Oncology Healthcare Professionals Research Articles

Virtual consultations: the experience of oncology and palliative care healthcare professionals

ObjectivesTo maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient-healthcare practitioner interactions. The aim of this study was to explore the views of oncology and palliative care healthcare professionals (HCPs) regarding the medium of VC.MethodA cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. This was undertaken in accordance with relevant guidelines and regulations.Results87 surveys were completed. Three master themes were identified. Personal, professional, and familial factors including patient age, illness and VC skillset all influenced practitioner’s experience of VC. Relationships and connection were highlighted by survey respondents as important influences, with a perception that VC could reduce usual relationships with patients, compared to previous face-to-face consults. There was a perceived loss in these domains with VC. Sharing bad news and having challenging conversations was seen as particularly difficult via VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a significant benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant worry, alongside the challenges faced with occasionally failing technology.ConclusionVC were felt to have a role for those patients who are already known to professionals, where there was an established relationship. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patient suitability prior to offering VC, with emphasis on the importance of patient choice, was seen as a priority in this new era of VC.

SCOPING THE AVAILABILITY AND APPROPRIATENESS OF EXERCISE SERVICES FOR PEOPLE WITH CANCER IN REGIONAL WESTERN AUSTRALIA

BACKGROUND National guidance directs oncology healthcare professionals to refer patients to exercise in standard care, yet referrals happen rarely in practice resulting in a critical research-to-practice gap. One major barrier preventing referrals—especially in rural and regional areas—is the lack of appropriate exercise programming available to people with cancer. Therefore, the aims of this study are to 1) determine the availability of exercise oncology programs in a regional area of Western Australia; and 2) explore the appropriateness of these resources to meet the needs of people living with cancer in this region so that a comprehensive referral resource can be created for the region. METHODS A comprehensive online search identified all exercise services available in the region for people with cancer. Services were categorised using the Cancer Rehabilitation to Recreation (CaReR) framework to describe the level of care each provided. The geographical makeup and demographics of the cancer population in the region were matched to the services to identify service-gaps. RESULTS Approximately 194 000 people live in the Soutwest, with ∼1300 residents diagnosed with cancer each year. Sixty-six exercise oncology services were identified as appropriate for serving this entire population. 62% of all programs were located in the two largest shires across the region. 66% of services were categorised as CaReR Phase 1, providing targeted, supervised care for high-needs patients; 79% as Phase 2, providing targeted, supervised care for medium needs patients; and 28 percent as Phase 3, independent, community-based care for low needs patients. CONCLUSION The Southwest region is significantly under-resourced to meet the national directive to embed exercise referrals into care for people with cancer. Lack of available exercise services for this population, and few programs catering for a diverse range of patient needs underpin this. Implementation-focused research is required to address this critical research-to-practice gap.

Future Fertility Among Pediatric Cancer Patients: Experiences and Perspectives of Health Workers in a Low-Resource Setting.

Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.

Identifying Factors Associated With Disparities in Access to Integrative Oncology Program

Context and ObjectivesCancer centers are increasingly providing complementary medicine as part of an emerging discipline termed ‘integrative oncology’ (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. MethodsThe databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0–3 sessions). ResultsOf 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0–4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3–2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02–2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03–1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32–0.83, P = 0.006). ConclusionPatients’ ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.

Investigating the Needs and Concerns of Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning Cancer Patients

ABSTRACT The needs and concerns of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients with cancer remain poorly understood. This is important as LGBTQ+ patients have an elevated risk of developing certain cancers and have poorer oncologic outcomes compared to non-LGBTQ+ patients. The lack of research may be linked to the complexity of studying the needs and concerns of this patient population. This review aimed to describe the evidence that sought to identify the needs and concerns of LGBTQ+ cancer patients. Studies were extracted using keywords such as “LGBTQ” and “Oncology.” Patient participants were excluded if they did not identify as LGBTQ+ and if they did not have cancer or were not cancer survivors. Healthcare professionals were excluded if they were not oncology specific. A total of 22 studies met our inclusion criteria. LGBTQ+ cancer patients expressed concerns surrounding heteronormative assumptions made by healthcare professionals, a lack of LGBTQ±specific cancer support groups, and psychosexual concerns such as erectile dysfunction following cancer treatment. Oncology healthcare professionals lacked the knowledge and education that are required to manage this patient cohort. Further research is required to investigate the needs and concerns of LGBTQ+ cancer patients specifically in the radiation oncology setting.

