Deborah McLeod

A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue.

PURPOSEnThe purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (crf) in adults.nnnMETHODSnThe internationally endorsed adapte methodology was used to develop a practice guideline for pan-Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of crf. The search included medline, embase, cinahl, the Cochrane Library, and other guideline and data sources to December 2009.nnnRESULTSnTwo clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process.nnnCONCLUSIONSnPractice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care.

Evaluation of CancerChatCanada: a program of online support for Canadians affected by cancer

BACKGROUNDnProfessional-led cancer support groups can improve quality of life and address unmet needs, but most Canadians affected by cancer do not have access to or do not make use of cancer support groups. A collaborative interdisciplinary team developed, operated, and evaluated Internet-based, professional-led, live-chat support groups (osgs) for cancer patients, caregivers, and survivors across Canada.nnnOBJECTIVEnOur study aimed to report participant and participation characteristics in the pan-Canadian initiative known as CancerChatCanada, and to understand participant perspectives about the quality of communication and professional facilitation, overall satisfaction, and psychosocial benefits and outcomes.nnnMETHODSnParticipants in osgs provided informed consent. Participant and participation characteristics were gathered from program data collection tools and are described using frequencies, means, and chi-squares. Patient, survivor, and caregiver perspectives were derived from 102 telephone interviews conducted after osg completion and subjected to a directed qualitative content analysis.nnnRESULTSnThe 55 professional-led osgs enrolled 351 participants from 9 provinces. More than half the participants came from rural or semirural areas, and more than 84% had no received previous cancer support. The attendance rate was 75%, the dropout rate was 26%, and 80% of participants were satisfied or very satisfied. The convenience and privacy of osgs were benefits. Meaningful communication about important and difficult topics, kinship and bonding with others, and improved mood and self-care were perceived outcomes.nnnCONCLUSIONSnOur results demonstrate that this collaborative initiative was successful in increasing reach and access, and that pan-Canadian, professional-led osgs provide psychosocial benefit to underserved and burdened cancer patients, survivors, and family caregivers.

Knowing the family: Interpretations of family nursing in oncology and palliative care

PURPOSEnFamilies are acknowledged as a focus of care in oncology nursing in many countries but the meaning of family nursing in this practice setting has received little attention from researchers and theorists. In this article, we report the findings of a study that explored family nursing practices in three adult cancer care settings: ambulatory care (medical and radiation oncology clinics), a palliative care service, and an in-patient unit.nnnMETHODnData included in-depth interviews with 30 nurses and 19 families, as well as participant observations in each practice setting. The interviews were transcribed verbatim and the analyses guided by philosophical hermeneutics.nnnRESULTSnWe identified several narratives related to family nursing practices, and in this article we offer the interpretations of two of these narratives: 1) knowing the family and being known; and 2) addressing family concerns and distress. In knowing the family and being known nurses opened relational space for families to become involved in the care of their loved ones and gained an understanding of the family by reading non-verbal and para-verbal cues. Knowing the family created opportunities for nurses to address family concerns and distress in meaningful ways. These included guiding families by being a bridge, helping families to conserve relationships, and negotiating competing family agendas. Nurses relied on questioning practices to create relational space with, and among, family members.nnnCONCLUSIONSnImplications for the development of family nursing practice, theory, and education are discussed.

The Interprofessional Psychosocial Oncology Distance Education (IPODE) project: perceived outcomes of an approach to healthcare professional education

Abstract The Interprofessional Psychosocial Oncology Distance Education (IPODE) project was designed as an approach to the problems of feasibility and accessibility in specialty health professional education, in this case, psychosocial oncology (PSO). In this article, we report the evaluation findings from the first three years of the project in relation to one IPODE course, which was offered as a graduate level university elective in nine Canadian universities and as a continuing education (CE) option to health professionals between January 2008 and May 2010. The evaluation included a pre and post questionnaire that explored how an interprofessional (IP), web-based, PSO course influenced participants’ knowledge, attitudes and beliefs about IP, person-centered PSO care. It also examined what attributes of a web-based platform were most effective in delivering an IP PSO course. The study yielded two key findings. First, web-based learning in a pan-Canadian and cross-university collaboration is a viable alternative to providing specialty education and significantly improves knowledge, attitudes and beliefs about IP, person-centered PSO care. Second, a web-based platform with real-time seminars, discussion boards and multiple audio visual resources that privilege first person illness narratives were important elements in expanding knowledge and shifting attitudes about IP practice and person-centered care in regards to PSO. In their evaluation, course participants highlighted a variety of ways in which the course expanded their vision about what constitutes an IP team and increased their confidence in interacting with healthcare professionals from professions other than their own.

Enhancing clinical practice in the management of distress: The Therapeutic Practices for Distress Management (TPDM) project

The Therapeutic Practices for Distress Management (TPDM) project was carried out to support clinicians in integrating recommendations from four clinical practice guidelines (CPGs) in routine care at five Pan Canadian cancer care sites.

