Interprofessional education about patient decision support in specialty care

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.Medical Decision MakingAnalysis and support of clinical decision makin

Surveys of Cancer Patients and Cancer Health Care Providers Regarding Complementary Therapy Use, Communication, and Information Needs

Background. Complementary therapies (CTs) are increasingly utilized by cancer patients. Nonetheless, patients report insufficient support from health care practitioners (HCPs) and there is a general lack of patient-practitioner communication about CT use. Best care practices suggest that HCPs should address the needs of patients, including CT use. This study examined current practices of patients and HCPs as well as their interactions relating to CTs. Methods. A total of 481 cancer outpatients and 100 HCPs completed questionnaires. Patient questions addressed CT use and information needs; HCP questions addressed knowledge, opinions and beliefs about complementary and alternative medicine. Patient-practitioner communication around CT was also examined. Results. 47% of patients reported using CTs since diagnosis. Many commenced CT use to improve quality of life (65%) based on recommendations from family or friends. Patients acknowledged the need for trusted sources of information and would attend a hospital-based education program (72%). HCPs reported limited training about CTs but most (90%) expressed interested in receiving more training. The majority of HCPs (\u3e80%) reported limited knowledge about the role of CTs in cancer care or evidence to support CT use. Questions about communication and interactions revealed that 80% of patients reported not having had an HCP speak to them about CTs. However, 63% of HCPs reported addressing CT use. Conclusion. Results demonstrate a need for improved CT education and training for patients and HCPs. increasing HCP knowledge and clinical skills will ensure patients information needs about CTs are acknowledged and attended to, thereby providing safer and comprehensive cancer care

Complimentary therapies : the decision-making process of women with breast cancer

Complementary therapy (CT) use by women with breast cancer is increasing in popularity. However, informed decisions about CT use are difficult for women due to limited and conflicting sources of information in the accessible lay literature, and lack of knowledge by health care professionals. The purpose of this grounded theory study was to describe the process by which women with breast cancer make decisions about CTs, including the integration of CTs into orthodox cancer treatment plans. Open-ended interviews were conducted with 16 women receiving orthodox cancer treatment, from across the breast cancer trajectory, from a variety of cultural groups, and who used a wide range of CTs. Analysis of the interviews involved identification of three interconnected phases of the CT decision-making process: 1) Getting Something in Place: Covering all the Bases, 2) Hand-picking CTs which Fit: Getting a Personalized Regimen in place, and 3) Living with the Security of CTs: Fine-Tuning a Regimen to Live With. All of these phases occurred within the breast cancer trajectory, with the first phase initiated at the time of diagnosis. Phase two usually did not begin until after surgery and lasted throughout orthodox treatment and beyond. The third phase generally began sometime after the completion of orthodox treatment, lasting perhaps for the remainder of one's lifetime. However, when a recurrence of breast cancer occurred, or a shift from a curative to palliative intent, women returned to the second phase, modifying their existing CT regimen. The use of CTs was identified as an important means by which to regain control and maintain hope. Relationships with health care professionals were found to be highly influential, both positively and negatively, in the CT decision-making process. The process described in this study provides a beginning understanding of how women with breast cancer make decisions about CT use. Interventions to support CT decision-making were outlined which help women to maintain control and foster hope. The findings of this study will help nurses and other health care professionals in assisting women to make informed decisions about their health, including the safe integration of CTs into their cancer treatment plan.Applied Science, Faculty ofNursing, School ofGraduat

NEXUS Seminar: Complementary Medicine Education and Outcomes

The Complementary Medicine Education and Outcomes (CAMEO) program is a collaborative UBC/BC Cancer Agency research initiative that aims to develop and evaluate evidence-based decision support for people living with cancer and their significant others who are interested in using complementary medicine (CAM) during their cancer experience, as well as education on CAM for oncology health professionals. The aim of this presentation is to describe and invite discussion about some of the key research activities that are being developed through CAMEO, as well as the potential outcomes for the diverse community of people living with cancer in urban and rural regions of British Columbia. Particular attention will be paid to how diversity (i.e., gender, age, culture, geographical location) will be addressed within the CAMEO research program.Applied Science, Faculty ofNursing, School ofUnreviewedResearcherFacult

Exploring equitably high quality cancer survivorship care

Evidence of health disparities among cancer survivors is growing. Globally, survivorship models of care are evolving rapidly, yet few consider health and social disparities in their development, limiting access to high quality survivorship care for many. In the current context, Canada’s survivorship care systems may privilege some, and not others, to receive high quality survivorship care and optimize health in this context. Understanding the role of disparities in models of care development and access is essential to ensure individual need, rather than social privilege, guides opportunities for high quality survivorship care. This study aims to improve survivorship care systems by helping clinicians and decision makers to a better understanding of how various factors (e.g. social, political, economic, personal) and survivors’ health experiences and health management strategies might shape the development of and access to high quality survivorship care for Canadians with cancer. A nursing disciplinary epistemology, underpinned by pragmatism and informed by critical and intersectional perspectives, served as a framework to explore complexity within survivorship care. A phased qualitative Interpretive Description approach was used to analyze data from three distinct data sources: 1) critical textual analysis of 70+ document sources (e.g., survivorship guidelines, education programs, policies, resources); 2) secondary analysis of multiple transcripts from 19 survivors in an existing data base; and 3) 34 survivor and 12 stakeholder interviews. Survivors described a gap between their expected and actual survivorship care experiences. This gap was shaped by contextual and structural factors that further marginalized some individuals/groups. Factors shaping this gap at all levels included: individual (e.g., previous experiences, social determinants of health, advanced cancer, age); group (e.g., defining standardized “norms”); and system (e.g. efficiency drivers, underdeveloped guidelines, exclusionary messaging such as “cancer can be beaten”). Recommendations arising from these findings ranged from strategies to build survivor trust to integrated policies across social and health sectors to promote survivors’ holistic health. This multilayered, intersectoral approach to understanding what shapes survivorship care systems and resources highlights and unravels the complex nature of the issue, helping clinicians and decisions makers find multi-layered approaches for equitably high quality survivorship care.Applied Science, Faculty ofNursing, School ofGraduat

Will designated patient navigators fix the problem? Oncology nursing in transition

With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient “navigators” to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary

Les intervenants pivots solutionneront-ils le problème? Les soins infirmiers en oncologie en transition

L’accès aux soins et leur équité dans l’ensemble du système de soins contre le cancer étant devenus des préoccupations grandissantes, on constate un enthousiasme toujours plus vif pour divers types de postes d’intervenants pivots afin de faciliter la coordination des soins. Bien que l’intention soit digne de louanges, plusieurs stratégies les plus populaires d’implantation risquent d’accentuer les pressions sur le système et de compliquer encore plus le problème de coordination. Les auteures de cet article affirment qu’il est possible de reformuler les motivations sous-tendant le mouvement en faveur de l’aide à la navigation des patients en reconnaissant la valeur du travail du personnel infirmier lorsque ce dernier est déployé de façon optimale pour offrir aux patients du soutien tout au long de leur expérience du système de soins contre le cancer. Cet article incite les infirmières en oncologie du Canada à faire la critique des stratégies d’aide à la navigation, à les remettre en question et à adopter uniquement celles qui correspondent aux importantes réformes nécessaires pour rendre le système de soins contre le cancer si efficace qu’il n’aura plus besoin de faire appel à des intervenants pivots externes