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Nekhlyudov L, Levit LA, Ganz PA. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis: One Decade Later. J Clin Oncol 2024:JCO2401243. [PMID: 39356979 DOI: 10.1200/jco-24-01243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 10/04/2024] Open
Abstract
In 2012, the National Academies of Sciences, Engineering, and Medicine convened a committee charged with addressing the quality of cancer care in the United States and providing recommendations to policymakers and the cancer care community on strategies to improve cancer care delivery from the time of diagnosis through end-of-life. The resulting committee report, titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (2013), presented a conceptual framework that included six interconnected components of care with corresponding recommendations. Over the past decade, the delivery of high-quality of cancer care has become more challenging and increasingly demanding on the workforce. In this manuscript, we review the goals and recommendations made in 2013, describe progress to date, and offer insights into future dedicated efforts and/or new strategies needed to achieve high-quality cancer care.
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Affiliation(s)
- Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Laura A Levit
- American Society of Clinical Oncology, Alexandria, VA
| | - Patricia A Ganz
- UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA, and the Jonsson Comprehensive Cancer Center, Los Angeles, CA
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Zhang L, Gao B, He F, Wu C, Du J, Zhang L, Liang J, Lang H. Construction of learning objectives and content for emergency triage nurses in tertiary general hospitals: A Delphi study. Nurse Educ Pract 2024; 80:104145. [PMID: 39317090 DOI: 10.1016/j.nepr.2024.104145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 09/07/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
AIM To construct learning objectives and educational content for emergency triage nurses based on core competencies. BACKGROUND The core competencies of emergency triage nurses has an impact on the quality of medical services and patient treatment outcomes. However, research on learning objectives and educational content aimed at cultivating the core competencies of emergency triage nurses is limited. DESIGN A Delphi study. METHODS To develop a draft of the teaching objectives and content for emergency triage nurses based on core competencies, a literature review, semistructured interviews and expert group meetings were conducted. Then, 24 experts were invited to provide feedback on the draft and suggest revisions through two rounds of Delphi consultation. RESULTS Consensus was reached on six core competencies, 30 learning objectives and 43 educational contents. The response rate for the two rounds of expert questionnaires was 100 %, with 79.2 % and 54.2 % of the experts providing feedback in the first and second rounds, respectively. The judgement coefficient (Ca) was 0.910, the familiarity coefficient (Cs) was 0.917 and the authority coefficient (Cr) was 0.914. The Kendall's W coefficients for the two rounds of expert inquiry were 0.321 and 0.334, indicating a statistically significant difference (P<0.05). CONCLUSIONS Constructing learning objectives and educational content for emergency triage nurses based on core competencies is scientific and reliable and can provide a reference for the training and management of emergency triage nurses.
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Affiliation(s)
- Linyuan Zhang
- School of Nursing, Air Force Medical University, Xi'an, Shaanxi 710032, China.
| | - Bo Gao
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Fang He
- School of Nursing, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Chao Wu
- School of Nursing, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Juan Du
- School of Nursing, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Li Zhang
- Department of Emergency Medicine, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Juan Liang
- Department of Paediatrics, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Hongjuan Lang
- School of Nursing, Air Force Medical University, Xi'an, Shaanxi 710032, China.
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Humphrey Y, Elliott A, Madni A, Mandrell B. Early Onset Psychosis in a Pediatric Oncology Setting: A Case Report. Issues Ment Health Nurs 2024; 45:826-830. [PMID: 39012786 DOI: 10.1080/01612840.2024.2360588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Schizophrenia (SCZ) and schizoaffective disorder (SHZ) are psychiatric disorders commonly identified in individuals in their late adolescence or early adulthood. Comorbidities are common, though a concurrent diagnosis of leukemia, one of the most frequently occurring cancers of adolescence, has not yet been described in such cases. This case study outlines the clinical presentation, course, and treatment response of two 17-year-old male adolescents whose psychotic disorders complicated their leukemia treatment. The first patient was diagnosed with leukemia and subsequently with SCZ while undergoing leukemia treatment. The second patient was diagnosed with SHZ prior to the onset of leukemia. The case study will follow the methodology of Robert E. Stake (Abma & Stake, 2014), as the two cases share a leukemia diagnosis and the reported mental health impact connected with cancer-directed treatment. Early identification and treatment are critical for both psychotic disorders and cancers, often impacting the long-term prognosis. However, when co-occurring, their interplay can present unique challenges to care.
