Uncertainty in cancer survivors : physical factors, beliefs about control, and psychological well-being

Cancer represents a threat to health which leads long-term cancer survivors to appraise uncertainty about the outcome regularly. This descriptive correlational study examined the level and stress of uncertainty and related variables in a sample of 72 adult cancer survivors of eight to twelve years. The conceptual framework was based on Hilton's uncertainty stress model (1988, 1994) and Lazarus and Folkman's conceptualization of coping (1984). The objectives were to determine if there was a relationship between person factors and uncertainty and between uncertainty and psychological responses. Data included demographic and physical status, locus of control, uncertainty and stress, depression, psychological distress, and perceived control. The overall level of uncertainty was low, but it was positively associated with recurrence, depression, and illness worry. Results support uncertainty as a mediator between person factors and psychological responses. Nursing implications include periodic assessment of uncertainty long after diagnosis

Intervention patterns of pivot nurses in oncology

The Pivot Nurse in Oncology (PNO) is a health care professional dedicated to providing patients with cancer and their families with continuing and consistent supportive care throughout the care trajectory. The purpose of this paper is to describe the variation and frequency of nursing interventions delivered by 12 PNOs at our health centre. An administrative analysis over a three-year period revealed a total of 43,906 interventions that were grouped into 10 categories. This analysis provided a description of the intervention frequency and these interventions were further collapsed into the four role functions of the PNO. Coordination/continuity of care and the assessment of needs and symptoms were identified as the dominant practice domains of the PNO in the professional cancer navigator role

Caractéristiques des interventions des infirmières pivots en oncologie

L’infirmière pivot en oncologie (IPO) est une professionnelle de la santé dont la mission est d’offrir aux patients atteints du cancer et à leurs familles, des soins de soutien pour répondre à leurs besoins tout au long de la trajectoire des soins. Cet article a pour but de décrire les variations et la fréquence des interventions infirmières offertes par 12 IPO de notre centre de santé. Une analyse adminis- trative couvrant une période de trois ans a permis de dénombrer 43 906 interventions au total qui ont été reparties dans 10 catégories. Cette analyse a abouti à une description de la fréquence des inter- ventions, et celles-ci ont été regroupées selon les quatre fonctions clés du rôle de l’IPO. La coordination/continuité des soins et l’évaluation des besoins et des symptômes ont été dégagées comme les domaines de pratique prédominants de l’IPO à l’intérieur de son rôle de navi- gateur professionnel en oncologie

Remote symptom support training programs for oncology nurses in Canada: An environmental scan

The overall aim of this study was to explore current remote symptom support training programs provided to nurses in ambulatory oncology programs across Canada, using a survey-methods environmental scan. Of 36 delivered invitations, 28 programs responded (77.8%) representing 10 provinces. Of 25 programs that offer telephone symptom support, 17 provide symptom support training, seven do not, and one did not say. Seven programs shared training materials with the investigators and elements of training included: symptom management guidelines (n=6), telephone triage process/principles (n=5), competent telephone practices (n=4), documentation (n=4), professional standards (n=3), role-play (n=3), communication skills/etiquette (n=3), and monitoring quality (n=1). Formats included: presentations (n=3), paper-based resources (n=3), or e-learning modules (n=1). No training programs were rigorously evaluated. Training in telephone nursing symptom support across oncology programs is variable. Opportunities exist to identify core competencies and evaluate if training programs enhance delivery of remote cancer symptom support

Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. Discussion Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.</p