Ashley Leak

Why Do Patients With Cancer Visit Emergency Departments? Results of a 2008 Population Study in North Carolina

PURPOSE Emergency departments (EDs) in the United States are used by patients with cancer for disease or treatment-related problems and unrelated issues. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) collects information about ED visits through a statewide database. PATIENTS AND METHODS After approval by the institutional review board, 2008 NC DETECT ED visit data were acquired and cancer-related visits were identified. Descriptive statistics and logistic regressions were performed. Of 4,190,911 ED visits in 2008, there were 37,760 ED visits by 27,644 patients with cancer. RESULTS Among patients, 77.2% had only one ED visit in 2008, the mean age was 64 years, and there were slightly more men than women. Among visits, the payor was Medicare for 52.4% and Medicaid for 12.1%. More than half the visits by patients with cancer occurred on weekends or evenings, and 44.9% occurred during normal hours. The top three chief complaints were related to pain, respiratory distress, and GI issues. Lung, breast, prostate, and colorectal cancers were identified in 26.9%, 6.3%, 6%, and 7.7% of visits, respectively, with diagnosis. A total of 63.2% of visits resulted in hospital admittance. When controlling for sex, age, time of day, day of week, insurance, and diagnosis position, patients with lung cancer were more likely to be admitted than patients with other types of cancer. CONCLUSION To the best of our knowledge, this is the first study to provide a population-based snapshot of ED visits by patients with cancer in North Carolina. Efforts that target clinical problems and specific populations may improve delivery of quality cancer care and avoid ED visits.

Patient and Provider Preferences for Survivorship Care Plans

PURPOSE Survivorship care plans (SCPs) are tools used to assist in the transition from treatment to surveillance cancer care. However, few studies have investigated survivor and provider preferences regarding SCPs. Our purpose was to explore survivor and primary care provider preferences regarding content, format, and delivery of SCPs. METHODS Focus groups and provider interviews were performed in 2010. Five different templates were presented to study participants for their feedback. Each SCP included a treatment summary, surveillance schedule, and care plan for the same fictitious patient. Sessions were transcribed, and field notes taken. RESULTS Four focus groups (n = 29 survivors) and five primary care providers participated. No cancer survivors had ever received a written SCP. We found clear preferences for the Journey Forward format (with some modifications) and face-to-face delivery (print or electronic) to the survivor by his or her oncologist just before or soon after completion of treatment. Primary care providers preferred an abbreviated version. CONCLUSION Written SCPs were endorsed by all patients and primary care providers as helpful communication tools. However, if used alone, the SCP would be insufficient to ease the transition to follow-up care. Improved communication and care coordination were identified as important for survivorship care that went beyond what this document might provide.

Symptom Distress, Spirituality, and Quality of Life in African American Breast Cancer Survivors

This study examined the relationships among the demographic characteristics, symptom distress, spirituality, and quality of life (QOL) of African American breast cancer survivors. A convenience sample of 30 survivors with a mean age of 56 years and a mean survival of 6 years was recruited from African American breast cancer support groups and churches in the Southeastern United States. Data were collected through face-to-face interviews using a demographic questionnaire, the Quality of Life Index-Cancer Version, the Symptom Distress Scale, and the Spiritual Perspective Scale. Statistically significant relationships were found between symptoms and QOL (r = −0.62, P < .05) and between spirituality and QOL (r = 0.70, P < .05). No statistically significant relationships were found between age at diagnosis, income, or education and QOL. This research suggests that symptoms and spirituality are associated with QOL. Culturally appropriate care should be provided to these women to reduce health disparities and to improve their QOL.

