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Bourkas AN, Menard A, Tarulli E, Jodoin L, Biagi JJ. Impact of an Accelerated Diagnostic Assessment Program on the Timeliness of Cancer Diagnosis and Treatment. JCO Oncol Pract 2023; 19:e511-e519. [PMID: 36657095 DOI: 10.1200/op.22.00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The Accelerated Diagnostic Assessment Program (ADAP) manages patients with imaging abnormalities, with or without concomitant symptoms, where cancer is suspected. The ADAP is offered to primary care practitioners and emergency departments with cases triaged by a medical oncologist. METHODS We performed a retrospective patient chart review of electronic medical records from January 2019 until June 2021 to validate the program. We collected information on the referral pathways, patient demographics, wait-times, and diagnostic results. The control group consisted of outpatients who were referred for biopsy over a 1-year period outside the ADAP stream. Statistical analyses were performed using IBM SPSS software. RESULTS Of the 97 patients included, 54% were female, with ages ranging from 18 to 96 years. Twenty-nine percent (n = 20) of the malignant cases were incidental findings. Most patients referred to the ADAP were diagnosed with a malignancy (71%; n = 69), comprising hematologic (45%; n = 31), GI (26%; n = 18), or other cancers (29%; n = 20). The ADAP had decreased wait-times from referral to biopsy collection (17.6 days ± 10.7 [standard deviation (SD)]; n = 43) when compared with the control group (41.2 days ± 40.0 [SD]; n = 67; P < .001). ADAP patients with malignancies saw a treating specialist 7.6 ± 7.6 days [SD] after their follow-up appointment at the ADAP. CONCLUSION The ADAP accelerated time to biopsy in a statistically significant manner when compared with age-, referring physician-, and biopsy site-matched controls. It also outperformed national and provincial standards, suggesting that its model addresses a gap in care by providing an underserved population timely access to diagnosis and treatment.
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Affiliation(s)
- Adrienn N Bourkas
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alexandre Menard
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Emidio Tarulli
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Leah Jodoin
- The Cancer Center of Southeastern Ontario, Kingston Health Sciences Center, Kingston, Ontario, Canada.,Faculty of Health Sciences School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - James J Biagi
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada.,The Cancer Center of Southeastern Ontario, Kingston Health Sciences Center, Kingston, Ontario, Canada
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2
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Franco-Rocha OY, Carillo-Gonzalez GM, Garcia A, Henneghan A. Cancer Survivorship Care in Colombia: Review and Implications for Health Policy. HISPANIC HEALTH CARE INTERNATIONAL 2022; 20:66-74. [PMID: 33754879 PMCID: PMC8808458 DOI: 10.1177/15404153211001578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The number of cancer survivors is increasing in Colombia, and health policy changes are necessary to meet their unmet needs and improve their health outcomes. Similar trends have been identified in developed countries, and positive changes have been made. METHODS We conducted a narrative review to provide an overview of Colombia's social structure, health care system, and health care delivery in relation to cancer, with recommendations for improving cancer survivorship in Colombia based on the model of survivorship care in the United States. RESULTS We proposed general recommendations for improving cancer survivors' care including (1) recognizing cancer survivorship as a distinct phase of cancer, (2) strengthening methods and metrics for tracking cancer survivorship, (3) assessing and monitoring cancer symptoms and quality of life of cancer survivors, (4) publishing evidence-based guidelines considering the social, economic, and cultural characteristics of Colombian population and cancer survivors' specific needs. CONCLUSION These recommendations could be used to inform and prioritize health policy development in Colombia related to cancer survivorship outcomes.
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Affiliation(s)
- Oscar Yesid Franco-Rocha
- 1710 Red River St. University of Texas at Austin, School of Nursing. Austin, TX, US, 78712
- Cra 30 # 45-03, Edificio 228. Facultad de Enfermería, Universidad Nacional de Colombia, Sede Bogotá. Bogotá, D.C., Colombia, 111321
| | - Gloria Mabel Carillo-Gonzalez
- Cra 30 # 45-03, Edificio 228. Facultad de Enfermería, Universidad Nacional de Colombia, Sede Bogotá. Bogotá, D.C., Colombia, 111321
| | - Alexandra Garcia
- 1710 Red River St. University of Texas at Austin, School of Nursing. Austin, TX, US, 78712
| | - Ashley Henneghan
- 1710 Red River St. University of Texas at Austin, School of Nursing. Austin, TX, US, 78712
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3
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Needs Assessment for an Introductory Radiation Oncology Curriculum for Advanced Practice Providers. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.05.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schneider F, Kempfer SS, Backes VMS. Training of advanced practice nurses in oncology for the best care: a systematic review. Rev Esc Enferm USP 2021; 55:e03700. [PMID: 33978139 DOI: 10.1590/s1980-220x2019043403700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To search for evidence on the training of advanced practice nurses, through clinical practice and nursing care with cancer patients. METHOD Systematic review, searching the databases: MEDLINE-PubMed, LILACS, Web of Science, Scopus, CINAHL and Cochrane CENTRAL. A manual search of the reference list and Google Scholar was also carried out. To assess the methodological quality of the studies, the following tools were used: Cochrane Collaboration Risk of Bias Tool (RoB 1) for randomized controlled trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for quasi-experimental studies. RESULTS A total of 12 experimental studies were identified. The main intervention identified in the studies was educational guidance. The studies showed improvement in pain control or other symptoms related to disease and/or treatment, satisfaction and improvement in the quality of life of cancer patients. CONCLUSION It is observed that there are studies that demonstrate the value of advanced practice nursing in oncology, through differentiated clinical training and advanced professional performance. Registration number of the systematic review: CRD42018098906.