Burnout and attachment in oncology and palliative care healthcare professionals

ObjectivesExamine the prevalence of burn-out in health professionals working in a hospital dedicated to patients with cancer. Explore the relationship between attachment style and burn-out in healthcare professionals working in...

We Are Done! Now What? Exploring End of Treatment Needs of Childhood Cancer Survivors and Their Parents.

Background: Increased childhood cancer survival rates have spurred a new body of research pertaining to the cancer-survivorship continuum. Literature suggests a lack of research and guidelines for care at the end of treatment (EOT). To improve the transition to survivorship and determine any posttreatment challenges, this study explored the experiences of childhood cancer survivors (CCSs), parents/caregivers, and pediatric oncology health care professionals (HCPs) at EOT. Method: This study employed a mixed methods design. EOT Questionnaires were completed by CCSs and parents/caregivers within 6 months of completing treatment, and by pediatric oncology HCPs. Results: A total of 75 CCSs and parents/caregivers and 21 HCPs completed the study. The majority of parents/caregivers (78%) and older CCSs (94%) recalled having an EOT "meeting." Most were satisfied with the meeting, but described unexpected worries/problems following EOT. Family members stating they were "very satisfied" with the EOT meeting increased significantly relative to the number of EOT topics addressed. In contrast, the omission of certain psychosocial discussion topics negatively correlated with satisfaction. Oncologists provided the majority of EOT services, with infrequent provision by other HCPs. Less than 20% of HCPs characterized families as "very satisfied" with EOT services and suggested improvements to meet families' needs. Discussion: This study found unmet psychosocial and anticipatory guidance needs, indicating a lack of preparedness. The results suggest that end of cancer treatment requires a more standardized, comprehensive, and multidisciplinary approach. Enhanced education and support services are needed to promote the successful navigation of all families through this period of transition.

Involvement of family members of older patients with cancer in triadic decision-making processes during medical consultations on an outpatient ward - an observational exploratory study using quantitative and qualitative methods

IntroductionThere is a growing interest in the involvement of family members of older patients with cancer in decision-making processes. The aim of this study is to identify how and to what extent family members, together with patients and physicians, are involved in triadic decision-making processes in clinical practice. Materials and MethodsThis study was conducted using an exploratory observational design. The Observer Patient Involvement Scale for patients with Multiple Chronicle Conditions (OPTIONMCC) was used to assess the interaction in triadic decision-making between patients, family members, and physicians. Physicians' behaviour was scored on a Likert-scale ranging from 0 (not observed) to 4 (executed to a high standard), while the behaviour of patients and their family members was scored on a scale from 0 (no or minimum participation) to 2 (active participation). Atlas.ti software was used to facilitate coding, and the SPSS statistical analysis platform was used to explore correlations between the shared decision-making (SDM) skills of the physician and the participation of patients and their family members. ResultsIn total, ten physicians performed 25 consultations with older patients and 30 family members. Patients showed higher levels of participation in the SDM process than family members (OPTIONMCC mean scores 0.96 vs 0.61). Physicians' SDM skills were observed at a low or moderate skill level (OPTIONMCC mean score 1.81). Exploratory correlation analysis showed that higher physician scores were related to higher levels of both patients' and family members' involvement in the decision-making process. The level of family members' involvement in SDM varied from no involvement at all to active involvement. Qualitative analysis of family involvement revealed that relatives are likely to: emphasize patients' values and goals of care; inquire about different treatment options; assist in the deliberation process; and ask for clarification of the further medical process. Physicians showed responsive behaviour towards family members but seldom actively involved them in the SDM process. DiscussionThe study findings suggest that there is a need to include strategies to facilitate family involvement in current SDM models for older patients with cancer. Healthcare professionals in geriatric oncology might benefit from additional training covering family dynamics and managing challenging situations.

