Denice Economou

Oncology Nurse Participation in Survivorship Care

Oncology nurses play an important role in the provision of survivorship care. Using report recommendations from the Institute of Medicine, nurses provide quality cancer care based on the specific characteristics of individual healthcare settings and the populations they serve. As part of the planning process, the evaluation of a settings resources and goals for desired survivorship activities can make the difference between success and failure. Collaborating with local and national resources for cancer survivors can help expand a settings services in an efficient and cost-effective manner. Models of care vary, and resources and communication differ among settings; as a result, survivorship care changes across models. Nurses are critical to implementing survivorship activities and facilitating communication among healthcare providers, patients, and caregivers. In addition, nurses significantly contribute to the dissemination and coordination of information between patients and healthcare providers.

Preparing professional staff to care for cancer survivors

IntroductionOncology health care professionals frequently lack the background to implement needed survivorship activities and follow-up care. The purpose of this project is to assist providers in the clarification and initiation of potentially durable changes in survivorship care by developing a health professional curriculum, recruiting participants, implementing the course, conducting course evaluation and following participants’ defined goals over time.Materials and methodsThe curriculum was developed based on recommendations from the Institute of Medicine Report-From Cancer Patient to Cancer Survivor—Lost in Transition. Three concepts were used to structure the course: cancer survivorship quality of life, changing practice via performance improvement, and principles of adult education. Expert faculty designed and implemented the curriculum and teaching methods using adult learning principles and an interactive approach. Competitively-selected, two-person interdisciplinary teams for the first course (July 12–15, 2006, Pasadena, California) were selected based on stated interests, three projected goals, and letters of commitment from administrators.ResultsParticipants represented 52 cancer care settings from 28 states. Teams included Nurses (48.1%), Social Workers (20.7%), Physicians (18.8%), Directors/Administrators (6.6%), Psychologists (2.8%), and others (3%). The institutional barriers identified by teams were lack of survivorship knowledge (94 %), financial constraints (61%), lack of administrative support (6%), and staff philosophy that excluded survivorship (15%). Evaluation of content from the first course was consistently positive.ConclusionsDissemination of survivorship education for health care professionals stimulates participants to define and begin to implement goals for improving survivors’ care.Implications for cancer survivorsA training program such as the one described provides professional knowledge regarding survivorship that has the potential to facilitate change in the health care that cancer survivors receive thus ideally improving long term health and well being.

Spirituality in cancer care at the end of life.

There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress.

Integrating a cancer-specific geriatric assessment into survivorship care.

Older adults constitute the greatest percentage of cancer survivors in the country, with 61% being aged 65 years and older. Assessing older adult cancer survivors beyond chronological age to include changes in functional status is an essential process to help nurses anticipate cancer treatment impact and aid in planning individualized survivorship care. The objective of this article is to identify a method to assess older adult cancer survivors to be used in tailoring survivorship care. A review of geriatric literature was conducted through MEDLINE(®) and PubMed from 1997-2011 and focused on the pathophysiology of aging, cancer impact, and comorbidities in this population. Results were combined with previous research to provide an evidence-based approach to assessing older cancer survivors. The resulting assessment provides valuable information on the functional status of older adult patients with cancer. This assessment can be used by nurses to develop treatment plans and tailor management strategies to improve quality of life.

Building a Critical Mass of Health-Care Providers, Administrators, and Services for Cancer Survivors

To build a critical mass of health-care providers, administrators, and services for cancer survivors, education about cancer survivorship and multidiscipline involvement in survivorship care activities is the initial and essential step. One cannot practice what one does not know. This education is most successful when developed by those with educational expertise. This chapter focuses on the initial definitions needed to begin an educational program in cancer survivorship care, approaches to define the content or curriculum needed, approaches to conducting educational needs assessments, how to formulate educational objectives, how to identify appropriate teaching methods, and will end with approaches to evaluations. Examples focused on cancer survivorship care are provided throughout.

Survivorship Care Planning and Quality of Life

Roughly 436,000 survivors are living with a history of head and neck cancer (HNC), accounting for approximately 3% of all cancer survivors in the United States [1, 2]. With advances in treatment, long-term survival is increasingly common in HNC populations. Despite increasing awareness of survivorship issues, many challenges remain. These include lack of knowledge on late and long-term effects of treatment, and poor integration of survivorship care guidelines into oncology practice. Survivorship care plans (SCPs) are increasingly important for HNC survivors to improve quality of long-term survival. Quality survivorship care should focus on management of late and long-term effects of treatment, surveillance for cancer recurrence and second primaries, promotion of healthy lifestyle, and care coordination between providers. This chapter will describe common quality of life (QOL) issues in HNC survivorship, and review the current survivorship care guidelines in HNC.

