Cancer Nursing Research Articles

Characteristics by Age Groups of Difficult Cases Recognized by Nurses in Cancer Nursing for Adolescents and Young Adults

Characteristics by Age Groups of Difficult Cases Recognized by Nurses in Cancer Nursing for Adolescents and Young Adults

Implementing a web-based system of screening for symptoms and needs using patient-reported outcomes in people with cancer

To evaluate the implementation of a web-based system of screening for symptoms and needs in people with diverse cancers in a general hospital in Australia. This was a prospective, single-arm, pragmatic intervention study. After local adaptation of an online portal and training, cancer nurses were asked to register patients to screen via the portal in clinic or at home. Symptoms were scored according to severity, and scores above cut-off were reported to nurses for assessment and management, according to best practice. Fifteen nurses working across diverse tumour types agreed to approach patients for screening. Of these, 7 nurses approached 68 patients, with 5 approaching more than 1 during the 7-month study period. Forty-seven (69%) patients completed screening, and 22 rescreened at least once. At first screening, 33 (70%) patients reported at least one symptom, most commonly tiredness (n = 27; 57%), reduced wellbeing (n = 24; 51%) and drowsiness (n = 17; 36%). Of the total 75 screens undertaken during the study, 56 (75%) identified at least one symptom, and 22 (29%) identified at least one severe symptom. All patients with a positive first screen were followed up by a nurse assessment and intervention-mostly reassurance (n = 19, 59%) or referral to another health professional (n = 11, 34%). Screening for symptoms and needs using a web-based portal identified many unmet needs, but the uptake of this intervention by nurses and patients was lower than expected.

Coproducing and Implementing Person-Centered Key Performance Indicators in Ambulatory Cancer Nursing.

Policy advocates person-centered healthcare for people living with cancer. Although nurses and patients alike recognize that a good care experience cannot be measured solely by clinical outcomes, the difficulty in finding indicators that measure the delivery of effective person-centered care remains a challenge. The aim of this study was to explore the impact of a coproduced implementation project using the person-centered nursing key performance indicators to support the development of person-centered practice across ambulatory chemotherapy units. The study adopted an evaluation approach derived from work of the Medical Research Council. A mobile app was used to collect and analyze 3 cycles of data using 4 measurement tools, with the aim of informing quality improvement activities. Six implementation teams were recruited from chemotherapy units across a region in the United Kingdom. Qualitative interviews were used to evaluate the experience of participants. Data analysis revealed 4 themes: building relationships that nurture the care experience, inspiring nursing staff to flourish, shaping practice and service changes through the nature of the conversations, and becoming person-centered through coproduction. This study provides evidence of the value of implementing these person-centered key performance indicators using a model of coproduction in cancer nursing. The data generated by the key performance indicators offer valuable feedback to nurses that can inform the development of person-centered practice and contribute to an enhanced patient experience. This study provides an innovative and transferable approach for implementing relevant and appropriate key performance indicators within cancer nursing, which can contribute to developing person-centered cultures.

Information needs in patients with bladder cancer undergoing radical cystectomy - A qualitative review with thematic synthesis.

Worldwide, bladder cancer is the eleventh most common cancer. Self-care is significant after surgery and optimal information needs to be individualized. This will help the patient to understand and become involved in their own care. This study investigated experiences of information needs in patients with bladder cancer undergoing radical cystectomy. A qualitative review study with a thematic synthesis according to the PRISMA Statement Guidelines was performed. Thirteen peer-reviewed original articles were included. This review highlighted that patient experienced unmet information needs about postoperative care and self-care. Patients also experienced receiving too much information in a limited time. This led to difficulties in understanding and processing the information. Patients also experienced limited information about sexual and psychological support and requested more information about physical activity. Information is essential but needs to be adapted and based on person-centred care principles related to the patients' needs and wishes. Unmet needs impact patients' lives and are associated with misunderstandings and insecurity, which need to be considered in cancer nursing. The review was not registered.

