Development of an International Competency Framework for Nurses in the Provision of Self-management Support to Cancer Populations

A multimodal cancer rehabilitation programme promoting sense of coherence for women treated for female reproductive cancers: a pilot randomised controlled trial

PURPOSE

To investigate the feasibility, acceptability, and preliminary effects of a theory-driven multimodal cancer rehabilitation intervention (MCRI) programme among Hong Kong Chinese women treated for female reproductive cancers (FRC).

METHODS

A single-blinded randomised controlled trial was conducted in two regional hospitals in Hong Kong involving 35 women treated for FRC. The intervention group (n = 18) received a 12-week MCRI which included 30 modules of app-based health education and three nurse-led individual counselling sessions. The control group (n = 17) received attention from the research nurse through telephone calls. Sense of coherence, health-related quality of life, and cancer-specific distress were measured at baseline (T0), immediately after completion of the intervention (T1) and 12 weeks post-intervention (T2). Twelve intervention completers were interviewed to explore the acceptability of the programme.

RESULTS

Recruitment, consent, and retention rates, counselling session attendance rate, and app usage were satisfactory. The intervention participants reported to have significant improvement in physical well-being at T1 (Cohen's d effect size (d) = 1.04, 95% CI 0.24, 1.83), sense of coherence (d = 0.76, 95% CI - 0.03, 1.54), and cancer-specific distress (d = 1.03, 95% CI - 1.83, - 0.21) at T2. Interviewed participants acknowledged the benefits of the programme and provided comments for improvement.

CONCLUSIONS

The MCRI is found to be feasible and acceptable and may improve their sense of coherence, distress, and physical health. A full-scale trial using a larger and more representative sample is warranted to confirm the effects of the programme.

IMPLICATIONS FOR CANCER SURVIVORS

Women treated for FRC may be benefited from the MCRI in improving sense of coherence, physical well-being, and distress.

TRIAL REGISTRATION

This trial was registered on ISRCTN registry with ID ISRCTN73177277.

Understanding supported self-management for people living with a lower-grade glioma: Implementation considerations through the lens of normalisation process theory

BACKGROUND

Supported self-management can improve clinical and psychosocial outcomes in people with cancer; the considerations required to implement self-management support (SMS) for people living with a lower-grade glioma (LGG)-who often have complex support needs-are not known. We aimed to identify and understand these implementation considerations through the lens of normalisation process theory (NPT), from the perspectives of healthcare professionals (HCP) and people with LGG.

METHODS

We conducted semistructured interviews with HCPs who support adults with brain tumours (n = 25; 12 different healthcare professions), and people with LGG who had completed primary treatment (n = 28; male n = 16, mean age 54.6 years, mean time since diagnosis 8.7 years), from across the United Kingdom. Interviews were transcribed and inductive open coding conducted, before deductively mapping to constructs of NPT. We first mapped HCP data, then integrated data from people with LGG to explore alignment in experiences and perspectives.

RESULTS

We generated supporting evidence for all four NPT constructs and related subconstructs, namely: 'Coherence', 'Cognitive participation', 'Collective action' and 'Reflexive monitoring'. Data from HCPs and people with LGG clearly demonstrated that effective SMS constitutes a collective activity. Key implementation considerations included: ensuring awareness of, and access to, support; building strong HCP-support recipient relationships; and careful inclusion of close family and friends. We identified pertinent challenges, such as identifying support needs (influenced by the extent to which those with LGG engage in help-seeking), resistance to support (e.g., technology literacy), training for HCPs and HCP cooperation.

CONCLUSIONS

This study demonstrates the collective nature of, and provides insight into the individual roles within, supported self-management. We outline considerations to operationalise, sustain and appraise the implementation of SMS for people with LGG.

PATIENT OR PUBLIC CONTRIBUTION

People with brain tumours, and informal caregivers, were involved in the development of information materials and topic guides to ensure accessibility and pertinence. They also had opportunities to comment on interview findings.

Learning to provide humanistic care and support in the context of chronic illness: Insights from the narratives of healthcare professionals in hemato-oncology

PURPOSE

To document the process by which healthcare professionals (HCPs) support people living with and beyond hematological cancer and detail how they learned from their personal and clinical experience.