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Affiliation(s)
- Franciane Schneider
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
| | - Silvana Silveira Kempfer
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
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Alotaibi T, Al Anizi CA. The impact of advanced nurse practitioner (ANP) role on adult patients with cancer: A quantitative systematic review. Appl Nurs Res 2020; 56:151370. [PMID: 33280789 DOI: 10.1016/j.apnr.2020.151370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 01/06/2023]
Abstract
AIM This study aims to identify how Advanced Nurse Practitioners (ANPs) can contribute to oncology care. BACKGROUND The position of ANPs has grown significantly in recent years and ANPs have been shown to make significant contributions to various areas of healthcare. Due to improvements in research and techniques elder cancer patients are living longer, as beneficial, as this is to patients it is putting a strain on the provision of care as support is required at various stages. As there have been discussions about how ANPs +. can be most effectively employed this study identifies that ANPs, due to their skills and knowledge, may be able to assist elderly patients with long-term conditions specifically oncology patients. Therefore, research has been undertaken to identify how ANPs are currently employed in oncology. METHODS A systematic review was conducted in order to gain background information into how the role of ANPs in oncology is perceived and to gain understanding of some of the issues that they face and identify the skills that they have in order to be able to make a positive contribution. This was followed by a study of quantitative Randomized Control Trials, which looked at the roles of ANPs in oncology. Thematic Analysis was conducted in order to gain a perspective of how ANPs are best currently employed with elderly oncology patients. RESULTS Five studies were reviewed which showed that ANPs provide support to elder patients which helps to alleviate stress and improve the quality of life of cancer patients. Furthermore, it was seen that ANPs can aid patients in symptom management. CONCLUSION This study has shown that ANPs are effectively used in clinical support for cancer patients. Further studies are required to verify the extent of this support and to determine if this support is effective only in the short term or can it be applied just as effectively over a period of time. ANPs have high-level knowledge and skills but more research is required to determine how they work effectively.
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Affiliation(s)
- Taghreed Alotaibi
- Princess Nourah bint Abdulrahman University, Nursing College, Community Health Nursing Department, Airport Road, Building 4, Flat 2.4, Riyadh, Saudi Arabia.
| | - Co Amira Al Anizi
- Princess Nourah bint Abdulrahman University, Nursing College, Community Health Nursing Department, Airport Road, Building 4, Flat 2.4, Riyadh, Saudi Arabia.
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Chua GP. Challenges Confronting the Practice of Nursing in Singapore. Asia Pac J Oncol Nurs 2020; 7:259-265. [PMID: 32642497 PMCID: PMC7325770 DOI: 10.4103/apjon.apjon_13_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: 03/10/2020] [Accepted: 04/10/2020] [Indexed: 11/04/2022] Open
Abstract
Singapore, a young nation like many developed countries, faced a shortage of nurses. Attempts to resolve the workforce shortage through the employment of foreign nurses started in the mid-1980s. Over the years, workforce recruitment from traditional sources nearby, namely Malaysia and Philippines, has expanded to include nurses from countries such as People Republic of China, India, and Myanmar. Attempts have also been made to train, recruit, and retain local nurses such as improving working conditions and remunerations, raising the profile of nursing, improving career recognition and progression, and encouraging nonpracticing nurses back to the workforce. However, the institutions' and the government's attempts to ameliorate the nursing shortage were met with limited success. Even with the recruitment of foreign nurses, the shortage of workforce persists. The shortage is compounded by the three major health-care challenges confronting Singapore: (1) rapid growth in population; (2) rapid aging of the population; and (3) increasing burden of chronic diseases. As the population continues to grow and as more of the population ages, as life expectancy increases and the burden of chronic diseases increases, not only will the demand for nurses continue, but the intensity and the nursing care they require will also increase. This article describes the challenges confronting the practice of nursing in Singapore and their implications. Although these challenges are daunting, they offer nursing the unprecedented opportunities to shape health-care delivery systems and increase nursing influences everywhere across settings and along the delivery continuum.