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Affiliation(s)
- Yvette Humphrey
- Center of Advanced Practice, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew Elliott
- Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Arshia Madni
- Hospitalist Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda Mandrell
- Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Noh S, Kang Y. The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses. Nurs Open 2024; 11:e70003. [PMID: 39166373 PMCID: PMC11336653 DOI: 10.1002/nop2.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/15/2024] [Accepted: 08/04/2024] [Indexed: 08/22/2024] Open
Abstract
AIMS To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. DESIGN Cross-sectional descriptive design. METHODS Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. RESULTS Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. CONCLUSIONS The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. REPORTING METHOD We have adhered to STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.
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Affiliation(s)
- Suyeon Noh
- Division of Nursing, College of NursingEwha Womans UniversitySeoulSouth Korea
| | - Younhee Kang
- Graduate Program in System Health Science and Engineering, Division of Nursing, College of NursingEwha Womans UniversitySeoulSouth Korea
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Perrey HM, Taylor E, Cropp BF, Bumpus MJ, Lessard S, Pretorius JA, Angus JH, Duperreault MF, Snow A, Wang D, Curtis M, Couture LA, Adolphson DR, Smith K, Moody JH, Bianchi MJ, Parker MG, Sanyal A, Remick SC. Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network. Learn Health Syst 2024; 8:e10415. [PMID: 39036533 PMCID: PMC11257055 DOI: 10.1002/lrh2.10415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 07/23/2024] Open
Abstract
In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.
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Affiliation(s)
- Hilary M. Perrey
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Evelyn Taylor
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Brett F. Cropp
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meaghan J. Bumpus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Shannon Lessard
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jeanette A. Pretorius
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jonathan H. Angus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Megan F. Duperreault
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Amanda Snow
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Dorothy Wang
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meredith Curtis
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Lauren A. Couture
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - David R. Adolphson
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Kimberly Smith
- Harold Alfond Center for Cancer Care at Maine General Medical CenterAugustaMaineUSA
| | - Joy H. Moody
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Michael J. Bianchi
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
| | - Amit Sanyal
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
| | - Scot C. Remick
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
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Dowling M, Pape E, Geese F, Van Hecke A, Bryant-Lukosius D, Cerón MC, Fernández-Ortega P, Marquez-Doren F, Ward A, Semple C, King T, Glarcher M, Drury A. Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review. Semin Oncol Nurs 2024; 40:151627. [PMID: 38556366 DOI: 10.1016/j.soncn.2024.151627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. METHODS This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. RESULTS Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. CONCLUSIONS The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. IMPLICATIONS FOR NURSING PRACTICE Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.
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Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
| | - Eva Pape
- Cancer Center, Ghent University Hospital, Belgium; Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium
| | - Franziska Geese
- Department of Nursing, Clinical Practice Development and Digitalisation, Bern University Hospital, Inselspital, Insel Gruppe, Switzerland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium; Nursing Department, Ghent University Hospital, Belgium
| | - Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M Consuelo Cerón
- Escuela de Enfermería, Facultad de Enfermería y Obstetricia, Universidad de los Andes-Chile
| | - Paz Fernández-Ortega
- Catalan Institute of Oncology and Faculty of Nursing, University of Barcelona, Spain
| | - Francisca Marquez-Doren
- School of Nursing, PAHO Collaborating Center, Pontificia Universidad Católica de Chile and School of Nursing Pontificia Universidad Católica de Chile, PAHO Collaborating Center and Sigma Chapter Alfa Beta Ómicron
| | - Ashleigh Ward
- School of Medicine, Dentistry and Nursing College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland; NHS Forth Valley, Stirling, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Tracy King
- Cancer Care Research Unit (CCRU) Susan Wakil School of Nursing and Midwifery, The University of Sydney, Australia; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Manela Glarcher
- Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland
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Triglianos T, Tan KR, Prewitt J, Fajardo M, Hirschey R. Expanding Leadership and Professional Development Opportunities for Oncology Nurse Practitioners. J Contin Educ Nurs 2024; 55:94-100. [PMID: 37971228 DOI: 10.3928/00220124-20231109-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Nurse practitioner (NP) involvement in professional organizations improves clinical practice, patient outcomes, and health care policy. Results of a survey for a local professional nursing organization showed a need for more NP-level education and NP mentorship and leadership training. Findings were applied to develop a leadership initiative through an NP-led continuing education program. At the conclusion of the program, NP presenters completed a survey. The NP presenters agreed that participating in this program and the mentoring that was provided helped them prepare for their sessions, improve their leadership skills, and prepare for additional speaking engagements. Additionally, each session's attendees completed evaluation surveys. Results from program attendees indicated a high level of agreement about meeting learning objectives in sessions and the effectiveness of the NP presenters. This innovative program may be modeled across a variety of nursing specialties, settings, and organizations to enhance NP professional development and support nursing-led continuing education. [J Contin Educ Nurs. 2024;55(2):94-100.].
