Gail Mallory

Sleep wake disturbances in people with cancer and their caregivers: state of the science.

PURPOSE/OBJECTIVES To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.

Symptom clusters in adults with chronic health problems and cancer as a comorbidity.

PURPOSE/OBJECTIVES To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. DESIGN Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. SETTING School of Nursing at the University of Pittsburgh. SAMPLE The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. METHODS Analysis of existing comorbidity and symptom data collected from both studies. MAIN RESEARCH VARIABLES Symptom clusters, chronic disease, and cancer as a comorbidity. FINDINGS Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. CONCLUSIONS The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. IMPLICATIONS FOR NURSING Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.

Oncology Nursing Society year 2004 research priorities survey.

PURPOSE/OBJECTIVES To determine the Oncology Nursing Society (ONS) research priorities for 2005-2008 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, survivorship, and palliative care. DESIGN Descriptive, cross-sectional survey. SAMPLE Stratified into two groups: random sample of general membership (N = 2,205; responses = 287, or 13%) and all ONS active members in the United States with doctoral degrees (N = 627, responses = 144, or 23%); overall response rate was 15%. METHODS The 2000 survey was revised and updated. Postcards were mailed to the original sample (N = 1,605) prior to the launch of the online survey, inviting participation via an online or paper-and-pencil survey. An e-mail announcement of the survey was launched one week later, followed by reminders the following week. Because of low response rates, a second sample (N = 600) was selected and contacted. MAIN RESEARCH VARIABLES 117 topic questions divided into seven categories. Several items were new or reworded. FINDINGS The top 20 research priorities included 12 of the top 20 items found in the 2000 survey; 8 topics were new to the top 20. Priority topics were distributed across six of seven categories. When general membership results were compared to the doctoral sample, 10 topics were among the top 20 for both groups. Nine topics were top priorities in the 2000 (researcher) and 2004 (doctorally prepared) surveys. CONCLUSIONS Response rates to the electronic survey were lower than for previous paper-and-pencil surveys, but an adequate response was obtained. Rank order of mean importance ratings was determined by narrow differences in scores. The general membership and doctorally prepared samples showed similarities as well as differences in results. IMPLICATIONS FOR NURSING The 2004 survey results will inform the 2005 research agenda and assist the ONS Foundation and other funding organizations in distributing research funds.

Year 2000 Oncology Nursing Society Research Priorities Survey.

PURPOSE/OBJECTIVES To determine the Oncology Nursing Societys (ONSs) research priorities for 2001-2005 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, and palliative care. DESIGN A cross-sectional, mailed survey. SAMPLE Stratified by the general member group (i.e., a random sample of 1,850 ONS members) and researcher group (i.e., census of 150 ONS researchers). 788 responded for an overall response rate of 39%. MAIN RESARCH VARIABLES: 113 topics that were identified from the 1994 ONS Research Priority Survey questionnaire and earlier ONS Research Priority Surveys, with the addition of 20 new items to existing questionnaire categories and one new category area: health services research. FINDINGS Top 20 research priorities were distributed across six of eight questionnaire categories, and the number of top 20 priorities within categories differs. Compared to the 1994 survey, 9 topics were common to both top 20 lists; 8 were new to the top 20, and 11 dropped out of the top 20. When the researcher group and adjusted total sample group top 20 priority ratings were compared, nine topics were common to both groups. CONCLUSIONS Examining research priorities affords different perspectives to guide practice, education, research, management, and administration. IMPLICATIONS FOR NURSING ONS Research Priority Survey results provide an important foundation for developing future research across the entire scope of oncology nursing.

2008 ONS research priorities survey.

PURPOSE/OBJECTIVES To determine the priorities of oncology nursing research, including the effect of evidence-based practice resources as identified by the Oncology Nursing Society (ONS) membership in June 2008. DESIGN Descriptive, cross-sectional. SETTING A Web-based survey of ONS members. SAMPLE Stratified into three groups: a representative random sample of the general membership (n = 4,460, 421 responded), an over-sampled random sample of advanced practice nurses (n = 980, 149 responded), and all ONS members who were doctorally prepared (n = 589, 143 responded); 713 responded overall. METHODS The 2004 survey was revised and the new 2008 survey was beta tested. The invitation to complete the survey was sent via e-mail with a link to the survey Web site. A follow-up reminder was sent one week after the initial invitation. MAIN RESEARCH VARIABLES 70 oncology nursing research topic questions, divided into five categories, and two additional categories regarding ONS Putting Evidence Into Practice resources. FINDINGS Quality of life and pain were the two highest rated topics, consistent with 2000 and 2004 research priority survey findings. Eleven topics were new to the top 20 ranked priority topics in 2008. Differences in rankings were apparent between member groups. CONCLUSIONS The respondents represented the broad spectrum of ONS membership. Changes in topic rankings indicate that oncology nursing research priorities have shifted since the 2004 survey. The lag in research result dissemination to clinical practice may account for differences in topic rating between groups. IMPLICATIONS FOR NURSING The survey results will be used to develop the 2009-2013 ONS Research Agenda. The results also will assist the ONS Foundation and other funding agencies in setting priorities.