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Affiliation(s)
- Gek Phin Chua
- Cancer Education and Information Service (Research and Data), National Cancer Centre Singapore, Singapore
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7
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Chua GP. Oncology Nursing in Singapore: How It Evolved and What Does the Future Hold? Asia Pac J Oncol Nurs 2020; 7:129-133. [PMID: 32478129 PMCID: PMC7233564 DOI: 10.4103/apjon.apjon_55_19] [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: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022] Open
Abstract
Cancer is the leading cause of death in Singapore since the early 1980s and has remained so since then, accounting for 29.7% of deaths in 2015. Rapid technological advancements in the treatment of cancer and the development of the specialty of radiation and medical oncology demanded nurses with the knowledge and skills to provide care and support to cancer patients and their families. The evolvement of oncology nursing as a specialty in Singapore mirrors many countries due to the increase in cancer incidences as well as the development of medical specialty in the treatment of cancer. This paper traces the development of oncology nursing as a clinical specialty in Singapore. The historical perspective maps up the factors that caused oncology nursing to develop as a specialty within nursing practice. As cancer continues to be the leading cause of mortality for many years to come in Singapore and cancer care continues to evolve, the roles of oncology nurses will continue to unfold and expand as part of an interdisciplinary team in the fight against cancer.
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Affiliation(s)
- Gek Phin Chua
- Cancer Education and Information Service (Research and Data), National Cancer Centre Singapore, Singapore
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Coombs LA, Noonan K, Diane Barber F, Mackey H, Peterson ME, Turner T, LeFebvre KB. Oncology Nurse Practitioner Competencies: Defining Best Practices in the Oncology Setting. Clin J Oncol Nurs 2020; 24:296-304. [PMID: 32441678 PMCID: PMC8152155 DOI: 10.1188/20.cjon.296-304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The oncology nurse practitioner (ONP) role has evolved since the first ONP competencies were published by the Oncology Nursing Society in 2007. An update was completed in 2019 to reflect the rapidly expanding role. OBJECTIVES The purpose of this article is to describe the process of the ONP competency development and identify potential applications across a variety of oncology settings. METHODS The team performed an extensive literature review of the research about ONP practice across the cancer care continuum. Peer and expert review were conducted to ensure the competencies were comprehensive and relevant. FINDINGS The ONP competencies provide a solid, evidence-based benchmark to standardize the ONP role and practice, thereby ensuring that patients receive the highest-quality cancer care.
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Affiliation(s)
| | | | | | | | | | - Tamika Turner
- Franciscan Physician Alliance Hematology Oncology Specialists
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9
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Lockhart JS, Oberleitner MG, Fulton JS, Nolfi DA. Oncology Resources for Students Enrolled in Pre-Licensure and Graduate Nursing Programs in the United States: A Scoping Review of the Literature. Semin Oncol Nurs 2020; 36:151026. [PMID: 32416943 DOI: 10.1016/j.soncn.2020.151026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This scoping review summarizes oncology resources for pre-licensure and graduate nursing programs in the United States. DATA SOURCES PubMed, CINAHL, and Scopus databases were searched to identify resources (2008-2019) published in peer-reviewed journals. While 1,503 papers were initially identified, 49 met inclusion criteria. CONCLUSION Thematic analysis revealed five themes with subthemes: (1) didactic courses; (2) clinical opportunities; (3) didactic and clinical resources; (4) simulation resources; and (5) other. IMPLICATIONS FOR NURSING PRACTICE Academic educators are charged with preparing a nursing workforce capable of providing safe and quality evidence-based care across the cancer continuum. Findings offer examples that overcome curriculum barriers.
