Debra Bakker

Utilization of professional supportive care services by women with breast cancer

This paper reports on the results of a survey of utilization of professional supportive care services by women with breast cancer, and on patterns of differential service utilization by sub-groups of patients. Study participants were women with invasive breast cancer diagnosed 23–36 months prior to contact about the study, and randomly selected from the Ontario Cancer Registry. From among 1,119 eligible women sent survey questionnaires, 731 returned completed questionnaires (65%). A total of 31% of respondents reported accessing one or more of the following professionals: social worker, psychologist, psychiatrist, dietitian, physiotherapist. Among those who responded to a question about whether they would have liked specific services, 34% reported that there was at least one professional supportive care service they would have liked to use, but were unable to access. Factors shown to be related to greater utilization of services included: younger age, higher household income, employed or student status, private health insurance coverage, and having received chemotherapy. Overall, there was a surprisingly low utilization of professional specialized supportive care services among women with breast cancer. Policy implications include finding strategies to better inform cancer patients about existing services, and ensuring that a core set of services are available to all patients.

Core Domains for a Person-Focused Outcome Measurement System in Cancer (PROMS-Cancer Core) for Routine Care: A Scoping Review and Canadian Delphi Consensus

OBJECTIVES The objectives of this scoping review study were 1) to identify core domains and dimensions for inclusion in a person-focused and self-reported outcome measurement system for cancer and 2) to reach consensus among key stakeholders including cancer survivors on the relevance, acceptability, and feasibility of a core outcome set for collection in routine clinical care. METHODS Following a scoping review of the literature, a Rand Delphi consensus method was used to engage key interdisciplinary decision makers, clinicians, and cancer survivors in reaching consensus on a core patient-reported outcome domain taxonomy and outcome measures. RESULTS Of the 21,900 citations identified in the scoping review, 1,503 citations were included in the full article review (380 conceptual articles, 461 psychometric evaluation articles, and 662 intervention studies) and subjected to data abstraction and mapping. Final consensus was reached on 20 domains, related subdimensions, and 45 self-report measures considered relevant and feasible for routine collection in cancer by the Delphi panel (PROMS-Cancer Core). CONCLUSIONS Standardization of patient-reported outcome data collection is key to assessing the impact of cancer and treatment on the person for population comparison and monitoring the quality of clinical care. The PROMS-Cancer Core taxonomy of domains and outcome measures can be used to guide the development of a patient-reported outcome information system for cancer.

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

BackgroundManagement 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.MethodsA 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.DiscussionGiven 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.

The Context of Oncology Nursing Practice An Integrative Review

Background: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. Objective: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how “context” has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. Methods: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. Results: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses’ work, and interactions and relationships) of oncology nursing practice settings. Conclusions: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. Implications for Practice: The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Facteurs influençant la satisfaction professionnelle des infirmières en oncologie au fil du temps

Dans cette etude, nous avons mis a l’epreuve un modele d’equations structurelles en vue d’examiner les facteurs associes au milieu de travail en relation avec les changements touchant la satisfaction professionnelle des infirmieres en oncologie entre 2004 et 2006. Le leadership relationnel et une bonne relation medecin-infirmiere influencaient constamment les perceptions quant a la presence d’un nombre suffisant d’infirmieres pour fournir des soins de qualite et quant a la liberte de prendre des decisions a propos des soins des patients, ce qui influencait directement a son tour la satisfaction professionnelle des infirmieres au fil du temps. Le soutien des superviseurs en matiere de resolution de conflits et la capacite a influencer les resultats pour le patient constituaient des influences significatives sur la satisfaction professionnelle en 2004, tandis qu’en 2006, une philosophie claire des soins infirmiers revetait une plus grande importance. Plusieurs facteurs exercant une influence sur la satisfaction professionnelle des infirmieres en oncologie du Canada ont evolue au fil du temps, ce qui peut refleter des changements sur le plan des milieux de travail et de la vie au travail. Ces resultats proposent des pistes pour la modification des conditions de travail qui pourraient rehausser la satisfaction professionnelle et la vie au travail des infirmieres. Mots cles : satisfaction professionnelle, soins infirmiers en oncologie, relation medecin-infirmiere, modelisation par equation structurelle