Nursing Leaders as Visionaries and Enablers of Action

ObjectivesThe engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future. Data SourcesAuthor experience, journal articles and organizational position papers were used. ConclusionTo improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management. Implications for Nursing PracticeNursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

Burnout, coping and resilience of the cancer care workforce during the SARS-CoV-2: A multinational cross-sectional study.

PurposeOver the past year, the SARS-CoV-2 pandemic has significantly increased the demand placed on health care professionals around the world. The already complex cancer care has been complicated further by the restructuring of services (e.g., working processes, treatment allocation). This study was designed to explore the level of burnout, coping and resilience of the cancer care workforce during SARS-CoV-2.MethodsCross-sectional, multinational study undertaken between March–May 2021. In total 271 healthcare professionals were recruited in the study. These were specialized and/or working in the oncology sector from around the globe. Data were collected with an online survey with the Connor-Davidson Resilience Scale, Brief-COPE (Coping Orientation to Problems Experienced) Scale and The Maslach ‘s Burnout Inventory.ResultsThe majority of the participants were cancer nurses followed by oncologists. The mean overall Burnout score was 64.86 (SD 17.15), the overall COPE score was 31.72 (SD 12.39) and the overall Resilience score was 69.48 (SD 12.4). Positive correlations were found between the COPE dimensions and the burnout overall score (0.316, 0.388, 0.398). The burnout overall score was negatively correlated with the resilience score (p −0.126).ConclusionThe findings showed significand levels of burnout, diminished coping abilities and reduced resilience among cancer care professionals. This study emphasizes the need for a timely and appropriate preparation of the healthcare systems to better support cancer care professionals in the event of a new SARS-CoV-2 healthcare emergency.

Roles and practices of specialist lung cancer nurses: a scoping review protocol.

The objective of this scoping review is to map the available literature on the specialist lung cancer nurse role. The international literature acknowledges the importance of specialist cancer nurses who provide supportive care to patients. Historically, however, there has been a lack of consistent evidence to inform development and implementation of the role. This review will consider quantitative and qualitative studies of any design or methodology that report on role characteristics or behaviors, practices or activities, or other aspects of the specialist lung cancer nurse role in the acute care setting. Systematic reviews, professional body reports, as well as unpublished or published studies and reports will also be considered for inclusion. Textual or opinion papers will be excluded. This review will follow JBI methodology for scoping reviews. Relevant papers from 2006 to 2022, in any language, will be searched for in the following databases and registries: MEDLINE (PubMed), CINAHL (EBSCO), Web of Science, Embase, and the Cochrane Register of Controlled Trials. Websites to be searched will include the World Health Organization, International Council of Nurses, and Agency for Healthcare Research and Quality. ProQuest Dissertations and Theses (ProQuest) and Grey Matters (CADTH) will be searched for unpublished literature. Results will be presented in tabular and narrative format and mapped according to the specified concepts of interest, as well as to the domains of practice for specialist nursing roles.

Impact of Covid-19 on lung cancer and mesothelioma specialist nurses: A survey of experiences and perceptions.

PurposeThe covid-19 global pandemic has impacted on nurses who have rapidly adapted to new ways of working, and experienced negative impacts due to over-stretched services. Two surveys captured the experiences of lung cancer and mesothelioma specialist nurses in the United Kingdom (UK) in 2020, but the impact of later stages of the pandemic was unknown. This study aimed to explore the impact of covid-19 on lung Cancer and mesothelioma nurses since January 2021, the second wave of the pandemic.MethodsAn online cross-sectional survey with both open and closed questions explored the impact of covid-19 on ways of working and workload, quality of care, and health and wellbeing. The survey was open to UK based lung cancer and mesothelioma advanced or specialist nurses.Results85 nurses responded to the survey. The majority were Clinical Nurse Specialists, based in England. Respondents reported changes in ways of working due to redeployment, staff shortages, and home working. Widespread adoption of virtual working practices led to concerns of negative impacts. Perceived excessive workload impacted on care with two-thirds of the sample (57, 67%) reporting they had been unable to provide the same quality of care to patients. Impacts on nurses’ health and wellbeing were reported with two-thirds of the sample (56, 66%) reporting a deterioration in emotional wellbeing and mental health. Coping mechanisms employed included online team support to share experiences and increased uptake of exercise; however, impacts on lifestyle and access to coping mechanisms varied.ConclusionNurses have stepped up to the challenges of the pandemic with teamwork and innovation, but pressure arising from the pandemic and high workloads led to negative impacts on wellbeing. The authors have provided recommendations to improve patient care and support the wellbeing of nurses, which will be key to a resilient workforce living with covid-19. Whilst this study focussed on lung cancer and mesothelioma specialists, the findings have wider implications for other cancer specialties.