A Knowledge, Attitude, and Practice Survey on Oncology Healthcare Professionals’ Awareness of Cancer Cachexia Diagnosis and its Management: A Cross-sectional Study

Introduction: As per the new classification of Cancer Cachexia (CC), the clear distinct precachexia stage can be identified, enabling early interventional strategies to retard the progression of CC. Given its recent classification and potential to prevent the onset of CC, it is imperative to study its awareness among Oncology Health Care Providers in India. Aim: To assess the Knowledge, Attitude, and Practices (KAP) of diagnosing and managing CC in a group of oncologists and Onco-physiotherapists in India. Materials and Methods: This was a survey-based crosssectional study. The surveys were disseminated through various Indian Oncology professional organisation bodies in the country via emails from May 2020 to April 2021. Two survey questionnaires were formulated and validated based on a literature review and input from experts in the field. A total of 64 oncologists with an average of 11.96±8.49 years of experience and 53 physiotherapists with an average of 3.86±4.89 years of experience participated in the survey. Data was analysed using descriptive statistics. Results: In the knowledge domain, oncologists considered muscle wasting (37, 58%), weight loss (36, 57%), and loss of appetite (18, 14%) as the most accurate determinants of CC, and Onco-physiotherapists considered weight loss (18, 34%), muscle wasting (16, 30%), and loss of appetite (11, 21%) as the most accurate determinants. In the attitude domain of both surveys, nutritional therapy was considered an extremely important treatment. In the practice domain, the results showed that the majority of Oncologists (25, 39%) would initiate treatment at a weight loss of &gt;5% when the stage of cachexia or refractory cachexia may have set in, while Oncophysiotherapists (23, 43%) would do so at 5%. Conclusion: These surveys suggest a knowledge-to-action gap and highlight the need for increased awareness about CC among cancer healthcare providers for optimal patient care.

Mixed methods study of attitudes on location of gynaecological oncology outpatient care: a patient and healthcare professional questionnaire

ObjectiveGynaecological oncology place of care is often based on evolution of services, along historical professional boundaries, rather than user needs or preferences. We aimed to assess existing evidence, gather views...

Stress, resilience, and moral distress among health care providers in oncology during the COVID-19 pandemic.

The coronavirus pandemic has potential implications for stress levels and resilience among oncology healthcare professionals (HCPs). This study aims to assess perceived stress, resilience, and moral distress levels among oncology HCPs in Jordan during the pandemic and identify associated risk factors. An online cross-sectional survey was conducted among oncology HCPs in Jordan using three validated tools: Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RSIC), and Moral Distress Thermometer (MDT). Seven items were used to assess sources of stress. A total of 965 participants enrolled with a 74% response rate. The participants' ages ranged from 20 to 74 (mean = 32.74, SD = 5.197), with 79.1% males, 45.1% were physicians, 32.6% were public hospital workers, 57.1% were married, and 56.6% had children below 18 years. Findings indicated moderate perceived stress (Mean = 15.87, SD = 5.861), low resilience (Mean = 29.18, SD = 5.197), and high moral distress (Mean = 4.72, SD = 2.564). Females, unmarried individuals, and younger age groups exhibited higher PSS (p = 0.009, p < 0.001, and P<0.001) and lower resilience (p = 0.024, p = 0.034, and p = 0.001). Not having children below 18 years correlated with higher perceived stress (P < 0.001). In linear regression analysis, age and gender emerged as significant predictors of both perceived stress and resilience. Female participants reported stress related to the risk of contracting COVID-19 (p = 0.001), transmitting it to others (p = 0.017), social isolation (P < 0.001), and having children at home due to school closures (p = 0.000). A cohort of 239 participants repeated the survey within a two-month interval, revealed a statistically significant decrease in the CD-RISC scores (p < 0.001). Oncology HCPs in Jordan experienced moderate stress, high moral distress, and poor resilience during the COVID-19 pandemic. These factors may negatively affect the quality of oncology care. Urgent measures are necessary to support HCPs in coping with unforeseen circumstances in the future.

