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Dopelt K, Asna N, Amoyal M, Bashkin O. Nurses and Physicians' Perceptions Regarding the Role of Oncology Clinical Nurse Specialists in an Exploratory Qualitative Study. Healthcare (Basel) 2023; 11:1831. [PMID: 37444665 DOI: 10.3390/healthcare11131831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of the study was to examine the attitudes of nursing and medical teams about the role of oncology clinical nurse specialists in the healthcare system in Israel, where, unlike many countries in the world, such a role has not yet been developed or professionally defined. We conducted 24 interviews with physicians and nurses between August and October 2021. The interviews were transcribed and analyzed using a thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. Five main themes emerged from the interviews: (1) contribution to the healthcare system, (2) contribution to the patient, (3) drawing professional boundaries, (4) additional responsibilities and authority for oncology clinical nurse specialists, and (5) the field's readiness for a new position of oncology clinical nurse specialists. The findings provide evidence about the need to develop the role of clinical nurse specialists in the oncology field due to its potential benefits for nurses, physicians, patients, family members, and the healthcare system. At the same time, an in-depth exploration of the boundaries of the role and its implementation, in full cooperation with the oncologists and relevant professional unions, is needed to prevent unnecessary conflicts in the oncology field. Professional development training programs in nursing must create a platform for open dialogue between key stakeholders, nurses, and physicians, in order to help all involved parties, place the benefits to the patients above any personal or status considerations.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Noam Asna
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem 91031, Israel
| | - Mazal Amoyal
- Palliative Care Unit, Barzilai Medical Center, Ashkelon 78306, Israel
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel
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Linder LA, Newman A, Bernier Carney KM, Wawrzynski S, Stegenga K, Chiu YS, Jung SH, Iacob E, Lewis M, Linder C, Fox K, Altizer R. Symptoms and daily experiences reported by children with cancer using a game-based app. J Pediatr Nurs 2022; 65:33-43. [PMID: 35490550 PMCID: PMC10405915 DOI: 10.1016/j.pedn.2022.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/18/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app. DESIGN AND METHODS Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis. RESULTS Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms. CONCLUSIONS Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population. PRACTICE IMPLICATIONS Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Amy Newman
- College of Nursing, Marquette University, 530 N 16(th) St., Milwaukee, WI 53233, USA
| | - Katherine M Bernier Carney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-4026, USA
| | - Sarah Wawrzynski
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Yin-Shun Chiu
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Se-Hee Jung
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Melina Lewis
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Huntsman Cancer Hospital, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Caitlin Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Kaitlyn Fox
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd, SN-ADM, Portland, OR 97239-2941, USA
| | - Roger Altizer
- Population Health Science, Entertainment Arts and Engineering, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
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Horlait M, De Regge M, Baes S, Eeckloo K, Leys M. Exploring non-physician care professionals' roles in cancer multidisciplinary team meetings: A qualitative study. PLoS One 2022; 17:e0263611. [PMID: 35113976 PMCID: PMC8812975 DOI: 10.1371/journal.pone.0263611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/21/2022] [Indexed: 12/14/2022] Open
Abstract
The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.
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Affiliation(s)
- Melissa Horlait
- Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Melissa De Regge
- Faculty of Economics and Business Administration, Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Saskia Baes
- Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark Leys
- Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Cohen Castel O, Dagan E, Keinan-Boker L, Low M, Shadmi E. Patients' Perceived Continuity of Care and Adherence to Oral Anticancer Therapy: a Prospective Cohort Mediation Study. J Gen Intern Med 2021; 36:1525-1532. [PMID: 33768501 PMCID: PMC8175494 DOI: 10.1007/s11606-021-06704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown. OBJECTIVES To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT. DESIGN AND SETTING A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model. PARTICIPANTS Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days. MAIN MEASURES The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence. KEY RESULTS Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17). CONCLUSIONS In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.
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Affiliation(s)
- Orit Cohen Castel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel.
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marcelo Low
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Clalit Health Services, Head Office, Tel Aviv, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
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Patients' Non-Medical and Organizational Needs during Cancer Diagnosis and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165841. [PMID: 32806666 PMCID: PMC7459913 DOI: 10.3390/ijerph17165841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/07/2023]
Abstract
The aim of this cross-sectional study was to determine non-medical and organizational needs among cancer patients during diagnosis and treatment. The study included 384 cancer patients treated in five oncological centers in Poland. A questionnaire designed for the study was used. Most of the patients received psychological support from their partner/family/friends (88%), to a lesser extent from a psychologist (21%) and priests (4%). Forty-three percent of patients received social support from their partner/family/friends and only 7% of respondents received support from a social worker. Most patients stated they would like to have a professional who would help them with their non-medical problems during the diagnostic process and cancer treatment. The youth, with a higher education level who were professionally active and living in cities seemed to be more aware of their needs. Improvements to the oncological system in Poland should focus on expanding patient access to professional support of non-medical needs.
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Alternative provision of public health care: the role of citizens' satisfaction with public services and the social responsibility of government. HEALTH ECONOMICS POLICY AND LAW 2020; 17:121-140. [PMID: 32686632 DOI: 10.1017/s1744133120000201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper explores the factors that influence citizens' attitudes toward the alternative provision of health care services, leading them to be willing to make extra, informal payments within the public health care system. We question whether these attitudes depend primarily on inherent normative preferences, such as beliefs about the government's responsibility to its citizens, or on certain aspects of the reality that they experience, such as satisfaction with the quality and quantity of services as well as the fairness of public systems. Analyzing the findings from a national survey, the paper shows that practical considerations and real-world conditions strongly relate to attitudes more than normative perceptions do.
