Post-Conference Session Summaries

Research Findings

ONS offers a selection of abstract summaries to give a flavor of each day's research (podium) session content. These presentations represent the finest in oncology nursing research: research conducted by oncology nurses for oncology nurses, with the common goal of improving patient outcomes. The researchers received support from prestigious national funders (including the National Cancer Institute, the National Institutes of Health, the Oncology Nursing Foundation, the American Cancer Society, the Centers for Disease Control and Prevention, and various drug companies), as well as local and institutional sources.

All abstracts are available in full in Oncology Nursing Forum, 34 (2), 473-580.

Tuesday, April 24, 2007  

The Role of the Clinical Trial Nurse

Four of today's presentations, prevented in a single session, related to the role of the oncology nurse in clinical trials (2472, 2083, 2333, and 2401). M. Fitch (2472) described her interviews with Canadian senior decision makers in cancer organizations, change champions, middle managers, and staff nurses. She found that overall, awareness of policy reports about creating quality work environments is low and use of the information primarily symbolic. Her findings raise questions about the dissemination of information about workplace change initiatives.

A. DelaCruz and T. Curley (2083) presented a description of Response Evaluation Criteria in Solid Tumors (RECIST) from the clinical trial nurse perspective. The presentation included eligibility, methods of measurement, and response criteria, as well as guidelines for use and their limitations. The speakers provided tools for clinical use. Understanding RECIST enables nurses to use standard terminology when reporting treatment responses and aid their communication with patients.

Cunningham (2033) and colleagues reported the process of establishing a centralized education service for clinical research personnel. The purpose of Centralized Education Services (CES) is to enhance the quality of cancer research through education, and it designs, develops, and implements educational programs for clinical research nurses (CRNs). The CES provides ongoing education based on evolving needs, and it has been well received by investigators and CRNs.

The final paper, by Vaughn and colleagues (2401), described the creation of a career advancement process for CRNs at their institution. The presentation revealed the planning process, the design of the new program, and its implementation, which resulted in CRN position-level adjustments and pay changes. The advancement process recognizes and rewards CRNs who demonstrate excellence, leadership, and achievement – and who previously had little opportunity for advancement.

Professional Development for Oncology Nurses
(Abstracts 2139, 2362, 2248, 2389)

The impact of an oncology nursing critical thinking project was reviewed by S. Westlake, N. Delzer, P. O'Connell, and P. Quinn-Casper. Their paper presented the one-year evaluation data from a 90-nurse project designed to foster critical, sensitive, thinking. The actual training process wass described as didactic and grounded in patient stories. The self-report responses indicated that nurses did change their practice through enhanced communication skills, oncology knowledge, stronger relationships with colleagues, and improved patient and family teaching.

E. Glemser, S. Lindsey, and M. Andres described OnCollege, a program they created to expand basic nursing knowledge incorporating the unique needs of the adult oncology nursing population. OnCollege consists of six, eight-hour sessions for nurses new to oncology that provide a basic introduction to oncology. Participants take the Basic Knowledge Assessment Test before and after the course. This presentation included the researchers' experiences in developing the course and the lessons they learned.

A somewhat different paper explored the use of a journal club to format practice change in neutropenia management (O'Leary, Holmes, and Vancura – 2248). The journal club was created to review evidence regarding institutional neutropenia management policies and procedures. Specifically, the use of neutropenic diets, elimination of patient flowers, and wearing of masks by patients when not in their rooms were examined. After evidence review, neutropenic diets were discontinued, flowers were allowed for non-neutropenic patients (and silk flowers for neutropenic ones), and patients who remained on the unit were no longer required to wear masks. Neutropenic events have not increased after the changes. This process was an example of nurse empowerment to make practice changes for good patient outcomes.

K. Mullaly et al. described the creation of an Oncology Professional Development Council at their institution. The aims were: Identify the needs of nursing across the oncology service line; implement evidence-based educational programs; increase use of expertise; and develop and implement criteria for attending educational events. After a survey identified nursing needs, educational events were organized that have been well received. A mentor subcommittee has recently been organized. The council has provided an integrated process for evaluating nurses' needs and implementing educational programs.