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Affiliation(s)
| | - Melinda G Oberleitner
- College of Nursing and Allied Health Professions University of Louisiana at Lafayette, Lafayette, LA
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Yen TWF, Laud PW, McGinley EL, Pezzin LE, Nattinger AB. Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 2020; 179:57-65. [PMID: 31542875 DOI: 10.1007/s10549-019-05447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Advanced practice providers (APPs) have increasingly become members of the oncology care team. Little is known about the scope of care that APPs are performing nationally. We determined the prevalence and extent of APP practice and examined associations between APP care and scope of practice regulations, phase of cancer care, and patient characteristics. METHODS We performed an observational study among women identified from Medicare claims as having had incident breast cancer in 2008 with claims through 2012. Outpatient APP care included at least one APP independently billing for cancer visits/services. APP scope of practice was classified as independent, reduced, or restricted. A logistic regression model with patient-level random effects was estimated to determine the probability of receiving APP care at any point during active treatment or surveillance. RESULTS Among 42,550 women, 6583 (15%) received APP care, of whom 83% had APP care during the surveillance phase and 41% during the treatment phase. Among women who received APP care during a given year of surveillance, the overall proportion of APP-billed clinic visits increased with each additional year of surveillance (36% in Year 1 to 61% in Year 4). Logistic regression model results indicate that women were more likely to receive APP care if they were younger, black, healthier, had higher income status, or lived in a rural county or state with independent APP scope of practice. CONCLUSIONS This study provides important clinical and policy-relevant findings regarding national practice patterns of APP oncology care. Among Medicare beneficiaries with incident breast cancer, 15% received outpatient oncology care that included APPs who were billing; most of this care was during the surveillance phase. Future studies are needed to define the degree of APP oncology practice and training that maximizes patient access and satisfaction while optimizing the efficiency and quality of cancer care.
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Affiliation(s)
- Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Purushottam W Laud
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily L McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Mackey H, Noonan K, Kennedy Sheldon L, Singer M, Turner T. Oncology Nurse Practitioner Role: Recommendations From the Oncology Nursing Society's Nurse Practitioner Summit. Clin J Oncol Nurs 2019; 22:516-522. [PMID: 30239518 DOI: 10.1188/18.cjon.516-522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncology nurse practitioners (ONPs) are advanced practice RNs prepared at the graduate level with high-level knowledge and skills in oncology. Because of challenges in educational programs and variability in the scope of practice at the state and institutional level, many ONPs are challenged to practice to the full extent of their education, certification, and licensure. OBJECTIVES The purpose of this article is to review issues affecting the education and practice patterns of ONPs and to identify solutions to address the challenges that exist for ONPs. METHODS Members of the Oncology Nursing Society's Nurse Practitioner Summit summarized the challenges faced by ONPs related to education, training, practice, and professional development. FINDINGS Efforts to promote ONP practice at the fullest extent of licensure and across various settings should be prioritized. Resources must be devoted to education, onboarding, and retention to integrate and retain ONPs as leaders of the interprofessional team.
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12
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Coombs LA, Max W, Kolevska T, Tonner C, Stephens C. Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer. J Am Geriatr Soc 2019; 67:1489-1494. [PMID: 31059140 PMCID: PMC6612567 DOI: 10.1111/jgs.15931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the composition of the US provider workforce for adults with cancer older than 65 years and to determine whether there were differences in patients who received care from different providers (eg, nurse practitioners [NPs], physician assistants [PAs], and specialty physicians). DESIGN Observational, cross-sectional study. SETTING Adults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database. PARTICIPANTS Medicare beneficiaries who received ambulatory care for any solid or hematologic malignancies. MEASUREMENTS International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes were used to identify Medicare patient claims for malignancies in older adults. Providers for those ambulatory claims were identified using taxonomy codes associated with their National Provider Identifier number. RESULTS A total of 2.5 million malignancy claims were identified for 201, 237 patients, with 15, 227 providers linked to claims. NPs comprised the largest group (31.5%; n = 4,806), followed by hematology/oncology physicians (27.7%; n = 4,222), PAs (24.7%; n = 3767), medical oncologists (10.9%; n = 661), gynecological oncologists (2.6%; n = 403), and hematologists (2.4%; n = 368). Rural cancer patients were more likely to receive care from NPs (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.65-2.05) or PAs (OR = 1.57; 95% CI = 1.40-1.77) than from physicians. Patients in the South were more likely to receive care from NPs (OR = 1.36; 95% CI = 1.24-1.49). CONCLUSIONS A large proportion of older adults with cancer receive care from NPs and PAs, particularly those who reside in rural settings and in the southern United States. Workforce strategies need to integrate these provider groups to effectively respond to the rising need for cancer care within the older adult population.