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He J, Li J, Feng LN, Feng LX, Qiang W, Wang W, Dong L. Oncology nurse competency in chimeric antigen receptor T-cell therapy: A qualitative study. NURSE EDUCATION TODAY 2024; 132:106040. [PMID: 37956569 DOI: 10.1016/j.nedt.2023.106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell therapy is a promising therapeutic method in the field of tumor immunotherapy. An increasing number of patients are beginning to select CAR T-cell therapy in mainland China. It is characterized by a complex process, a long period of treatment, high individualization, quick disease status changes and unique side effects. Oncology nurses play a crucial role in the provision of CAR T-cell therapy. OBJECTIVE To explore oncology nurses' competency in CAR T-cell therapy with guidance from the iceberg model. DESIGN A descriptive qualitative study. SETTINGS This study was conducted with nurses on lymphoma wards in three tertiary hospitals in China. PARTICIPANTS A total of 13 nurses and 2 nursing managers were approached, and all of them took part in this study. METHODS Data were collected face-to-face or via online video using a semistructured interview guide between November 2022 and February 2023 by the first author. The study was performed and reported following the Consolidated Criteria for Reporting Qualitative Research. Content analysis was used to analyze the data. RESULTS Nursing competency in CAR T-cell therapy was identified as including four main categories encompassing 12 subcategories and 40 codes. The main categories were theoretical knowledge, operation skills, personality traits and motives. The subcategories were basic knowledge of chemotherapy, professional knowledge of CAR T-cell therapy, basic skills, professional skills, relevant discipline skills, communication/coordination ability, critical thinking, basic traits, professional personality, enthusiasm for the nursing profession, empathy with patients and motivation to promote professional development. CONCLUSIONS Medical staff can develop a competency-based nurse training program to improve the professional competencies of oncology nurses in CAR T-cell therapy and meet patients' supportive needs for optimal care. Additionally, the findings may be helpful for building measurement standards to assess oncology nurses' performance.
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Affiliation(s)
- Jin He
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jing Li
- Tianjin Medical College, Tianjin, China
| | - Li Na Feng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Li Xia Feng
- Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Wanmin Qiang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wen Wang
- Institute of Hematology, Blood Diseases Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Tianjin, China
| | - Lei Dong
- The First Affiliated Hospital of Zhengzhou University, Henan, China
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Serra-Barril MA, Ferro-Garcia T, Falco-Pegueroles A, Delgado-Hito P, Romero-Garcia M, Benito-Aracil L. Patients' and professionals' experiences with advanced practice nursing in cancer care: A qualitative study. Eur J Oncol Nurs 2023; 66:102407. [PMID: 37769540 DOI: 10.1016/j.ejon.2023.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
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.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Tarsila Ferro-Garcia
- Innovation and Quality Department, Catalan Institute of Oncology, Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Anna Falco-Pegueroles
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Pilar Delgado-Hito
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institute of Biomedical Research, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marta Romero-Garcia
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Llúcia Benito-Aracil
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institute of Biomedical Research, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Serra-Barril MA, Benito-Aracil L, Pla-Consuegra M, Ferro-García T. Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care. J Nurs Manag 2022; 30:4339-4353. [PMID: 36194472 PMCID: PMC10092559 DOI: 10.1111/jonm.13843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
AIM This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. BACKGROUND Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. METHODS Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. RESULTS Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. CONCLUSIONS The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. IMPLICATIONS FOR NURSING MANAGEMENT Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito-Aracil
- Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Margarida Pla-Consuegra
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tarsila Ferro-García
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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11
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Barber FD, Campbell E, Yamamura Y, Patterson CJ, Hartnett AC, Kinahan H, Miller VA, Brink AL, Poullard A, Urschel GE, Brantley A, Cepeda IG, Goswami P, Charles S, Philip S, Bresser S, Musekiwa-Adjei S, Perez N, Le H, Phillips P, Subbiah V, Meric-Bernstam F, Dumbrava EE. Management of Adverse Events in Early Clinical Trials by Advanced Practice Providers in the Outpatient Setting: The University of Texas MD Anderson Cancer Center Experience. J Adv Pract Oncol 2022; 13:664-672. [PMID: 36199491 PMCID: PMC9514129 DOI: 10.6004/jadpro.2022.13.7.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Advanced practice providers (APPs) play important roles in enrolling, educating, and caring for patients in clinical trials. However, much remains unknown about the role of APPs in managing adverse events (AEs) in early (phase I to II) clinical trials. In this study, we assessed the outpatient management of grade 3 to 4 AEs by APPs in early trials and characterized the workflow of our APP Phase I to II Fast Track (FT) Clinic. Patients and Methods We retrospectively reviewed records of patients with advanced or metastatic solid tumors enrolled in phase I to II clinical trials who were seen by APPs from September 2017 to August 2018 in the APP phase I to II FT clinic in the Department of Investigational Cancer Therapeutics. Results A total of 808 patients enrolled in 159 clinical trials were seen in 2,697 visits (median 3 visits per patient; range 1-28) by 10 APPs. Treatment was interrupted in 6.9% of visits, and grade 3 to 4 AEs were seen in 5.4% of visits; however, patients from 1.4% of visits were sent to the emergency center (EC) and/or admitted. Patients referred to the EC and/or admitted were more likely to have baseline hypoalbuminemia, high lactate dehydrogenase, and poor Eastern Cooperative Oncology Group performance status (i.e., ECOG > 1; p < .001). There were no associations between EC referral and gender, APP years of experience, or type of treatment. Conclusions The APP Phase I to II FT Clinic has an important role in the management of AEs by APPs in early clinical trials in the outpatient setting, potentially avoiding EC visits and admissions.
