80. Improving the Care of Adolescent and Young Adults (AYA) Oncology: Educational Programming for Pediatric Oncology Nurses

Abstract

Adolescent and young adult (AYA) cancer patients have needs unique from their pediatric or adult counterparts. AYAs with cancer experience demands of and strivings for age appropriate developmental tasks including identity formation, exploring sexuality and engagement in risk taking behaviors amidst cancer diagnosis and treatment. Providers often feel ill equipped to address the psychosocial needs of AYAs with cancer. This study aims to describe practices and comfort of oncology nursing staff in discussing adolescent health issues with AYA patients with cancer and the effects of an adolescent health educational in-service for pediatric oncology nurses. In the initial phase, a survey of pediatric oncology nurses caring for AYA patients with cancer was conducted at The Children's Hospital of Philadelphia. Participants were asked to recall interactions with AYA over the past 6 months and how often they discussed adolescent health issues including sexual health, mental health and substance use. Nurses' perception of their comfort discussing these topics with AYAs with cancer was also assessed via Likert scale. Then, nurses participated in a one-hour interactive in-service providing information on confidentiality, consent, body image, sexuality, mental health, risk taking behavior and transition to adulthood. Finally, a follow-up survey was obtained 3-6 months after in-service completion to assess changes in knowledge and comfort. In the initial survey, 109 nurses who had been working in pediatric oncology for an average of 6.5 years in both inpatient and outpatient settings, participated. Few nurses reported that they had had conversations with AYA patients about sexual health (17%), mental health (53%) or risk taking behavior such as substance use (21%) over the prior 6 month period, though the majority of nurses (77%) felt that nursing should have a role in discussing adolescent health issues with AYA patients with cancer. Fewer than half of nurses stated that they were comfortable discussing sexual health (26%), mental health (48%) or substance use (43%) with their AYA patients. More nurses were comfortable discussing body image (61%). Regarding sexual health, 36% of nurses acknowledged they are more likely to discuss sexual health with female patients and 84% stated they were most likely to discuss AYA issues with patients over 18 years in contrast to teenagers thirteen to eighteen. For the follow up survey, based on the responses of 47 nurses, a higher proportion of nurses reported feeling comfortable discussing sexual health (40%), mental health (72%), substance use (64%) and body image (77%). In addition, 89% of nurses who completed the follow up survey were familiar with the institutional policy for pregnancy testing for female cancer patients as compared to 60% before the intervention. Pediatric oncology nurses may not feel comfortable addressing routine adolescent health care issues with AYA patients with cancer. This study demonstrates the feasibility of educational in-services for subspecialty nurses to disseminate information on routine adolescent care and improve interactions with AYA. Future directions include development of educational programming for AYA cancer patients on general adolescent health issues.