Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India

Impact of educational interventions on utilization patterns of anticancer agents in patients with breast cancer at the specialty oncology care setting in South India

Aims/Objectives:

This study was conducted to assess the utilization patterns of anticancer agents in patients with breast cancer and to provide practice recommendations/educational interventions to optimize medication use in patients with breast cancer.

Materials and Methods:

This was an ambispective study conducted for a period of 3 years at a private, specialty oncology care hospital in South India. In the initial phase, the selection of anticancer agents, dosage of anticancer agents, and management of chemotherapy-induced nausea and vomiting (CINV) were reviewed retrospectively (using paper medical records) with respect to the National Cancer Comprehensive Network guidelines. The administration of anticancer agents and anti-emetics were reviewed with respect to the hospital drug administration policies. The deviations from the standards were reported, and practice recommendations/educational interventions were developed. Treatment patterns were reevaluated prospectively after providing educational interventions. Descriptive statistics were used to report and compare the results from both phases.

Results:

During retrospective phase, we observed 80% compliance in the selection of anticancer drugs, 74% compliance in drug dosing, and 63.5% compliance in the administration of anti-cancer agents. After the implementation of educational interventions, we observed 85% compliance in the selection of anticancer agents, 82.3% in their dosing, and 86.9% compliance in the administration of anticancer agents. For the management of CINV, we observed 75% compliance in the selection of drugs (vs. 53% during preintervention), 92% compliance in their dosing (vs. 90% during preintervention), 85.1% compliance in the administration of anti-emetics (vs. 50% during preintervention), and 80% compliance in the management of delayed CINV (vs. 60% during preintervention).

Conclusions:

Treatment patterns of breast cancer were improved with respect to treatment standards after educational interventions to oncology care team.

Exploring the occupational health needs of oncology nurses: A qualitative study

BACKGROUND

Although the work environment of oncology nurses is highly complex and challenging, their occupational health needs are scarcely studied. This study aimed to explore the occupational health needs of oncology nurses.

MATERIALS AND METHODS

This qualitative descriptive study was conducted in 2018-2019. The participants consisted of 52 oncology nurses and 11 other key informants. They were chosen from eight cancer treatment centers in different cities of Iran. Data were collected through semi-structured individual interviews and analyzed using conventional content analysis.

RESULTS

The occupational health needs of oncology nurses were grouped into three main categories included needs for self-care, development of professional competency, and a safe and healthy work environment.

CONCLUSION

The work environment of oncology nurses needs to be optimized in terms of physical, psychological, organizational, and sociocultural conditions. Furthermore, the necessary measures should be taken to encourage oncology nurses to implement self-care, thus creating the preparedness to face the challenges of the workplace by developing their professional competencies.

Occupational stressors in oncology nurses: A qualitative descriptive study

AIM AND OBJECTIVES

The present study aims at exploring oncology nurses' perceptions regarding work-related stressors.

BACKGROUND

Oncology nurses work in an environment with a high degree of stress, which can negatively affect their health. There is limited research on work-related stressors from the oncology nurses' perspective.

DESIGN

Qualitative descriptive study.

METHODS

Fifty-two oncology nurses were selected purposefully from eight cancer treatment centres in different cities of Iran. Data were collected through semi-structured interviews and analysed using conventional content analysis. The COREQ checklist was used to document the report of the study.

RESULTS

The extracted contents were classified into four main categories. The first category involved personal ability with two subcategories (person-job fit and psychological competencies). The second category included physical environment arrangements with two subcategories (physical working conditions and equipment and facilities). The third category involved psychosocial safety in the workplace with four subcategories (creating a safe work environment, overcoming the challenges of providing care to cancer patients, work/life balance and social recognition of the nursing status). The fourth category holds an organisational context with four subcategories (organisational support, interpersonal relations, justice at work and human resources).

CONCLUSION

It is necessary to find measures attenuating work-related stresses in oncology nurses. These measures should be in line with developing personal abilities in nurses and creating a safe environment in terms of optimising physical, psychosocial and organisational conditions. It is also important to develop programmes protecting the oncology nurses' occupational health.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can help improve nursing work conditions, attenuate work-related stresses in nurses and introduce efficient interventions reducing occupational stressors.

Healthcare providers' views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis

BACKGROUND

Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients' disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed.

AIM

To synthesise the evidence on healthcare providers' views and experiences of non-specialist palliative care in hospitals.

DESIGN

A qualitative systematic review and thematic synthesis using Thomas and Harden's thematic synthesis framework.

DATA SOURCES

Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers' views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews.

RESULTS

Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers' views and experiences. Four major analytical themes emerged; 'Understanding of Palliative Care', 'Complexities of Communication', 'Hospital Ecosystem' and 'Doctors and Nurses - a Different Lens'.

