association between psychological capital and work engagement among nurses, and to examine whether the underlying mechanism of the relationship between psychological capital and job satisfaction differs between nurse specialists and general nurses.

MATERIALS AND METHODS

A convenience sampling was used to assess a sample of 372 nurse specialists and 318 general nurses from nine provincial general hospitals in China to participate in the online survey. Data were collected using self-report questionnaires, including the following tools: self-designed socio-demographic questionnaire, psychological capital scale, job satisfaction scale, and work engagement scale.

RESULTS

Compared with general nurses, the nurse specialists had higher psychological capital, job satisfaction, and work engagement. Job satisfaction partially mediated the positive association between psychological capital and work engagement and the indirect effect was stronger in nurse specialists in comparison to general nurses during the COVID-19 pandemic.

CONCLUSION

The findings provide important practical implications for future intervention programs aimed at enhancing nurses' work engagement, which may be realized through strengthening psychological capital and job satisfaction during the pandemic. Moreover, considering the cost-effectiveness of limited health care spending, nursing managers should pay more attention to the continuing professional development of young general nurses.

Being assigned a clinical nurse specialist is associated with better experiences of cancer care: English population-based study using the linked National Cancer Patient Experience Survey and Cancer Registration Dataset

Objective

This study aimed to examine whether being given the name of a clinical nurse specialist (CNS) is associated with better cancer patients' experiences across different points along their cancer care pathway.

Methods

We identified 100,885 colorectal, lung, breast and prostate cancer patients who responded to the National Cancer Patient Experience Survey between 2010 and 2014. We compared experiences of four key aspects of cancer care among patients who reported being given a CNS name with those who did not, adjusting for age, sex, socio‐economic deprivation, ethnicity, route to diagnosis and disease stage.

Results

Across all cancers, patients who reported being given the name of a CNS reported better experiences with involvement in treatment decisions, care coordination, treatment with more respect and dignity, and overall care experience. Experience of being involved in treatment decisions was the aspect of care most strongly associated with being given a CNS name (colorectal: OR 2.69, 95% CI: 2.45–2.96; lung: OR 2.41, 95% CI: 2.07–2.78; breast: OR 2.68, 95% CI: 2.47–2.92; and prostate: OR 2.11, 95% CI: 1.92–2.32).

Conclusion

These findings may provide new evidence of the vital contribution CNS make to cancer care and suggest their input and support should be available to all patients after the diagnosis.