"I'm not being serviced; I'm being cared for": A mixed methods study of patients' and nurses' perceptions of community oncology nursing delivered by a Community Intervention Team.

Many patients do not have access to community oncology nursing care in a primary setting and are completely reliant on tertiary hospital care. The aim of this study is to gain an understanding of oncology patients' and nurses' perceptions of community oncology nursing, delivered by an urban Community Intervention Team (CIT) in Ireland. A descriptive, concurrent mixed methods approach was used which included semi-structured interviews with 14 oncology patients and an online survey of 27 hospital and community nurses. Thematic analysis and descriptive statistics were used to analyse the data. Six broad themes captured patients' views. Right care related to patients' satisfaction with the range of care available. Right place reflected positive views of the physical setting and the option for homecare for those that needed it. Right time represented patients' comments about the increased appointment efficiency, flexibility, and availability of the service out-of-hours, compared to hospital-based care. Right people was based on patients' portrayals of community cancer nurses as professional, confident, friendly, reassuring and relatable. Integration and communication reflected the communication between the services and patients' impressions of how the services were integrated together. The last theme was improvements to the CIT service. Hospital nurses reported satisfaction with the CIT service while CIT nurses responses suggest the need for better communication with hospital partners. Patients had positive perceptions of the service provided by the CIT. Both hospital and community cancer nurses were satisfied with the service and reported that they would like to see an expansion of community oncology nursing services delivered by the CIT.

The need to protect cancer nurses from exposure to hazardous drugs.

Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in May 2022 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.

Using a cognitive framework with nurses to manage stress.

Nursing can be a stressful occupation with many nurses struggling to cope with stress on a day-to-day basis. Considerable evidence suggests that positive coping strategies can be an effective part of stress management education programs. This article describes the theoretical rationale for a cognitive framework for stress management that was developed as part of a well-being educational program for cancer nurses. This framework included an associated mnemonic (www.pst) to assist in the recall and utilization of positive coping strategies. The stress management framework was intended to increase nurses' perceptions of personal control which is central to stress management. The academic coping literature is complex, jargon laden and often conceptually abstract, and may not easily be understood by a nonacademic audience. The cognitive framework described here is an evidence-based, user-friendly tool that could be used and evaluated by counsellors, educators, and researchers in different settings.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BackgroundAlthough videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.ObjectiveThis study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).MethodsIn this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.ResultsMost patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.ConclusionsPerson-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.International Registered Report Identifier (IRRID)RR2-10.2196/27940

Australian cancer nurses' experiences of burnout: Exploring the job demands and job resources of metropolitan cancer nurses during 2019-2020.