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Affiliation(s)
| | - Wendy Max
- University of California San Francisco, San Francisco, CA
| | - Tatjana Kolevska
- University of California San Francisco, San Francisco, CA
- Kaiser Permanente Northern California, Vallejo, CA
| | - Chris Tonner
- University of California San Francisco, San Francisco, CA
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Alencar M, Butler E, MacIntyre J, Wempe E. Nurse Practitioner Fellowship: Developing a Program to Address Gaps in Practice. Clin J Oncol Nurs 2018; 22:142-145. [DOI: 10.1188/18.cjon.142-145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Monas L, Toren O, Uziely B, Chinitz D. The oncology nurse coordinator: role perceptions of staff members and nurse coordinators. Isr J Health Policy Res 2017; 6:66. [PMID: 29191228 PMCID: PMC5707790 DOI: 10.1186/s13584-017-0186-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is extensive evidence that the role of nurse coordinators is beneficial for patients. Nurse coordinators are more available to patients compared to general registered nurses, know better to control symptoms and work as team players with multiple care providers. Despite its significance, there is a dearth of literature on the subject in Israel and a lack of clarity regarding the definitions of the role in terms of responsibilities and authorities. The aim of the study is to: To examine how the role of nurse oncology coordinator is implemented in various fields of oncology and to describe the actual performance of different kinds of oncology nurse coordinators and staff perceptions regarding this role in one tertiary hospital in Jerusalem. METHODS A phenomenological approach was used to explore the participants' experiences and views of nurse coordinators' performance. We conducted a qualitative study using in-depth semi-structured interviews. Interviewees included 30 employees from different levels of the hospitals, and leading figures associated with oncology medicine outside of the hospital: Nurses and physicians of the Sharett Oncology Institute of Hadassah Ein Kerem Hospital in Jerusalem, the administrative staff of Hadassah Ein Kerem Hospital, head nurses of the Israel Cancer Association, the chairperson of the Non-Profit Organization of Oncology Nurses, nurse directors at the Ministry of Health Nursing Division, and seven nurse coordinators at Hadassah Ein Kerem Hospital in diverse fields of oncology. RESULTS The nurse coordinator is perceived as an important staff member providing care to cancer patients. Several key elements were found to be common features in the work of all nurse coordinators: emotional support, guidance to patients, and coordination of patients' care. CONCLUSIONS The nurse coordinator plays a noteworthy role in the health care system. In view of the variety of roles that the nurse coordinator assumes in different units, performance standards must be adapted to the performance areas for each unit, as well as nurses' professional development requirements. Changes in a service organization and careful attention to the continuum of care highlight the need to develop and to strengthen the role of a nurse who coordinates treatment over the entire continuum of care, both in the hospital and in the community.
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Affiliation(s)
- Liza Monas
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Orly Toren
- Safety and Risk Management Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Beatrice Uziely
- Sharett Institute of Oncology, Head Oncology Ambulatory Services Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Chinitz
- Health Policy and Management Braun School of Public Health, Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
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Pandey P, Nguyen V. Achieving the Triple Aim Through Doctor of Nursing Practice‒Directed Breast Cancer Survivorship Care. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yopp AW, Wall HM, Miller KC. Recognizing the Contributions of Advanced Practitioners to Oncology Care: Are Current Metrics Enough? J Adv Pract Oncol 2016; 7:748-754. [PMID: 29670810 PMCID: PMC5902154 DOI: 10.6004/jadpro.2016.7.7.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Amanda W Yopp
- Takeda Pharmaceuticals International, Cambridge, Massachusetts
| | - Holly M Wall
- Takeda Pharmaceuticals International, Cambridge, Massachusetts
| | - Kena C Miller
- Takeda Pharmaceuticals International, Cambridge, Massachusetts
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Abstract
In the United States, the lifetime risk of cancer is approximately 50% for men and 33% for women. Approximately 10% of these individuals have an inherited predisposition and substantially increased cancer risk. This article discusses an approach to identifying and managing patients based on a high-risk breast clinic model.
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Coombs LA, Hunt L, Cataldo J. A scoping review of the nurse practitioner workforce in oncology. Cancer Med 2016; 5:1908-16. [PMID: 27264203 PMCID: PMC4898979 DOI: 10.1002/cam4.769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 12/25/2022] Open
Abstract
The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed®, the Cumulative Index to Nursing and Allied Health Sciences (CINAHL®), Web of Science, Journal Storage (JSTOR®), Google Scholar, and SCOPUS®. Using the scoping review criteria, the research question was identified “How much care in oncology is provided by nurse practitioners (NPs)?” Key search terms were kept broad and included: “NP” AND “oncology” AND “workforce”. The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs.
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Affiliation(s)
- Lorinda A Coombs
- University of California San Francisco, San Francisco, California
| | - Lauren Hunt
- University of California San Francisco, San Francisco, California
| | - Janine Cataldo
- University of California San Francisco, San Francisco, California
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Vogel WH. Oncology Advanced Practitioners Bring Advanced Community Oncology Care. Am Soc Clin Oncol Educ Book 2016; 35:e97-e100. [PMID: 27249776 DOI: 10.1200/edbk_158751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.