“Normally I Always Ask Briefly…”: How Patients and Healthcare Professionals in Oncology Construct Sexuality as a Delicate Topic

Oncology healthcare professionals (HCPs) and cancer patients often have difficulties in navigating conversations about sexual changes and concerns due to cancer and its treatments. The present study draws on Discursive Psychology to analyze how the topic of sexuality is raised and managed in Dutch oncological consultations. Our corpus consists of 28 audio recordings. We analyzed the discursive practices used by cancer patients and oncology HCPs and to what effect. Patients, on the one hand, employ vagueness, pronouns, and ellipses, while HCPs attribute talk to others and use generalizations and speech perturbations. Through these practices they collectively keep the topic of sexuality at a distance, thereby constructing it as a delicate topic. Moreover, we explicate the norms related to sexual behavior that cancer patients and oncology HCPs orient to in their talk. Finally, we address ways in which oncology HCPs can open the door on discussing sexual changes with their patients.

Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study.

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.

Paediatric oncology nursing education and training programmes: a scoping review protocol

IntroductionThe care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children...

Using the Behavior Change Wheel to Identify and Understand Key Facilitators and Barriers for Lifestyle Care for Postmenopausal Breast Cancer Survivors: A Delphi-Study.

Optimal approaches to promote sustained adherence to lifestyle and bodyweight recommendations in postmenopausal breast cancer (PMBC) survivors are lacking. This Delphi-study aims to identify and understand expert-opinion on potential barriers and facilitators for promoting adherence to these lifestyle and bodyweight recommendations in (clinical) care for PMBC survivors, and to determine potential effective intervention strategies. The expert panel consisted of oncology Health Care Professionals (HCPs) (N = 57), patient advocates (N = 5), and PMBC survivors (N = 38). They completed three questionnaires: Q1-idea generation; Q2-validation and prioritization; Q3-ranking. The Behavior Change Wheel was used as theoretical framework for analysis. Thematic analysis was applied to identify key overarching themes based on the top-ranked facilitators and barriers. Potential Behavior Change Techniques (BCTs) and intervention strategies were identified using the Behavior Change Technique Taxonomy version 1 and the Behavior Change Wheel. Eleven core categories of key barriers/facilitators for the promotion of adherence to recommendations for lifestyle and bodyweight among PMBC survivors were identified. For each core category, relevant BCTs and practical potential intervention strategies were selected based on suggestions from the expert panel. These included: increasing knowledge about the link between lifestyle and cancer; enabling self-monitoring of lifestyle behaviors followed by evaluation; offering group lifestyle counseling for PMBC survivors, enhancing social support for favorable lifestyle behaviors; and stimulating multidisciplinary collaboration among HCPs. Findings provide valuable insight for the development of interventions changing behavior of PMBC survivors and HCPs toward increased healthy lifestyle (support) behavior.

Prevalence and Risk Factors for Moral Distress in Pediatric Oncology Health Care Professionals.

Moral distress (MoD) is prevalent among health care professionals (HCPs) in oncology and is associated with burnout. The objectives of this study were to quantify MoD among pediatric oncology healthcare professionals (HCPs) at a Canadian quaternary care hospital, identify root causes, and evaluate change over time. Eligible pediatric oncology HCPs were identified, and consenting participants completed the Measure of Moral Distress-Healthcare Professionals (MMD-HP) and MoD Thermometer (MDT) at baseline, followed by biweekly MDTs over 12 weeks. A total of 139 HCPs participated. The mean MMD-HP score was 123 ± 57.0, range 9-288. Demographic risk factors identified for elevated MMD-HP scores were female sex (female 127.1 and male 83.6, P = .01) and nursing role (nurse 136.3 and most responsible physician 85.3, P = .02). Higher MMD-HP scores were found in HCPs who were currently considering resigning because of MoD compared with those who were not (169.9 v 115.4, P < .001). Situations involving administration of treatment to children with poor prognosis cancers that was perceived to be overly aggressive were ranked as the greatest environmental contributor to MoD. Baseline and mean MDT scores over time strongly correlated with MMD-HP scores (P < .0001 and P = .0003, respectively), with mean MDT scores showing no significant fluctuation over the 12-week period. MoD was common among pediatric oncology HCPs. Risk factors for elevated levels of MoD included both demographic and environmental factors. Implementation of systems to improve team communication and decision making, especially in the care of patients with poor prognosis cancers, may affect HCP MoD.