Existing studies that seek to understand nurses' experiences of burnout are dominated by cross-sectional, quantitative survey designs employing predetermined measures, often overlooking important job-related stressors that can be highly dependent on industry and professional contexts. Cancer nurses are a group of professionals who warrant special attention, as burnout in this profession is often attributed to high job demands and the challenge of caring for a vulnerable cohort of patients. A deeper understanding of the job demands associated with cancer nursing is required to provide insights about the work experiences of cancer nurses and identify aspects that mitigate burnout and stress. This study describes the antecedents of burnout among Australian cancer nurses by focusing on the demands and resources inherent in their work. We aim to build on the existing literature by identifying job resources that may serve to mitigate the antecedents of burnout. An in-depth interview study of cancer nurses across a spectrum of age and experience in Australian metropolitan public health care services was conducted over a 2-year period that coincided with the COVID-19 pandemic. The job demands and resources model framed this study of job-related factors associated with burnout and conversely job resources that may foster work engagement. Patient aggression, workload, emotional demands, and abusive peers and managers were reported as distinct job demands, whereas job significance and supportive peers who demonstrated leadership, along with task variety, were identified as job resources. Australian cancer nurses work in an environment where job demands are increasingly disproportionate to job resources, leading to significant risk of burnout. Our study identifies modifiable strategies for improving work conditions for this group who play a critical role in the health care system.

CN47 Future-proofing the Irish Association for Nurses in Oncology: Identifying the professional and educational needs of members

The Irish Association for Nurses in Oncology (IANO) was established 40 years ago when specialist cancer nursing was in it's infancy in Ireland. The IANO supports cancer nurse education and provides opportunities for professional development. The IANO is structured into Regional Networks and Special Interest Groups. Cancer nursing has evolved significantly over the past few decades, and the education and professional development of Irish cancer nurses may have changed. Therefore, the IANO conducted a survey in 2021 to establish the professional needs of members so to identify areas for development within the organisation.

CN35 Workplace violence against cancer nurses during the COVID-19 pandemic: A correlational-predictive study

Workplace violence (WPV) impacts negatively both healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to WPV. This study aimed to describe the WPV against nurses and its predictive factors in oncology settings during the COVID-19 pandemic in Italy.

The effectiveness of nurse-led interventions for cancer symptom management 2000–2018: A systematic review and meta-analysis

• Cancer nurses are concerned with helping patients cope with common symptoms during cancer, either because of the disease itself or its treatment. • Novel nurse-led interventions provide benefit and usually have focused primarily on troublesome symptoms that impact negatively on people’s lives. • Reporting of novel symptom interventions should be strengthened, with outcome measures, duration of effect and component details made clearer. • This meta-analysis demonstrates the importance of new cancer nursing interventions and their contribution to supportive cancer care. Evidence for effectiveness of nurse-led interventions for cancer-related symptoms is of variable quality. This study aimed to identify, appraise and evaluate the nature and effectiveness of nurse-led interventions on symptoms for people with cancer. A systematic review and meta-analysis. Ten major databases were searched (2000 to 2018, no language restrictions). Two reviewers applied a priori selection criteria; data extraction included design, population, cancer type, and cancer-related symptoms. Interventions and providers were profiled using TIDieR reporting guidelines, and content analysis of components. Methodological quality was assessed using Cochrane risk of bias. A meta-analysis was performed using mean and standardised mean differences with 95% confidence intervals. Overall certainty was assessed using GRADE. From 29193 records, 149 studies ( n = 107286 participants) from 22 countries were eligible. Interventions included multiple components; education and psychological approaches dominated. Pooled meta-analyses found evidence of benefit for nurse-led interventions on measures of constipation (MD −4.54, 95% CI −8.08 to −0.99; 645 participants; 6 trials; I 2 = 0%; P = 0.01); nausea and vomiting (MD −1.97, 95% CI −3.61 to −0.33; 957 participants; 8 trials; I 2 = 12%; P = 0.02) and fatigue (MD −4.63, 95% CI −7.97 to −1.30; 1208 participants; 11 trials; I 2 = 34%; P = 0.007). Psychological morbidity (anxiety, depression, mood) also improved. However, few trials used consistent outcome measures, interventions were poorly defined, and certainty of evidence was low or very low. Nurse-led interventions improve specific cancer-related symptoms, including psychological morbidity. Enhanced reporting and collaboration to develop a minimum core dataset would strengthen the quality of evidence.