Nurse Education and Survivorship: Building the Specialty Through Training and Program Development

BACKGROUND: As the number of cancer survivors in the United States continues to grow, the need to educate healthcare providers in the components of survivorship care remains a challenge in the current healthcare system. Survivors have unique concerns and follow‐up requirements that are key to minimizing their risks for recurrence and supporting quality of life. OBJECTIVES: This article describes the impact of the curriculum, faculty, and teaching methods for an educational program to prepare nurses to provide cancer survivorship care. METHODS: Mixed methods with quantitative and qualitative approaches were used. FINDINGS: Course content and faculty received high scores in the evaluations. Analysis of the most common goals implemented by participants after the course focused on providing professional education, planning the process for survivorship care, and implementing treatment summaries and survivorship care plans.

Challenges in the implementation of survivorship care plans in an NCI-designated cancer center.

68 Background: The development and initiation of Survivorship Care Plans (SCPs) across all disease sites was identified as a Strategic Initiative Goals for 2015 by the Clinical Cancer Committee. The 2012 Commission on Cancer requirements for certification provided an additional incentive to meet this goal. Establishing a process that includes the development and distribution of a SCPs within the electronic medical record (EMR) is necessary to improve on the completion of SCPs and to improve the utilization of surveillance tests in cancer survivors. We describe the process developed at a free-standing NCI cancer center to meet the standard of SCP provision to all cancer patients. METHODS A multi-disciplinary subcommittee of the Cancer Committee was designated to develop the overall strategic plan for the implementation of this standard. It met with disease teams to facilitate a treatment summary from Cancer Registry data, identify patient reported symptoms using a self report tablet (SupportScreen). Electronic care plans were created using survivorship research program templates and ASCO framework for each disease site team. The disease team Nurse Care Coordinator inputs information into the eSCP. RESULTS Templates have been established within the EMR in the documents section under survivorship care plan title. These can be initiated and modified when the Nurse Care Coordinator chooses to start them. The disease teams have established their time points for SCP presentation to their patients. Using the cancer registry to provide data related to staging, treatments and genetic testing has helped minimize development time. Individual survivors concerns will be reflected in patient reports and physician symptom documentation. This eSCP completion process is a pilot program within the breast cancer disease team and will be expanded to include patients with head & neck and hematologic malignancies with a goal of including all patients by mid 2016. CONCLUSIONS The goal of improving survivorship care coordination and compliance with surveillance guidelines is challenging. Maximizing available interdisciplinary resources has helped to create a viable Survivorship Care plan at our institution.

Preparing nurses for cancer survivorship care.

27 Background: Although the 2006 IOM report on Cancer Survivorship calls for the education of health professionals, few formal programs have been instituted and evaluated. This NCI R25 grant focused on the preparation of nurses to provide comprehensive survivorship care. The program included didactic and interactive sessions, as well as goal development focused on plans for implementation of survivorship activities post course. This abstract will describe the goal analysis at 6, 12, and 18 months post course provided by the 113 nurses in the first two courses. METHODS Goals focused on survivorship activities to be implemented at the home institution/practice. Goals were coded using the results-based S.M.A.R.T. framework and they could have more than one code if they reflected multiple activities. Goal achievement was measured using a 5 point scale with 0 = never started, 1 = stopped or cancelled, 2 = Stalled, 3 = In Process or 4 = Completed at 6, 12 and 18 months post course. RESULTS A total of 403 goals were coded for the first 2 courses. The most frequent goal for both courses was Professional Education (23.1%, 21%). The second most frequent goal was -Institution of Survivorship Care (13%, 9.8%). The third most frequent goal for Course 1 was Evaluation of Survivor Needs. For course 2 the third most frequent goals were Evaluation of Survivor Needs and Team Development. Goal achievements for course 1: 70% completed or in process, 4.4% stalled or stopped and 25% never started. Course 2: 62% completed or in process, 18.3% stalled or stopped and 20% never started. CONCLUSIONS While participants from our 2 first courses represented a variety of academic and community settings, their goals were quite similar and reflected the basic need for staff education and plans for clinical services. Barriers to success were met by approximately 29% of the participants in Course 1 & approximately 38% in Course 2. These data demonstrate that Survivorship remains in the early stages as a formal period of care and ongoing development of experts/resources continues to be needed. Identification of barriers and facilitators to address them is critical.