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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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Mason I, Hewitt GD, McCracken KA, Whiteside S, Nahata L, Kebodeaux CA. Sexual and Reproductive Health Care after Gonadotoxic Treatment in Females at a Tertiary Pediatric Hospital. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00019-6. [PMID: 38253233 DOI: 10.1016/j.jpag.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
STUDY OBJECTIVES Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. METHODS Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. RESULTS We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. CONCLUSION This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.
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Affiliation(s)
- Isabelle Mason
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Geri D Hewitt
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kate A McCracken
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Stacy Whiteside
- Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Leena Nahata
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
| | - Chelsea A Kebodeaux
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
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Boone AN, Arbuckle JL, Ye Y, Wolfson JA. How Accurate Is Oncologist Knowledge of Fertility Preservation Options, Cost, and Time in Female Adolescents and Young Adults? J Adolesc Young Adult Oncol 2023; 12:110-117. [PMID: 35447034 DOI: 10.1089/jayao.2021.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Often cited barriers to fertility preservation (FP) among female adolescent and young adult (AYA) cancer patients include cost and time. We hypothesized that oncologists overestimate the time and costs required for female FP. Methods: We distributed an electronic survey to physicians in oncology-related departments. The survey assessed the knowledge and utilization of gonadotoxic therapies, FP options and requirements, and FP referral patterns. Student's t, Fisher's exact, ANOVA, and Wilcoxon signed-rank tests were used for continuous variables as appropriate; the chi-squared test was used for categorical variables. Results: Among respondents who reported prescribing gonadotoxic agents to AYAs (n = 38), 79% reported often/always discussing FP options, while only half referred to a reproductive specialist often/always. A smaller proportion of pediatric oncologists discussed FP often/always (p = 0.04) and most referred <25% of patients to a reproductive specialist; however, the majority of other specialists referred ≥75% of patients to a reproductive specialist (p = 0.001). While most respondents accurately estimated the time required to complete FP, the majority overestimated the cost of an FP procedure. Knowledge of FP options was inconsistent, with 63.2% reporting that suppression of the hypothalamic-pituitary-ovarian-axis is an option for FP, with 82.6% of these classifying it as standard of care. Conclusions: With variation across specialties, most oncology specialists prescribing gonadotoxic therapies for AYA females discuss FP, while a smaller proportion refer patients for FP. Despite relative accuracy in estimating the time required for FP, they overestimate costs of FP. Educational curricula related to FP are necessary across oncology specialties, especially pediatric oncology.
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Affiliation(s)
- Amy N Boone
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janeen L Arbuckle
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuanfan Ye
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie A Wolfson
- Division of Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wright ML, Theroux CI, Olsavsky AL, DaJusta D, McCracken KA, Hansen-Moore J, Yeager ND, Whiteside S, Audino AN, Nahata L. The impact of hiring a full-time fertility navigator on fertility-related care and fertility preservation at a pediatric institution. Pediatr Blood Cancer 2022; 69:e29857. [PMID: 35732078 DOI: 10.1002/pbc.29857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
Fertility navigators (FNs) are important in communicating infertility risk and fertility preservation (FP) options to patients receiving gonadotoxic therapies. This retrospective study examined electronic medical records of patients with fertility consults at a large pediatric institution (2017-2019), before and after hiring a full-time FN. Of 738 patient encounters, 173 consults were performed pre-navigator and 565 post-navigator. Fertility consults for long-term follow-up cancer survivors increased most substantially: pre-navigator (n = 7) and post-navigator (n = 387). Across diagnoses, females had a larger increase in consults compared to males (χ2 [3, N = 738] = 8.17, p < .05). Findings highlight FNs' impact on counseling rates, particularly in survivorship.
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Affiliation(s)
- Mariah L Wright
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Charleen I Theroux
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Anna L Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Daniel DaJusta
- Department of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kate A McCracken
- Division of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA
| | - Jennifer Hansen-Moore
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas D Yeager
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stacy Whiteside
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anthony N Audino
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Crespi C, Adams L, Gray TF, Azizoddin DR. An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2021; 48:491-505. [PMID: 34411081 DOI: 10.1188/21.onf.491-505] [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
PROBLEM IDENTIFICATION Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer. LITERATURE SEARCH The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer. DATA EVALUATION 85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review. SYNTHESIS Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers. IMPLICATIONS FOR PRACTICE Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.
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Lien C, Huang S, Hua Chen Y, Cheng W. Evidenced-based practice of decision-making process in oncofertility care among registered nurses: A qualitative study. Nurs Open 2021; 8:799-807. [PMID: 33570287 PMCID: PMC7877121 DOI: 10.1002/nop2.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
AIM The purpose of our study was to construct the context of the nursing action/role in oncofertility care. DESIGN Qualitative research. METHODS We applied grounded theory to guide the qualitative study. Data were collected through in-depth interviews with 12 nurses in Taipei. The data were collected from August 2018 to February 2019. RESULTS The core theme that described the role of nurses' decision-making in oncofertility care focused on understanding oncofertility from the self to the other. Care roles or actions in oncofertility that involved the process of psychological cognition were divided into four dimensions: perceiving the patient's changes and needs, triggering the self's emotions, empathizing with patient's situations and introspective care roles. Nurses who had experienced the phase of empathizing with the patient's situations developed more diverse roles and had positive actions toward oncofertility care. Based on the psychological changes for oncofertility decision-making process, implementing contextual training in oncofertility could help nurses create more positive actions in oncofertility care.
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Affiliation(s)
| | | | - Yi Hua Chen
- Department of NursingMackay Medical CollegeNew Taipei CityTaiwan
| | - Wen‐Ting Cheng
- Department of NursingMacKay Memorial HospitalTaipeiTaiwan
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Semler R, Thom B. Fertility Preservation: Improving Access Through Nurse-Advocated Financial Assistance. Clin J Oncol Nurs 2019; 23:27-30. [PMID: 31538989 DOI: 10.1188/19.cjon.s2.27-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Young adult patients and survivors may face impaired fertility or infertility as a result of their cancer treatment, and many will need costly assisted reproductive technology to build their families. Fertility nurse specialists (FNSs) can play a role in alleviating the distress associated with the co-occurrence of financial toxicity and impaired fertility/infertility. OBJECTIVES This article describes a nurse-led oncofertility program that offers counseling to patients of any age, with any diagnosis, and at any stage of treatment. METHODS An overview of the literature and a description of a clinical practice, including relevant case studies, are presented. FINDINGS FNSs can seek to lessen the financial burden associated with family building before and after cancer treatment by developing a network of reproductive specialists who will provide discounted services and by sharing information on available resources that might reduce the costs.
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Mitchell L, Stuart-McEwan T, Panet H, Gupta A. Adolescents and Young Adults: Addressing Needs and Optimizing Care With a Clinical Nurse Specialist. Clin J Oncol Nurs 2017; 21:123-126. [DOI: 10.1188/17.cjon.123-126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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