An ASCO leadership development project to understand barriers to clinical cancer research in the Asia-Pacific.

96 Background: There are huge challenges in conducting clinical research, with gross disparities in trial access for patients in the Asia-Pacific (APAC). ASCO initiated a leadership development program in 2021, and one of the projects involved understanding the barriers to conducting clinical research and trials regionally. Methods: We conducted a cross-sectional survey on barriers to clinical research using a 29-item questionnaire which covered potential barriers to establishing clinical groups to support trials, and respondents’ demographic and other information. We targeted oncology healthcare professionals (HCPs) from APAC via national societies, locoregional hospitals, and via social media channels. Data were collected through the SurveyMonkey platform. Countries were classified into high-income (HICs), upper-middle (UMICs), and lower-middle income countries (LMICs) according to the World Bank criterion. We hypothesized substantial differences in the responses of HCPs by income (HICs vs UMICs vs LMICs) due to political, cultural, ethical, and socioeconomic factors and evaluated the univariate association of each potential barrier using Chi-square test. Multivariable logistic regression models evaluated the association between the top five significant potential barriers and country grouping, adjusting for age, gender, specialty and affiliation. Results: Three-hundred responses were received from May to July 2022, representing 21 APAC countries and regions in total. Among these, 102 (34%), 57 (19%), and 137 (46%) HCPs practiced in HICs, UMICs, and LMICs, respectively, with 51% of respondents being female. Most HCPs practiced in medical oncology (35%), radiation oncology (29%), and surgical oncology (13%). Just under 70% of respondents had &lt;= 10 years of training. Overall, the top five reported barriers included competing demands (reported by 88% of respondents), lack of financial support (86%), healthcare access issues for patients (75%), lack of research environment and infrastructure (72%), and lack of expertise of staff (68%). Adjusting for other factors, among these barriers lack of financial support, research environment and infrastructure, expertise, and healthcare access differed significantly between HICs and LMICs with respondents from LMICs more often reporting these barriers than those from HICs (p&lt;=0.02 for all). Conclusions: This is the largest survey exploring the research and trial landscape in APAC that revealed common and specific challenges affecting different countries, thus emphasizing the importance of targeted measures when addressing these barriers. These findings will inform future potential action plans by ASCO and the APAC Regional Council such as skills training, embedding clinical research within practice and facilitating cross border interaction; to empower research in the region.

Resilience at Work among Healthcare Professionals in Oncology during and beyond the Pandemic: Report from A Deliberative Multi-Stakeholder Reflexive Symposium.

The chronic distress faced by healthcare professionals (HCPs) in oncology was exacerbated by the COVID-19 pandemic, heightening the need to improve their resilience. The Entretiens Jacques Cartier symposium provided an opportunity for participants from France and Quebec to share perspectives on resilience at work and discuss interventions at individual and organizational levels to support HCP health and well-being. Fifty-eight stakeholders were invited to the symposium, including HCPs, government decision-makers, researchers, and patient representatives. The symposium began with presentations on the nature of professional resilience at work in oncology and promising interventions developed in France and Quebec. Participants were then engaged in deliberation on how evidence and experiential knowledge could contribute to workplace strategies to strengthen resilience. Small-group reflexive sessions using the photovoice method, and an intersectoral roundtable, elicited the expression and deliberation of multiple perspectives on the nature and building blocks of resilience. Four main themes emerged from the discussions: (1) that resilience remains a muddy concept and can be associated pejoratively with "happycracy"; (2) that resilience must contend with bounded autonomy and captors; (3) that it relies on a sense of coherence at work; and (4) that patients play a role in improving HCP resilience. Stakeholders from healthcare systems in different countries view resilience at work as a means of equipping teams to handle chronic and punctual stresses in cancer care. The symposium emphasized the importance of better defining what resilience at work means and pursuing explorations of multicomponent interventions to support oncology HCPs and the patients they care for. The themes raised by participants at the symposium suggest pathways for furthering this exploration.

