Nursing implications of personalized and precision medicine

[Application Status and Prospects of Precision Nursing Under the Concept of Enhanced Recovery After Surgery]

With the development of enhanced recovery after surgery (ERAS), major breakthroughs have been made in this field of study. However, the research fields still need to be continuously expanded to meet the needs of patients. The concept of precision therapy is widely applied in the field of nursing. Under the concept of ERAS, practical studies of applying precision nursing for the perioperative period have already been conducted, exploring such issues as precision nursing assessment, precision nursing intervention design, precision risk prediction model, and information technology to assist precision nursing practice. Research findings have preliminarily validated the safety and effectiveness of applying precision nursing for ERAS in the perioperative period. Herein, we reviewed the reported findings of relevant research published in recent years and identified the following problems in the implementation of precision nursing under the ERAS concept, a lack of implementation standards, challenges concerning the the role of nurses, a lack of high-quality research evidence in the existing literature, and a relevant big data processing platform that China does not have and therefore cannot carry out data sharing, integration, mining, and utilization. We also made suggestions for effective improvement and discussed research prospects. In the future, multidisciplinary collaboration, translational medical research, and the development of various innovative tools are to be strengthened to help improve the quality and effectiveness of nursing care. We hope to provide reference for improving the scientific and targeted implementation of precision nursing for ERAS in the perioperative period.

Precision Medicine Is Changing the Roles of Healthcare Professionals, Scientists, and Research Staff: Learnings from a Childhood Cancer Precision Medicine Trial

Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia's first precision medicine trial for children with poor-prognosis cancer: the PRecISion Medicine for Children with Cancer (PRISM) national clinical trial of the Zero Childhood Cancer Program. We conducted semi-structured interviews with 85 PRISM professionals from eight professional groups, including oncologists, surgeons, clinical research associates, scientists, genetic professionals, pathologists, animal care technicians, and nurses. We analyzed interviews thematically. Professionals shared that precision medicine can add complexity to their role and result in less certain outcomes for families. Although many participants described experiencing a greater emotional impact from their work, most expressed very positive views about the impact of precision medicine on their profession and its future potential. Most reported navigating precision medicine without formal training. Each group described unique challenges involved in adapting to precision medicine in their profession. Addressing training gaps and meeting the specific needs of many professional groups involved in precision medicine will be essential to ensure the successful implementation of standard care.

Genetic and genomic learning needs of oncologists and oncology nurses in the era of precision medicine: a scoping review

Genetic and genomic data are increasingly guiding clinical care for cancer patients. To meet the growing demand for precision medicine, patient-facing oncology staff will be a part of leading the provision of genomic testing. A scoping review was undertaken to identify the range of genetic and genomic learning needs of oncologists and oncology nurses. Learning needs were reported relating to interpretation of genomic data, clinical decision-making, patient communication and counseling, and fundamentals of genetics and genomics. There was a lack of empirical research specific to oncology nurses and their learning needs in tumor sequencing. Our findings suggest that oncologists and oncology nurses need tailored support, education and training to improve their confidence and skills in adopting genomic testing into clinical practice.

Conceptualizing the digitalization of healthcare work: A metaphor-based Critical Interpretive Synthesis

The digitalization of healthcare work has gained center stage in academic debates spanning disciplines as diverse as medicine, sociology and STS. The different analytical interests and methodological traditions of these three strains of scholarship have, however, resulted in quite diverging approaches to this issue. Points of interest have ranged from the (disattended) promise of increased efficiency of healthcare work, to dynamics of task delegation, (re-)professionalization and (re-)distribution of invisible work, to the disruption of informal organization. Instead of studying these dynamics in practice, in this paper we foreground the potentiality for theory-making inherent in the systematic cross-contamination of different theoretical and disciplinary perspectives. We perform a Critical Interpretive Synthesis (CIS) centering the ways the digitalization of healthcare work has been investigated in recent STS, sociological and medical literature. To open up assumptions and insights intrinsic to each body of literature for scholars and practitioners in other fields, we propose here a metaphor-based variation on CIS approaches. We probe, in turn, what slime molds can teach us about STS's focus on interconnections and materiality, how we can better understand sociological analyses of invisible work exploring them through theatrical performances, and which lessons river engineering offers concerning medical scholarship's discussion of efficiency and proper healthcare work. Thinking through these metaphors, we conceptualize the digitalization of healthcare work as a phenomenon spanning, at once, the directionality of technological innovation trajectories and the open-endedness of situated changes in work practices. Based on our analysis, we propose focusing on technological scripts, and various forms of invisible work and informal organization as entry points into the study of the tension between directionality and open-endedness in the context of the digitalization of healthcare work.