Self-Care Recommendations of Middle-Aged and Older Adults with Sickle Cell Disease

Self-care management is an important part of living with a chronic illness. Sickle cell disease (SCD) is a chronic disease with acute, painful exacerbations that often results in a shortened life expectancy. Some middle-aged and older adults with SCD lived with the disease prior to having a diagnosis and without modern advances. The purpose of this study is to share the self-care recommendations of middle-aged and older adults with SCD. Using descriptive qualitative methods, data were gathered through semistructured interviews from 11 individuals living with SCD, including 6 women and 5 men. Self-care recommendations themes included physiological, psychological, and provider-related. The self-care recommendations may be seen as an additional resource or “words of wisdom” for younger adults with SCD who can use the recommendations to better manage their own disease. Additionally, providers may be able to use these recommendations to inform their practice.

Oncology certification: what is in it for you?

Most nurses are confident in their belief that they provide excellent care; however, many find the idea of taking an examination to demonstrate their knowledge frightening. Earning a specialty certification is one of the most important accomplishments a nurse can achieve for oneself, one’s patients, and one’s employer, as it signifies knowledge and practice competency in the specialty (Oncology Nursing Certification Corporation [ONCC], 2008c). This column explains the benefits of certification and solutions to potential barriers to obtaining certification for oncology nurses who are contemplating certification. Certification is a voluntary personal and professional accomplishment that is recognized by patients, their families, peers, other health professionals, and employers. Specialty certification is not limited to health professions; it exists in other occupations such as business, accounting, and information technology. Obtaining a formal credential—Oncology Certified Nurse (OCN®), Certified Breast Care Nurse (CBCN), Certified Pediatric Oncology Nurse (CPON®), Advanced Oncology Clinical Nurse Specialist (AOCNS®), or Advanced Oncology Certified Nurse Practitioner (AOCNP®)—is not only an achievement, but a validation of the nurse’s clinical experience and knowledge. “Certification has been a personal challenge for me. It has helped validate my skills and knowledge in care of oncology patients. It was worth my time and energy to take the test”(Leak and Spruill, 2008). More than 2.9 million people in the United States are RNs (American Nurses Association, 2008). More than 500,000 nurses worldwide are certified in their specialty areas, including advanced practice nurses who have more than one specialty credential (American Board of Nursing Specialties, 2005). ONCC was established in 1984 to develop and administer a certification program in oncology nursing. It currently offers five certification examinations (ONCC, 2008c) (see Table 1). Currently, more than 27,000 nurses are certified, including 23,378 nurses with the OCN® credential, 1,731 CPON®, 1,225 AOCN®, 541 AOCNP®, and 220 AOCNS® (ONCC, 2008c). Table 1 Five Oncology Nursing Certification Examinations Offered by the Oncology Nursing Certification Corporation Since the 1990s, healthcare organizations have placed a higher value on specialty certification for nurses. Many employers now provide and pay for review courses for their employees. Some employers even reimburse their staff for the cost of successful completion of the credentialing examination. The increase in the number of healthcare organizations supporting nurses’ professional development via specialty certification may be partly because of the criteria for Magnet recognition from the American Nurses Credentialing Center (2008), which strongly encourages specialty certification to validate specialty nursing knowledge.

The Role of Oncology Nurses in the Care of Adults With Sickle Cell Disease

Oncology nurses are experts in pain management, and pain is the hallmark of sickle cell disease (SCD). Because individuals with cancer and individuals with SCD often receive care from hematologists or oncologists and are admitted to the same nursing units, oncology nurses need to have an understanding of SCD and the challenges that these individuals face.

Priapism in the oncology setting.

CASE STUDY N.L. is a 20-year-old Caucasian man with no significant medical history. He presented to the hospital with a two-day history of feeling ill with intermittent nausea, vomiting, blurred vision, and headache. He also noted slurred speech and left-upper-quadrant fullness for almost a month.

Inpatient Diabetes Education: Realistic and Evidence-Based

Hospitalization can present an opportunity to address unique urgent learning needs. Although some would argue that the hospital is a poor setting for patient education, this does not have to be the case. Brief targeted diabetes education is readily available, and take-home materials can reinforce instruction. Given the sheer volume of inpatients with diabetes, dedicated resources for their care and education are essential.