Could palliative sedation be seen as unnamed euthanasia?: a survey among healthcare professionals in oncology

BackgroundIn 2016 a French law created a new right for end-of-life patients: deep and continuous sedation maintained until death, with discontinuation of all treatments sustaining life such as artificial nutrition and hydration. It was totally unprecedented that nutrition and hydration were explicitly defined in France as sustaining life treatments, and remains a specificity of this law. End- of-life practices raise ethical and practical issues, especially in Europe actually. We aimed to know how oncology professionals deal with the law, their opinion and experience and their perception.MethodsOnline mono-centric survey with closed-ended and open-ended questions in a Cancer Comprehensive Centre was elaborated. It was built during workshops of the ethics committee of the Institute, whose president is an oncologist with a doctoral degree in medical ethics. 58 oncologists and 121 nurses—all professionals of oncological departments -, received it, three times, as mail, with an information letter.Results63/ 179 professionals answered the questionnaire (35%). Conducting end-of-life discussions and advanced care planning were reported by 46/63 professionals. In the last three months, 18 doctors and 7 nurses faced a request for a deep and continuous sedation maintained until death, in response to physical or existential refractory suffering. Artificial nutrition and even more hydration were not uniformly considered as treatment. Evaluation of the prognosis, crucial to decide a deep and continuous sedation maintained until death, appears to be very difficult and various, between hours and few weeks. Half of respondents were concerned that this practice could lead to or hide euthanasia practices, whereas for the other half, this new law formalised practices necessary for the quality of palliative care at the end-of-life.ConclusionMost respondents support the implementation of deep and continuous sedation maintained until death in routine end-of-life care. Nevertheless, difficulty to stop hydration, confusion with euthanasia practices, ethical debates it provokes and the risk of misunderstanding within teams and with families are significant. This is certainly shared by other teams. This could lead to a multi-centric survey and if confirmed might be reported to the legislator.

Attitudes Toward Interprofessional Health Care Teams in a Regional Cancer Institute: A Cross-Sectional Survey Study

ObjectivesOncology is a rapidly changing clinical setting. Research has shown improved patient outcomes and staff satisfaction following interprofessional collaborative education, but there has been limited research on perceptions of interprofessional collaboration among oncology health care professionals. The aims of this study were to: 1) assess attitudes of health care professionals toward interprofessional teams in oncology care, and 2) assess for differences in attitudes across various demographic and workplace groups. Data SourcesThe research design was an electronic cross-sectional survey. The main instrument utilized was the Attitudes Toward Interprofessional Health Care Teams (ATIHCT) survey. A total of 187 oncology health care professionals from a regional New England cancer institute completed the survey. The ATIHCT mean score was high (M = 4.07, SD = 0.51). Analysis revealed statistically significant differences in mean score among participant age groups (P = .03). Significant differences (P = .01) were also noted between different professional groups and their time constraints sub-scale score on the ATIHCT scale. A higher mean score occurred in participants who had a current certification (M = 4.13, SD = 0.50) compared to those without (M = 4.05, SD = 0.46). ConclusionHigh overall scores in attitudes toward health care teams suggest that cancer care settings are primed for interprofessional care model implementation. Future studies should examine strategies to improve attitudes among specific groups. Implications for Nursing PracticeNurses are in a position to lead interprofessional teamwork in the clinical setting. Further research is necessary to examine best collaborative models in health care to support interprofessional teamwork.