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Affiliation(s)
- Fedricker D. Barber
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erick Campbell
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yuko Yamamura
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clover J. Patterson
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Audrey C. Hartnett
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Holly Kinahan
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victoria A. Miller
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amanda L. Brink
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna Poullard
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriele E. Urschel
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andre Brantley
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabel G. Cepeda
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Poonam Goswami
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheena Charles
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shincy Philip
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sara Bresser
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sandra Musekiwa-Adjei
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nageli Perez
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hung Le
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Penny Phillips
- Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Subbiah
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ecaterina E. Dumbrava
- From Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Pinheiro LC, Cho J, Kern LM, Higgason N, O'Beirne R, Tamimi R, Safford M. Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators. Support Care Cancer 2022; 30:6901-6908. [PMID: 35543819 PMCID: PMC9093555 DOI: 10.1007/s00520-022-07112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Purpose Diabetes is a prevalent comorbid condition among many women with breast cancer. The roles and responsibilities of managing diabetes during cancer care are unclear, as oncologists lack interest and clinical expertise and many patients stop seeing their primary care providers (PCPs). Uncertainty around who should manage diabetes for cancer patients can result in gaps in care for survivors. We sought to elicit the perspectives of providers about a novel diabetes care delivery intervention for women undergoing chemotherapy for breast cancer. Methods We conducted nominal group sessions with PCPs and breast oncologists across the USA. We introduced a novel care delivery model, which involved a nurse practitioner (NP) specifically trained in diabetes to work within the oncology team to manage diabetes for women during chemotherapy. PCPs and oncologists were asked to identify potential barriers and facilitators to the intervention’s success and then vote on the top three most important barriers and facilitators, separately. Votes were aggregated across sessions and presented as frequencies and weighted percentages. Results From November to December 2020, two 60-min sessions with PCPs and two 60-min sessions with breast oncologists were held virtually. In total, 29 providers participated, with 16 PCPs and 13 breast oncologists. At the health system level, financial support for the NP-led intervention was identified as the most important barrier across both provider types. Clearly defined roles for each care team member were identified as the most important facilitator at the care team level. At the patient level, lack of cancer-specific diabetes education was identified as an important barrier. Conclusion Our findings underscore the need to engage various stakeholders including policy makers, institutional leadership, care team members, and patients to improve diabetes care for patients undergoing chemotherapy for breast cancer. As such, multi-disciplinary interventions are warranted to increase awareness, engagement, and self-management practices among breast cancer patients with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07112-4.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA. .,Population Health Sciences Department, Weill Cornell Medicine, New York, NY, USA.
| | - Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Noel Higgason
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ronan O'Beirne
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rulla Tamimi
- Population Health Sciences Department, Weill Cornell Medicine, New York, NY, USA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
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13
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Mahon SM, Yackzan S. Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence. Clin J Oncol Nurs 2022; 26:141-145. [PMID: 35302542 DOI: 10.1188/22.cjon.141-145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genomic science is rapidly evolving, and ordering germline testing requires appropriate and comprehensive assessment of a patient's personal and family history, as well as the knowledge base to facilitate selection of the best test or panel of tests, provision of pretest counseling for informed consent, interpretation of test results, post-test recommendations, and coordination of care for other at-risk family members. Prior to ordering germline genetic testing, an advanced practice RN's scope of practice accountability includes consideration of competence in the provision of genomic care. This article provides a case study to illustrate the complexities of issues related to competence when ordering germline genetic testing.
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