Authenticating Family A Grounded Theory Explaining the Process of Re/claiming Legitimacy by Lesbian Stepfamilies

Authenticating family is a process of becoming a lesbian stepfamily, working to affirm strong and healthy family relationships, and learning to accept nothing less than acknowledgment and inclusion as legitimate. Authenticating family demonstrates that the internal function of becoming a stepfamily is not dissimilar to that of heterosexual stepfamilies. Frequent encounters that are heterosexist underscore the challenges faced by lesbian stepfamilies. The new stepfamily faces obstacles that contest the sense of legitimacy for all family members. These families learn from multiple interactions among themselves and with outsiders how to negotiate a new understanding of family. The conditions that impact the process are age of the children, support, and heterosexism. The lesbian stepfamily develops the ability to demonstrate pride to a society that has marginalized in the past, even as society is evolving in acceptance. There are three stages in authenticating family: accepting the challenge, building the bonds, and thriving.

When jurisdictional boundaries become barriers to good patient care

Canada is a pioneer in remote cancer care delivery to underserved populations; however, it is trailing behind on policies that would support clinicians in providing care using distance technologies. The current policy framework is disjointed, and discussions by professional boards about online jurisprudence associated with licensure appear to be regressive. We hope that by addressing the discrepancies in interjurisdictional practice and focusing on the key issue of where therapy resides, we will be able to nudge dialogue and thinking closer toward the reasoning and recommendations of national telehealth organizations. We present this discussion of jurisdictional issues and e-health practice in the context of a pan-Canadian online support program developed for cancer patients and family members. Although the present paper uses online support groups as a springboard to advocate for e-health, it ultimately addresses a broader audience: that of all Canadian health care stakeholders.

Dépistage de la détresse : l’intervention est une fonction essentielle des infirmières en oncologie

Le depistage systematique de la detresse parmi les differents groupes de patients atteints de cancer est une pratique qui s’est progressivement repandue dans le monde ces derniers temps puisque la conceptualisation de la detresse veut que cette derniere soit le sixieme signe vital. Dans l’ensemble du Canada, l’experience que l’on possede du depistage de la detresse grandit a mesure que les etablissements de soins en cancerologie mettent en oeuvre des programmes de depistage. Les premiers enseignements tires de ces efforts soulignaient la necessite d’une approche programmatique et l’importance des infirmieres en oncologie sur le plan du depistage et de la prestation des interventions initiales visant a combattre la detresse. Jusqu’a present, peu d’ecrits refletent la perspective infirmiere sur le role des soins infirmiers en oncologie au sein d’un programme de depistage de la detresse et sur la facon d’aborder les preoccupations des patients. Cet article decrit les idees actuelles en matiere de detresse; explore la maniere dont le depistage de la detresse et les interventions pour la combattre font partie integrante de la pratique infirmiere en oncologie; partage les experiences et apprentissages initiaux d’infirmieres en cancerologie relativement a la mise en oeuvre d’initiatives de depistage de la detresse.

Book Review: Doane, G. H., & Varcoe, C. (2005). Family Nursing as Relational Inquiry: Developing Health-Promoting Practice. Philadelphia: Lippincott:

Family Nursing as Relational Inquiry is a compelling book. Enriched by numerous stories and learning activities and by the use of the first person voices of the authors, it explores the practice of family nursing from a relational perspective. As a textbook, the writing is informed by a commitment to constructive developmental pedagogy (Magolda, 1999), a pedagogy that commits to creating learning opportunities to address not only content but also the process of knowledge creation within everyday nursing practice. The chapters that follow are consistent with these goals, presenting practice in all its ambiguity and complexity. Features and learning activities include chapter notes, “try it out” and “this week in practice” activities to bring ideas to everyday life. Other major ideas are beautifully highlighted in stories and “to illustrate” sections, features that are particularly popular with the 3rd year undergraduate students with whom I have used the book as one option in a family nursing course. In chapter 1, informed by a pragmatic understanding of knowledge and truth, the reader is invited to consider any theory as “a” truth that may or may not be useful. Potentially problematic “habits of thought” that invite nurses to see certain things and not others are highlighted, revealing knowledge as socially constructed. In chapter 2, understandings of “family” are explored and the invitation is extended to consider family not in its literal form but as “a complex relational experience . . . where economics, emotion, context, and experience are interwoven and multi-layered” (p. 43). Common family theories such as structural–functional, developmental, and systems theories are briefly considered and discarded as being not very useful to relational family nursing practice. Instead, theories such as complexity, hermeneutic phenomenology, critical theories (feminist, postcolonial, and poststructural), and spirituality are offered as alternatives to the “grand” theories. Family is, thus, situated in a web of knowledges and understandings that include an appreciation of diversity, historicity, and power. Chapter 3 rounds out the first section of the book with an exploration of forms of knowledge and ways of knowing in nursing, drawing on Carper (1978) and others and highlights nursing theories in the human science Journal of Family Nursing Volume 13 Number 3 August 2007 385-387