METHOD

Using a narrative approach, we conducted nine semi-structured interviews with HCPs, including nurses, from a specialized care centre who support patients with hematological cancer. Interviews aimed to capture experiential learning gained from their practice. We performed a hybrid inductive/deductive content analysis on data using a framework based on sociological and educational models of experiential learning.

RESULTS

Among healthcare professionals, analysis revealed the need to provide care and support that is 'humane' and adapted to each patient. Learning to provide this type of care proved to be challenging. Over the course of their clinical experience, healthcare professionals learned to adapt the support they provided by straddling a boundary between sympathy and empathy. Learning outcomes were associated with personal-professional development among participants.

CONCLUSION

Our findings bring to light an overlooked facet of patient support in the context of cancer care, which is the acquisition of the soft skills required to deliver humanistic care and support. This learning process requires time and involves navigating between the realms of sympathy and empathy. Experiential learning is intertwined with the complexity of the often long-term patient-professional relationship that characterizes hemato-oncology. This unique relationship offers rewards for healthcare professionals on both personal and professional fronts.

The self-management instrument for breast cancer patients undergoing adjuvant therapy: Development and psychometric testing using the COSMIN methodology

Objective

This study aims to develop and test the self-management instrument for breast cancer patients undergoing adjuvant therapy (SMAT-B).

Methods

After a qualitative interview with 29 patients and two rounds of Delphi expert consultation with 15 experts, 49 items were initially generated. Before item reduction, another structured interview was conducted for content validity. Item analysis and exploratory factor analysis (n ​= ​377) were used for item reduction. After that, internal consistency, split-half reliability, test-retest reliability (n ​= ​30), measurement error, construct validity, and structural validity (n ​= ​342) were preliminarily evaluated using the COnsesus-based Standards for the selection of health Measurements INstruments guidelines.

Results

The final version of SMAT-B includes 7 dimensions and 31 items after item reduction. The testing results suggested that SMAT-B had good internal consistency (Total Cronbach's α ​= ​0.952), good split-half reliability (Spearman-Brown coefficient ​= ​0.904), good stability (Total intraclass correlation coefficient = ​0.797), acceptable measurement error (SEM ​= ​5.28), and acceptable construct validity (Standardized root mean square residual ​= ​0.055). The hypotheses of construct validity were all verified to a certain extent (r ​> ​0.20, P ​< ​0.01).

Conclusions

The 31-item SMAT-B, developed in interviews with patients and consultation with experts, demonstrated good psychometric properties and can be recommended for researchers and clinicians for further validity testing and evaluation of the self-management ability of breast cancer patients.

Trial registration

ChiCTR2100052868.

Impact of a Training Program on Oncology Nurses’ Confidence in the Provision of Self-Management Support and 5As Behavioral Counseling Skills

Background: Cancer patients and their families play a central role in the self-management of the medical, emotional, and lifestyle consequences of cancer. Nurses with training in self-management support can enable cancer patients to better manage the effects of cancer and treatment. Methods: As part of a randomized controlled trial, we developed a training program to build nurses’ confidence in the provision of self-management support (SMS). The SMS skills taught were adapted from the Stanford Peer Support training programs and embedded within the 5As (Assess, Advise, Agree, Assist, and Arrange) behavioral counseling process. We evaluated the impact of the training program on oncology nurses’ and coaches’ confidence using a Student’s t-test for paired samples in a nonrandomized, one-group pre/postsurvey. Results: Participants were experienced oncology nurses from three participating cancer centers. A two-tailed Student’s t-test for paired samples showed a significant improvement in nurses’ confidence for the 15 SMS microskills targeted in the training between the pretest and post-test as follows: for Center 1, a mean difference of 0.79 (t = 7.18, p ≤ 0.00001); for Center 2, a mean difference of 0.73 (t = 8.4, p ≤ 0.00001); for Center 3, a mean difference of 1.57 (t = 11.45, p ≤ 0.00001); and for coaches, a mean difference of 0.52 (t = 7.6, p ≤ 0.00001). Conclusions: Our training program improved oncology staff nurses’ and cancer coaches’ confidence in 15 SMS microskills and has potential for SMS training of nurses in routine care.