CN41 Comparison of professional quality of life, empathy and emotional intelligence in cancer health care professionals: A study of cancer nurses, radiation therapists and oncologists

Professional Quality of Life, that is compassion satisfaction (CS) and compassion fatigue (CF), is experienced by cancer health care professionals (HCP) as they are exposed to the distress and suffering of patients with cancer. Cancer HCPs use both emotional and cognitive empathy and aspects of emotional intelligence in their interactions with patients. This study was the first to examine the relationships between professional quality of life, empathy and emotional intelligence, and compare these constructs between cancer nurses, radiation therapists and oncologists.

CN37 Patient and public involvement in research: Reflections and experiences of doctoral cancer nurse researchers in Europe

Patient and public involvement (PPI) means doing research with the patient or members of the public wherein they contribute to research design, conduct and dissemination. Evidence shows the need for guidance about PPI among early career researchers. Our discussions about PPI during a doctoral workshop showed differences in our PPI experiences and the support we received. This motivated us to share our reflections and experiences to highlight gaps in PPI training and support. Between September to November 2021, cancer nurses from seven European countries who attended a doctoral workshop delivered by the European Oncology Nursing Society submitted written reflections of their experiences of PPI within the context of their doctoral research. Ten written reflective pieces were inductively analysed using reflexive thematic analysis to generate initial themes. Audio-recorded focus groups (n=2) with four to six participants were conducted. Focus group data was deductively analysed using the initial themes as framework. Final themes were identified following interpretation and several discussions, until consensus was reached. Four themes were identified in the analysis: (a) evolving recognition and appreciation of PPI, (b) embracing PPI and impact on doctoral studies, (c) the influence of the research environment, and (d) the need to empower doctoral students to integrate PPI in their research journey. Factors such as training, level of support, available funding, and research environment influenced doctoral researchers’ awareness and experiences of PPI . Varying experiences of PPI awareness was noted across Europe showing disparity in guidance about PPI for early career researchers. We recommend provision of early PPI training for doctoral students to support and encourage involvement of patients and the public in their research. Opportunities for sharing PPI experiences to help improve PPI culture in research environments that support doctoral students should be explored.

CN32 Cancer nurses' experiences and perceptions of potential occupational exposure to cytotoxic drugs: Systematic review utilising framework analysis

In the UK control of substances Hazardous to Health Regulations (COSHH) define chemotherapy as a hazardous substance. Therefore, it is imperative that employers assess the risk and take suitable precautions for their employees. The ‘Safe Handling of Cytotoxic Drugs in the workplace’ recommends a hierarchy of protection; closed systems and personal protection equipment (PPE) to reduce the exposure to cytotoxic drugs. In the UK, closed systems are not mandatory, and the evidence base for use is inconclusive.

CN43 Addressing the professional and educational issues for the cancer nursing and allied health professions workforce: A collaborative, strategic, UK-wide approach

Cancer will affect 1 in 2 of us during our lifetime. Never has the time to focus upon the cancer workforce been more critical. The importance of developing the cancer workforce has been emphasised globally, within Europe and the United Kingdom (UK). However, within the UK, there is no nationally defined career pathway or agreed overarching competency framework for cancer nurses and the allied health professionals across the spectrum of the cancer workforce. A multi partnership collaboration within the UK , including Health Education England (HEE), Macmillan Cancer Support, UK Oncology Nursing Society (UKONS) and the Royal College of Nursing (RCN), has developed the Aspirant Cancer Career and Education Development programme (ACCEnD). ACCEnD provides guidance regarding the knowledge and capabilities required by the nursing and allied health professional workforce to care for people affected by cancer. An overarching career pathway and education framework for nursing and the allied health professions has been developed. To support the implementation of the framework, four workstreams, ranging in focus from pre-registration to strategic leadership, provide guidance on the learning, development and educational needs and resources required to support the workforce throughout their cancer career. Finally, ACCEnD includes the development of a digital portfolio incorporating the framework to record practitioners’ development throughout their career pathway. The ACCEnD programme seeks to address and provide solutions to key issues that challenge the cancer workforce both now and into the future promoting both recruitment and retention. We welcome the opportunity to present the programme to the European Oncology Nursing Society audience.