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Steinberg H. Oncology Nurse Coordinators in Clinical Trials - Shaking up the Melanoma Team. Asia Pac J Oncol Nurs 2020; 7:250-254. [PMID: 32642495 PMCID: PMC7325773 DOI: 10.4103/apjon.apjon_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
In recent years, melanoma research has undergone a renaissance. The disease that was once viewed, at least in a metastatic setting, as intractable and untreatable is now revealing its molecular “weaknesses.” The year 2011 was a landmark year for melanoma therapy, with the introduction of two new agents – the anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody ipilimumab and the BRAF (V-raf murine sarcoma viral oncogene homolog B1) inhibitor vemurafenib. These two agents were shown to confer a survival benefit, which was followed by the approval by the Food and Drug Administration (FDA). In 2014, other immune checkpoint inhibitors, such as pembrolizumab and nivolumab, were approved for the treatment of metastatic melanoma. By 2019, the FDA had also approved pembrolizumab as adjuvant therapy. Target therapy and immunotherapy are now the standard of care for melanoma patients. Clinical trials are currently ongoing for new neoadjuvant therapies. Rapidly evolving knowledge will perhaps downgrade melanoma to the level of a chronic, manageable disease from the intractable “black cancer,” it was in the past and a disease that struck fear into the hearts of those who were diagnosed. Changes in immunotherapy treatments were followed by a large volume of clinical trials. This situation has resulted in the need for changes in the roles of existing melanoma multidisciplinary team members, including the clinical trials nurse (CTN). The role of the CTN is not suitable for these new conditions. A new role and tasks need to be established, evolving the CTN into an oncology nurse coordinator (ONC). In this article, we have described the role and responsibilities of an ONC and the changes that have taken place within the multidisciplinary melanoma team.
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Affiliation(s)
- Hani Steinberg
- Department of Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Kiryat Hadassah, Jerusalem, Israel
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Ness E. The Oncology Clinical Research Nurse Study Co-Ordinator: Past, Present, and Future. Asia Pac J Oncol Nurs 2020; 7:237-242. [PMID: 32642493 PMCID: PMC7325777 DOI: 10.4103/apjon.apjon_10_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022] Open
Abstract
Clinical research nursing is a specialty practice that has evolved over the past century. Clinical research nurses (CRNs) work directly (e.g., direct care provider and advance clinician) or indirectly (e.g., manager, educator, and study co-ordinator) to support clinic research. For more than 50 years, oncology nurses have contributed to the body of evidence describing and validating the responsibilities and importance of the nurse in clinical research, especially the study co-ordinator role. This article will focus on the CRN study co-ordinator role in oncology clinical trials highlighting the historical evolution of the role, the contributions of dedicated members of the Oncology Nursing Society, and the future landscape of clinical research nursing through the International Association of CRNs.
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Affiliation(s)
- Elizabeth Ness
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Gross AH, Driscoll J, Ma L. The nurse coordinator role: fulfillment of the nursing profession's compact with society. Isr J Health Policy Res 2019; 8:5. [PMID: 30609944 PMCID: PMC6318835 DOI: 10.1186/s13584-018-0280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022] Open
Abstract
The implementation of a new role in healthcare teams frequently emanates from emerging or changing needs in the care delivery system or expressed needs of clinicians, patients or caregivers. In this commentary on the experience of the nurse coordinator role in Israel we suggest based on similar experiences in the United States, that effective implementation is accomplished when the functions of the role are well delineated with respect to other members of the team and informed by the needs of patients, their caregivers and clinicians. The outcomes expected from those performing the role should be established and measured over time.
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Affiliation(s)
- Anne H. Gross
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Jessica Driscoll
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Laura Ma
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
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Cohen Castel O, Dagan E, Keinan-Boker L, Shadmi E. Reliability and validity of the Hebrew version of the Nijmegen Continuity Questionnaire for measuring patients' perceived continuity of care in oral anticancer therapy. Eur J Cancer Care (Engl) 2018; 27:e12913. [PMID: 30238665 DOI: 10.1111/ecc.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 12/14/2022]
Abstract
To assess the validity and reliability of the Nijmegen Continuity Questionnaire in Hebrew (NCQ-H) for measuring patients' perceived continuity of care in the multiprovider setting of oral anticancer therapy (OACT). Following forward-backward translation of the original instrument into Hebrew, the NCQ-H was administered to adult cancer patients in five oncology centres in Israel, 2-3 months after initiation of OACT (either targeted, hormonal or chemotherapy). Confirmatory factor analysis and Cronbach's alpha were used to assess the validity and reliability of the NCQ-H respectively. A total of 135 patients completed the questionnaire. The postanalysis models for measuring "personal continuity with care provider" (eight items for each provider: the oncology specialist and the primary care physician), and "team/cross-boundary continuity" (four items for each setting: within the oncology team, and between the oncology specialist and the primary care physician) showed good fit for the observed data (root-mean-square error of approximation (RMSEA) = 0.02; RMSEA = 0.015; for each model respectively). Cronbach's alpha was 0.79-0.95 for all subscales. Conclusions. This study provides preliminary evidence for the reliability and validity of the NCQ-H in assessing cancer patients' experience with continuity of care and for its usability in the context of OACT.
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Affiliation(s)
- Orit Cohen Castel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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