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To what extent are patients' needs met on oncology units? The phenomenon of care rationing. Eur J Oncol Nurs 2016; 21:48-56. [DOI: 10.1016/j.ejon.2016.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/26/2015] [Accepted: 01/10/2016] [Indexed: 11/20/2022]
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Kosty MP, Acheson AK, Tetzlaff ED. Clinical oncology practice 2015: preparing for the future. Am Soc Clin Oncol Educ Book 2016:e622-7. [PMID: 25993232 DOI: 10.14694/edbook_am.2015.35.e622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical practice of oncology has become increasingly complex. An explosion of medical knowledge, increased demands on provider time, and involved patients have changed the way many oncologists practice. What was an acceptable practice model in the past may now be relatively inefficient. This review covers three areas that address these changes. The American Society of Clinical Oncology (ASCO) National Oncology Census defines who the U.S. oncology community is, and their perceptions of how practice patterns may be changing. The National Cancer Institute (NCI)-ASCO Teams in Cancer Care Project explores how best to employ team science to improve the efficiency and quality of cancer care in the United States. Finally, how physician assistants (PAs) and nurse practitioners (NPs) might be best integrated into team-based care in oncology and the barriers to integration are reviewed.
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Affiliation(s)
- Michael P Kosty
- From the Division of Hematology/Oncology, Scripps Clinic, La Jolla, CA; Providence Oncology and Hematology Care, Providence Cancer Center, Portland, OR; Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Anupama Kurup Acheson
- From the Division of Hematology/Oncology, Scripps Clinic, La Jolla, CA; Providence Oncology and Hematology Care, Providence Cancer Center, Portland, OR; Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric D Tetzlaff
- From the Division of Hematology/Oncology, Scripps Clinic, La Jolla, CA; Providence Oncology and Hematology Care, Providence Cancer Center, Portland, OR; Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Risk Assessment, Prevention, and Early Detection: Challenges for the Advanced Practice Nurse. Semin Oncol Nurs 2015; 31:306-26. [DOI: 10.1016/j.soncn.2015.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Nurse practitioners should be aware that societal changes could lead to their being asked to actively assist terminally ill patients who wish to end their lives, as opposed to their current supportive role in palliative care. With physician staff shortages and the need for nurse practitioners to fill the gaps, end-of-life responsibilities could be placed in the hands of nurse practitioners, rather than being reserved for physicians alone (Sagon, 2013). End-of-life matters raise uncertainties about the nurse practitioner role because it differs state by state, relates to ethics, reflects the religious beliefs of those involved, and concerns the conflict of nurses simultaneously caring for their patients while advocating for their right to self-determination in choosing to end their lives.
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26
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Charalambous A, Adamakidou T. Construction and validation of the quality of oncology nursing care scale (QONCS). BMC Nurs 2014; 13:48. [PMID: 25598704 PMCID: PMC4296533 DOI: 10.1186/s12912-014-0048-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background There is scarcity of questionnaires specifically on the quality of the nursing care provided to patients diagnosed with cancer. The available questionnaires have been developed without attributing a holistic approach to the care provided with important patient’s needs remaining without assessment. The main aim was to develop a self-administered cancer specific questionnaire exploring patients’ views on quality nursing care provided in oncology settings. Methods The development of the scale proceeded through three phases. As part of the first development phase areas of concern and items of interest were identified through a literature review. The second phase included a pilot study of the QONCS and a subsequent validation phase through a multicentre study in 3 hospitals, 4 departments and 418 patients diagnosed with cancer and receiving care as inpatients. The study was designed to select items, identify dimensions, measure reliability, content and construct validity. Results The QONCS consisted of 34 items. A factorial analysis grouped the items into five categories that define quality nursing care: a) Being supported and confirmed, b) Spiritual caring c) Sense of belonging, d) Being valued and e) Being respected. Cronbach’s alpha was 0.95 for the entire questionnaire. The factor solution explained 68.53% of the variance. Conclusions QONCS appears to measure with adequate reliability and validity the attributes of quality nursing care within the oncological settings and to patients with a variety of cancer diagnoses and at different phases of the cancer trajectory. The instrument is quick to disseminate and easy to complete, making it a suitable instrument for nursing professionals to evaluate patients’ self-perceived quality of nursing care as a mean to promote the quality of the care provided in oncological settings.