Priorities for oncology nursing research: The 2013 national survey

PURPOSE/OBJECTIVES To advance the goals of evidence-based care and prioritize the knowledge generation that addresses contemporary challenges in oncology nursing. Results are used to inform the development of the Oncology Nursing Society (ONS) Research Agenda and by the ONS Foundation to develop strategic research initiatives. DESIGN Descriptive, cross-sectional survey. SETTING Web-based survey. SAMPLE 8,554 ONS members from all levels of education. All doctorally prepared members were invited to participate. A random stratified sample was obtained from the remainder of the membership. METHODS The ONS Research Priorities Survey project team created the survey and analyzed and interpreted the results. Members received an email invitation and follow-up reminders for survey completion. MAIN RESEARCH VARIABLES Oncology nursing research and evidence-based practice topic questions. FINDINGS The response rate was 11%, which is comparable to previous surveys. Topics ranked included descriptive research on patient adherence; intervention studies to optimize adherence, achieve concordance with cancer screening guidelines in minority populations, manage neurologic and cardiovascular late effects, and manage symptoms and symptom clusters; and studies to identify optimal delivery models for survivorship care. These findings have direct implications for translating existing evidence into practice and underscore the need for intervention research focused on improving patient-centered outcomes. CONCLUSIONS Results provide a broad assessment of member views regarding oncology research priorities. Given the response rate, additional strategies to encourage member participation will be considered. IMPLICATIONS FOR NURSING The results, together with the updates of the ONS Research Agenda, can guide ONS and ONS Foundation research and evidence-based practice initiatives.

The 2014-2018 oncology nursing society research agenda

PURPOSE/OBJECTIVES To identify priority areas of research for the Oncology Nursing Society (ONS) Research Agenda for 2014-2018, consistent with ONSs mission to promote excellence in oncology nursing and quality cancer care
. DATA SOURCES Review of the literature, 2013 ONS Research Priorities Survey, National Institute of Nursing Research, and the National Cancer Institute research foci
. DATA SYNTHESIS Multimethod consensus-building approach by content leaders and content experts of the ONS Research Agenda Project Team
. CONCLUSIONS The 2014-2018 Research Agenda Project Team identified eight high-priority research areas: symptoms, late effects of cancer treatment and survivorship care, palliative and end-of-life care, self-management, aging, family and caregivers, improving healthcare systems, and risk reduction. In addition, four cross-cutting themes were identified: biomarkers, bioinformatics, comparative effectiveness research, and dissemination and implementation science. IMPLICATIONS FOR NURSING The Research Agenda is a synthesis of the state of the science in cancer and identifies gaps and directions for the conduct and dissemination of research. Oncology nurses can use the agenda to inform clinical practice, develop research proposals, inform policy makers, support interdisciplinary research efforts, and promote scientist and clinician collaborations in targeted patient-centered research
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Setting the bar: developing quality measures and education programs to define evidence-based, patient-centered, high-quality care.

In 2008, the Oncology Nursing Society (ONS) initiated a multi-year project to develop and test quality measures in areas judged by oncology nurses as high-priority opportunities to improve quality of life for patients across the cancer continuum, and to provide education to oncology nurses on how to achieve high-quality care. Supported through a grant to the ONS Foundation by the Breast Cancer Fund of the National Philanthropic Trust, two teams of expert nurses convened to review the literature and draft potential measures that are considered important to providers and patients, are high-volume, high-impact issues, and are supported by strong clinical evidence linking high-quality care processes to improved outcomes. The ONS Foundation contracted with the Joint Commissions Department of Quality Measurement to combine its measure-development experience with ONSs ambulatory oncology perspective to create a reproducible testing process. A third project team designed and implemented a series of 10 regional education workshops illustrating the use and benefits of quality measurement in clinical care.

Development of an evidence-based, patient-centered breast cancer chemotherapy and survivorship quality measures (QM) by the Oncology Nursing Society (ONS).

273 Background: QM focused on areas illustrating high-quality cancer care valued by nurses and patients are needed to complement existing measures in the ambulatory oncology setting. ONS has utilized a reproducible process for pilot testing two sets of evidence-based QM for validity and reliability in the breast cancer population, drawing on evidence from ONS Putting Evidence into Practice (PEP), Institute of Medicine (IOM) recommendations and other resources. METHODS The ONS Foundation supported teams of expert nurses to review evidence, draft and prioritize topic areas for potential QM. Final QM were selected after soliciting national public comment from stakeholders, and were judged on importance to clinical care, prevalence and potential for impact, scientific basis and link between process and outcome. The Joint Commission (TJC) was contracted to conduct testing, and diverse pilot sites were recruited to perform retrospective data abstraction on patient charts. The Breast Cancer Care (BCC) QM set focused on symptom management for patients receiving chemotherapy, and the Breast Cancer Survivorship (BCS) set explores needs in the first year post-treatment. TJC and ONS staff co-managed development of QM specifications, abstractor training, clinical and technical support of pilot sites, and re-abstracted 15% of 2,835 submitted cases for reliability testing. RESULTS QM scores were examined for gaps in care; there are clear opportunities to improve the consistency of symptom assessment and management. Symptom intensity, trajectory over time, success/failure of interventions are frequently undocumented, impacting coordination of care. Post-treatment/transition to survivorship education and resource provision as recommended by the IOM are lacking. CONCLUSIONS Audit and feedback to practices using valid and reliable QM provide a strategy to link high-level evidence-based interventions and practice changes to improve quality cancer care. National testing across diverse practice sites illustrates a strong need to improve the consistency of symptom assessment/management and post-treatment survivorship interventions.