Nursing Personnel in the Era of Personalized Healthcare in Clinical Practice

Personalized, stratified, or precision medicine (PM) introduces a new era in healthcare that tries to identify and predict optimum treatment outcomes for a patient or a cohort. It also introduces new scientific terminologies regarding therapeutic approaches and the need of their adoption from healthcare providers. Till today, evidence-based practice (EBP) was focusing on population averages and their variances among cohorts for clinical values that are essential for optimizing healthcare outcome. It can be stated that EBP and PM are complementary approaches for a modern healthcare system. Healthcare providers through EBP often see the forest (population averages) but miss the trees (individual patients), whereas utilization of PM may not see the forest for the trees. Nursing personnel (NP) play an important role in modern healthcare since they are consulting, educating, and providing care to patients whose needs often needs to be individualized (personalized nursing care, PNC). Based on the clinical issues earlier addressed from clinical pharmacology, EBP, and now encompassed in PM, this review tries to describe the challenges that NP have to face in order to meet the requisites of the new era in healthcare. It presents the demands that should be met for upgrading the provided education and expertise of NP toward an updated role in a modern healthcare system.

Secondary Data Analysis in Nursing Research: A Contemporary Discussion

This editorial provides an overview of secondary data analysis in nursing science and its application in a range of contemporary research. The practice of undertaking secondary analysis of qualitative and quantitative data is also discussed, along with the benefits, risks and limitations of this analytical method.

Using precision medicine to individualize healthcare

The Precision Medicine Initiative (PMI) is a government initiative to encourage individualized care. This article provides a snapshot of precision medicine and its implications for patients and study participants, as well as the PMI and the role of nurses as educated patient advocates.

Precision health research and implementation reviewed through the conNECT framework

BACKGROUND

Precision health is a population-based approach that incorporates big-data strategies to understand the complex interactions between biological, environmental, lifestyle, and psychosocial factors that influence health.

PURPOSE

A promising tool to facilitate precision health research and its dissemination is the ConNECT Framework.

METHODS

Here, we discuss the relationship of the five broad and synergistic principles within the ConNECT Framework as they may apply to nursing science research: (1) Integrating Context, (2) Fostering a Norm of Inclusion, (3) Ensuring Equitable Diffusion of Innovations, (4) Harnessing Communication Technology, and (5) Prioritizing Specialized Training.

DISCUSSION/CONCLUSION

The principles within this framework can be used by nurse scientists and educators to guide and disseminate precision health research.

The implementation and evaluation of a communication skills training program for oncology nurses

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.

Unsolved challenges of clinical whole-exome sequencing: a systematic literature review of end-users' views

BACKGROUND

Whole-exome sequencing (WES) consists in the capture, sequencing and analysis of all exons in the human genome. Originally developed in the research context, this technology is now increasingly used clinically to inform patient care. The implementation of WES into healthcare poses significant organizational, regulatory, and ethical hurdles, which are widely discussed in the literature.

METHODS

In order to inform future policy decisions on the integration of WES into standard clinical practice, we performed a systematic literature review to identify the most important challenges directly reported by technology users.

RESULTS

Out of 2094 articles, we selected and analyzed 147 which reported a total of 23 different challenges linked to the production, analysis, reporting and sharing of patients' WES data. Interpretation of variants of unknown significance, incidental findings, and the cost and reimbursement of WES-based tests were the most reported challenges across all articles.

CONCLUSIONS

WES is already used in the clinical setting, and may soon be considered the standard of care for specific medical conditions. Yet, technology users are calling for certain standards and guidelines to be published before this technology replaces more focused approaches such as gene panels sequencing. In addition, a number of infrastructural adjustments will have to be made for clinics to store, process and analyze the amounts of data produced by WES.

The Future of Patient Engagement in the Governance of Shared Data

BACKGROUND

The emerging health care system increasingly values patient engagement and shared decision-making between patients and their providers. The practice of these values is gaining importance as the patient-centered medical home model and personalized medicine come into greater use.

OPPORTUNITY FOR IMPROVEMENT

Exploration of patient preferences about personal health data use for research and quality improvement is a fundamental element of the provider-patient relationship. Giving patients an explicit opportunity to discuss their options about use of their data and implementing a process that allows patients to receive desired communications about how their information is used can help build patient trust, a requirement for successful care partnerships.

PRACTICE ADVANCEMENT

Working to change organizational cultures that exclude patients from participation in important decisions related to personal health information use promotes a strong patient-provider relationship and, ultimately, lays the foundation for improved health care through expanded use of patient data.