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Affiliation(s)
- Andreas Charalambous
- Cyprus University of Technology, 15th Vragadinou Street, 3041 Limassol, Cyprus ; University of Turku, Turku, Finland
| | - Theodoula Adamakidou
- Department of Nursing Technological Educational Institute (TEI) of Athens, Athens, Greece
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Sattar S, Alibhai SMH, Wildiers H, Puts MTE. How to implement a geriatric assessment in your clinical practice. Oncologist 2014; 19:1056-68. [PMID: 25187477 PMCID: PMC4200997 DOI: 10.1634/theoncologist.2014-0180] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022] Open
Abstract
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Shabbir M H Alibhai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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Bowyer SE, Schofield DJ. The role of oncology nurse practitioners in current oncology practice and lessons for Australia. Med J Aust 2014; 200:382-4. [DOI: 10.5694/mja13.10535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Deborah J Schofield
- NHMRC Clinical Trials Centre and School of Public Health, Sydney Medical School, Sydney, NSW
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Cox K, Karikios D, Roydhouse JK, White K. Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit. AUST HEALTH REV 2014; 37:632-5. [PMID: 24176186 DOI: 10.1071/ah13069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This case study evaluates the oncology nurse practitioner (NP) role in a chemotherapy unit. BACKGROUND The NP works in the cancer centre of a major metropolitan public hospital. The NP role was established in the chemotherapy unit in 2007. The NP reviews all patients that have an unscheduled presentation to the unit, with symptoms relating either to their disease or treatment. METHODS All unscheduled occasions of service provided by the NP in the chemotherapy unit over 6 months were recorded. Data were collected on patient demographic characteristics, medical problems and reason for presentation. Data on duration of care, interventions and outcomes administered by the NP were captured. RESULTS There were 87 occasions of service (72 patients) during the study period. Nausea, vomiting or dehydration were the most common presenting problems and most presenting problems were moderate or severe (n = 73, 84%). The median time to review for the NP was 5 min and nearly all consultations (n = 83, 96%) took 30 min or less. Following NP consultation, most occasions of service did not require subsequent hospital admission (n = 52, 60%), medical advice (n = 61, 70%) or medical review (n = 75, 86%). CONCLUSIONS The NP is a valuable asset to a busy department, increasing access to timely and appropriate healthcare for patients on chemotherapy.
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Affiliation(s)
- Keith Cox
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
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Bellury L, Ellington L, Beck SL, Pett MA, Clark J, Stein K. Older breast cancer survivors: can interaction analyses identify vulnerable subgroups? A report from the American Cancer Society Studies of Cancer Survivors. Oncol Nurs Forum 2014; 40:325-36. [PMID: 23803266 DOI: 10.1188/13.onf.325-336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE/OBJECTIVES To explore interactions among personal, cancer, aging, and symptom variables relative to physical function (PF) in older adult breast cancer survivors to better identify vulnerable subgroups. DESIGN Secondary analysis of the American Cancer Society Studies of Cancer Survivors II. SETTING U.S. population-based mail and telephone survey. SAMPLE 2,885 breast cancer survivors from 14 different state cancer registries stratified by cancer type and time since diagnosis. A total of 184 female breast cancer survivors, aged 70 years or older, had complete data on variables of interest and were, therefore, included in this analysis. METHODS Chi-Square Automatic Interaction Detector (CHAID) analysis was used to examine variable interactions. MAIN RESEARCH VARIABLES PF, symptom bother, comorbidity, social support, length of survivorship, treatment, stage, body mass index, physical activity, emotional health, and personal characteristics. FINDINGS An interaction effect between symptom bother and comorbidity was found in 39% of older adult breast cancer survivors, and an interaction effect between symptom bother and marital status was found in 40%. The most vulnerable group (8%) had high symptom bother and more than four comorbid conditions. CONCLUSIONS Symptom bother, comorbidity, and marital status were found to have significant interactions such that high comorbidity and high symptom bother were significantly related to lower PF. Married participants with lower symptom bother had significantly higher PF scores. Comorbidity may be the best predictor of PF for the extreme ends of the symptom bother continuum. Advancing age alone was not a sufficient predictor of PF in this analysis. IMPLICATIONS FOR NURSING Specific attention to symptom reports, comorbidity, and marital status can guide identification of older adult cancer survivors in need of ongoing survivorship care. The findings support use of a comprehensive assessment and tailored approach to care based on factors other than age. KNOWLEDGE TRANSLATION CHAID interaction analysis may be useful in exploring complex nursing problems, such as the needs of older adult cancer survivors, and help oncology nurses develop appropriate interventions and referrals.
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Affiliation(s)
- Lanell Bellury
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA.
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Hollis G, McMenamin E. Integrating Nurse Practitioners Into Radiation Oncology: One Institution's Experience. J Adv Pract Oncol 2014; 5:42-6. [PMID: 25032032 PMCID: PMC4093461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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32
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Lattimer JG. Population-Based Advanced Practice Nursing: Where Does Oncology Fit in? Clin J Oncol Nurs 2013; 17:576-7. [DOI: 10.1188/13.cjon.576-577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Advanced practice nurses training for the geriatric oncology population. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Glotzbecker BE, Yolin-Raley DS, DeAngelo DJ, Stone RM, Soiffer RJ, Alyea EP. Impact of Physician Assistants on the Outcomes of Patients With Acute Myelogenous Leukemia Receiving Chemotherapy in an Academic Medical Center. J Oncol Pract 2013; 9:e228-33. [DOI: 10.1200/jop.2012.000841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors' findings suggest that the physician assistant service is associated with increased operational efficiency and decreased health service use without compromising health care outcomes.
