Margaret I. Fitch

Rehabilitation following cancer treatment.

Abstract Purpose: Cancer survivorship is increasing. However, life-saving treatments often leave people with physical, cognitive and emotional sequelae that contribute to activity and participation limitations. The purpose of this review is to summarize current evidence regarding rehabilitation interventions to address problems during survivorship. Method: Best evidence synthesis. The review took as its starting point a systematic review of patient needs and supportive care interventions following cancer treatment. The study team identified the needs which could be addressed by rehabilitation and suggested others not originally included. Then they built on the earlier review’s conclusions regarding effective intervention through extraction of results from subsequent systematic reviews and randomized controlled trials. Results: Evidence regarding the effectiveness of potential rehabilitation interventions was reviewed for physical functioning, fatigue, pain, sexual functioning, cognitive functioning, depression, employment, nutrition and participation. With the exception of physical rehabilitation interventions following breast cancer, this literature tends to focus on psychoeducational interventions, which have demonstrated limited effectiveness for rehabilitation outcomes. Conclusions: Most of the knowledge available regarding potential rehabilitation interventions comes from psychosocial oncology literature. While there are limitations, this literature provides an excellent starting point to examine the potential effectiveness of rehabilitation interventions within cancer survivorship programs. Implications for Rehabilitation Good evidence exists for the use of exercise/physical rehabilitation in reducing fatigue after treatment for most cancers, and improving upper extremity functioning following treatment for breast cancer. Preliminary evidence exists in a number of areas that may be improved by rehabilitation interventions, such as pain, sexual functioning, cognitive functioning and return to work, but further research is needed. No intervention studies addressing participation limitations were identified. Rehabilitation professionals are encouraged to take the lead in exploring participation limitations among cancer survivors and developing suitable interventions.

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

OBJECTIVESnThe 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.nnnMETHODSnFollowing 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.nnnRESULTSnOf 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).nnnCONCLUSIONSnStandardization 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.

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

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.