CONCLUSIONS

Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.

Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline

Purpose

The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016.

Methods

ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group).

Results

The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel).

Recommendations

The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines.

It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Improving medication safety in oncology care: impact of clinical pharmacy interventions on optimizing patient safety

Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible prevention subsequently. Objectives This study was conducted to detect and monitor ADRs to anti-cancer agents, and to assess impact of clinical pharmacists (CPs)' interventions in minimizing ADRs to anti-cancer agents. Setting Private, specialty oncology care hospital in South India. Methods CPs prospectively followed cancer patients admitted to inpatient wards and treated at ambulatory care in order to identify ADRs, for a period of 3 years. Identified/reported ADRs were discussed with concerned oncologists and/or nurses, documented electronically and assessed further for their causality, severity, preventability and grading. Based on study findings during year 1, interventions (educational, therapeutic and system based) were developed by CPs and implemented in order to minimize preventable ADRs. Impact of CPs' interventions was studied during year 2 and year 3. Main outcome measure(s) Preventable factors contributing to ADRs and percentage of preventable ADRs before and after CPs' interventions. Results A total of 1279 ADRs were reported in 1133 patients from a cohort of 1328 patients. Vomiting (23.22%), alopecia (9.53%), diarrhoea (8.67%) and myelosuppression (7.42%) were the common ADRs reported. Inappropriate administration frequency and regimen of anti-emetics (22%), lack of/suboptimal supportive care (18%) and administration errors (16%) were identified as common contributing (preventable) factors for ADRs in year 1. Percentage of preventable ADRs was 81% during year 1 (pre-intervention), and 45% and 34% in year 2 and year 3 respectively (post-interventions). Conclusion Interventions by CPs helped to minimize preventable ADRs to anti-cancer agents.

Challenges of Using Methadone in the Indian Pain and Palliative Care Practice

Palliative care providers across India lobbied to gain access to methadone for pain relief and this has finally been achieved. Palliative care activists will count on the numerous strengths for introducing methadone in India, including the various national and state government initiatives that have been introduced recognizing the importance of palliative care as a specialty in addition to improving opioid accessibility and training. Adding to the support are the Non-Governmental Organizations (NGOs), the medical fraternity and the international interactive and innovative programs such as the Project Extension for Community Health Outcome. As compelling as the need for methadone is, many challenges await. This article outlines the challenges of procuring methadone and also discusses the challenges specific to methadone. Balancing the availability and diversion in a setting of opioid phobia, implementing the amended laws to improve availability and accessibility in a country with diverse health-care practices are the major challenges in implementing methadone for relief of pain. The unique pharmacology of the drug requires meticulous patient selection, vigilant monitoring, and excellent communication and collaboration with a multidisciplinary team and caregivers. The psychological acceptance of the patient, the professional training of the team and the place where care is provided are also challenges which need to be overcome. These challenges could well be the catalyst for a more diligent and vigilant approach to opioid prescribing practices. Start low, go slow could well be the way forward with caregiver education to prescribe methadone safely in the Indian palliative care setting.

Implementation of clinical pharmacy services in an academic oncology practice in India

Objective This study was conducted to investigate medication-related problems after implementation of clinical pharmacy services at a speciality oncology care setting. Methods It was a prospective interventional study conducted for a period of three years at a private academic oncology care setting. Paper-based medical records and medication orders were reviewed and patients and care givers were interviewed to understand the treatment plan. All the medication-related problems were identified by clinical pharmacists by performing drug therapy review. Patients were also followed up at ambulatory care and in-patient units to ensure appropriate administration of anti-cancer drugs by nurses. All the medication-related problems were discussed with the concerned clinicians and then were resolved with the interventions of clinical pharmacists. Clinical significance of these interventions were assessed and classified as "Major", "Moderate "and "Minor". Educational, clinical and system-based interventions were developed and implemented to minimize medication-related problems at the study site. Results A total of 1359 medication-related problems were identified from 2120 medication orders reviewed of 1362 patients followed during the study period. The most common medication-related problems were lack of suboptimal supportive care (17.95%), inappropriate administration of medications (14.56%), untreated indication (14.20%), wrong dosing calculations (12.21%), drug-drug interactions (11.62%) and sub-therapeutic dose (11.11%). Clinical pharmacy interventions were made to resolve all the medication-related problems. Clinical significance of majority (n = 504, 37.08%) of medication-related problems was "Moderate" followed by "Major" (n = 434, 31.93%) and "Minor" (n = 421, 30.97%). Conclusion The study has demonstrated the importance of clinical pharmacy services in improving quality and safe use of medicines in oncology practice. Positive feedback of clinicians on clinical pharmacy services was a reflection of acceptance of clinical pharmacy interventions by clinicians.