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Affiliation(s)
| | | | - Daniel J. DeAngelo
- Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Richard M. Stone
- Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Robert J. Soiffer
- Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Edwin P. Alyea
- Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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McCorkle R, Engelking C, Lazenby M, Davies MJ, Ercolano E, Lyons CA. Perceptions of roles, practice patterns, and professional growth opportunities: broadening the scope of advanced practice in oncology. Clin J Oncol Nurs 2013; 16:382-7. [PMID: 22842689 DOI: 10.1188/12.cjon.382-387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Broadening the scope of advanced practice providers (APPs) has been offered as a solution to increasing healthcare costs, workforce shortage, and increased demand. To understand present scope and barriers to broadening it, the authors describe the perceptions and practice patterns of APPs. This cross-sectional study used a computerized self-report survey of 32 targeted nurse practitioners and physician assistants employed in the cancer center of an urban teaching hospital; 31 were included in the quantitative analyses. Survey items covered education and training background, expertise, professional resources and support, duties, certification, and professional development. Respondents practiced in a variety of oncology specialty areas, but all had advanced degrees, most held specialty certifications, and 39% had attended a professional or educational meeting within the last year. They spent a majority of their time on essential patient-care activities, but clerical duties impeded these; however, 64% reported being satisfied with the time they spent with patients and communicating with collaborating physicians. A model of advanced oncology practice needs to be developed that will empower APPs to provide high-quality patient care at the fullest extent of their knowledge and competence.
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Affiliation(s)
- Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, USA.
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Rosenzweig M, Giblin J, Mickle M, Morse A, Sheehy P, Sommer V, Bridging The Gap Working Group. Bridging the gap: a descriptive study of knowledge and skill needs in the first year of oncology nurse practitioner practice. Oncol Nurs Forum 2012; 39:195-201. [PMID: 22374493 DOI: 10.1188/12.onf.195-201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify the knowledge and skill needs of oncology nurse practitioners (ONPs) as they enter cancer care practice, and to identify necessary educational resources. DESIGN Cross-sectional, descriptive. SETTING A national e-mail survey. SAMPLE 610 self-described ONPs from the Oncology Nursing Society's database. METHODS The project team developed a 28-item electronic survey. The survey was randomly distributed via e-mail. MAIN RESEARCH VARIABLES ONPs' feelings of preparedness in the first year of ONP practice. FINDINGS In the first year of practice, 90% of ONPs rated themselves as prepared or very prepared in obtaining patient history, performing physical examination, and documenting findings. ONPs rated themselves as not at all or somewhat prepared in clinical issues of chemotherapy/biotherapy competency (n = 81, 78%), recognizing and managing oncologic emergencies, (n = 77, 70%), and recognizing and managing drug toxicities (n = 63, 61%). The primary source of oncology education for ONPs new to practice was almost exclusively the collaborating or supervising physician (n = 84, 81%). CONCLUSIONS Specific knowledge and skills, such as information about chemotherapy, oncologic emergencies, and side effects of therapy, are needed before an ONP enters a cancer care practice. IMPLICATIONS FOR NURSING Cancer-specific education should be made available to new ONPs as they begin independent practice.
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Colosia AD, Peltz G, Pohl G, Liu E, Copley-Merriman K, Khan S, Kaye JA. A review and characterization of the various perceptions of quality cancer care. Cancer 2011; 117:884-96. [PMID: 20939015 PMCID: PMC3073118 DOI: 10.1002/cncr.25644] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 08/12/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define "quality." The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy. METHODS A computerized literature search was conducted for articles concerning quality cancer care in patients who received chemotherapy. Among >1100 identified sources, 25 presented interviews/survey results from stakeholders. RESULTS Patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Waiting to see providers, having problems with referrals, going to different locations for treatment, experiencing billing inaccuracies, and navigating managed care reimbursement negatively affected patients' quality-of-care perceptions. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs. Providers objected to spending substantial time interacting with payers instead of delivering care to patients. Payers must control the costs of cancer care but do not want an adversarial relationship with providers and patients. Payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools. CONCLUSIONS Delivering quality cancer care is increasingly difficult because of the shortage of oncologists and rising costs of chemotherapy agents, radiation therapy, and imaging tests. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs.
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Affiliation(s)
- Ann D Colosia
- Market Access and Outcomes Strategy, RTI Health Solutions, Research Triangle Park, North Carolina.
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