Innovations in Cancer Screening
(Abstracts 2157, 2290, 2342, and 2009)

Matten et al. described their efforts to implement a Lung Screening Program, based on the International Early Lung Cancer Action Project findings that CT screening can detect curable lung tumors. This program is now in place in a community hospital and focuses on individuals at risk for developing lung cancer. Patients are followed for two years or more. This project has demonstrated that community hospital-based, low-cost CT screening programs can maximize the detection of early stage lung cancer.

A somewhat different screening innovation was described by J. McKiernan and J. Solan, who related the steps involved for an oncology nurse to plan and implement a free head and neck cancer screening day. Such events have occurred at this comprehensive cancer center for eight years. The presenters discussed the process and reviewed the screening results. They suggested that the process is transferable to other cancers and their screenings.

K. Griffith et al. reported on their study of the biological, psychosocial/behavioral, and social factors that predicted timely colorectal cancer (CRC) screening among African Americans aged younger than 40 years in Maryland. The team used the Biopsychosocial (BPS) Model as their guide. They found that healthcare provider recommendation was the most important predictor, regardless of family history of CRC. Thus, limited access to healthcare providers may interfere with timely CRC screening.

Another program, directly targeted to African Americans and others in high-risk regions of Delaware, employed Colorectal Screening Nurse Navigators (CRCNN) to engage in community outreach. The CRCNNs provided culturally sensitive recruitment, ensured screening access, monitored compliance, and ensured clinical evaluation and follow-up to positive screens. Post-initiation data suggested a significant increase in CRC screening among both African Americans and Caucasians in the target areas. The program has shown that CRCNNs can increase public awareness, assist with access to insurance and care, and work among diverse populations to increase screening rates.

Improving Patient Satisfaction: Safety, Symptom Management

A group of papers reviewed symptom management (2015, 2246, 2273, and 1955), looking particularly at a nurse-initiated symptom management program, an evidence-based review of managing constipation, using enemas in neutropenic or thrombocytopenic patients, and the use of a neutropenic diet in patients with leukemia.

Another set of important papers examined issues of patient safety. They described ways in which patient satisfaction and safety can be improved by reducing noise levels on an oncology unit (1858), applying an innovative method to decrease the incidence of falls in oncology patients (1952), and achieving the culture change necessary to increase hand hygiene among hospital staff (2437). Finally S. Vannice and P. Wimmer (2107) reviewed the use of Failure Mode and Effects Analysis to evaluate processes in chemotherapy administration and ensure a high standard of patient safety by reducing medication errors.

Wednesday, April 26, 2007

Recruiting and Retaining High Quality Oncology Nurses

Given the seriousness of the contemporary nursing shortage, oncology nurses are giving substantial attention to the issues of recruiting and retaining high-quality oncology nurses. Eight of Wednesday's presentations examined methods of obtaining and sustaining a healthy work environment (2097), recognizing and promoting oncology nursing certification (1913), and recruiting and retaining nurses through a variety of methods.

The issue of recruitment was explored in four papers. Denise Rutkowski (2259) described the factors that influence nurses' decisions to accept employment at Roswell Park Cancer Institute (RPCI) in preference to other institutions. Ms. Rutkowski's research indicated that staffing ratios, professional development/education, shared governance and autonomy, longevity of current staff, and available career ladders attract nurses to RPCI. Ms. Motie, Corcoran, and Reid describe dthe situation at Memorial Sloan-Kettering Cancer Center, where new recruitment and retention strategies were needed. There, nursing leadership, nurse educators, and clinical nurse specialists created the “Bridge to Oncology” orientation program to enable oncology naïve nurses to practice safely and competently. This program is undergoing continuous evaluation, and its details were described.

Brittain et al. (2194), of the Karmanos Cancer Institute, also described their efforts to create future oncology nurses through diversity, outreach, and mentorship. The Oncology Nurse Mentorship Program (ONMP) is a partnership between the Detroit Public Schools, the United Way of Southeastern Michigan, and a local bank. It is intended to increase the number of Detroit youths interested in oncology careers by reaching high school juniors and seniors with a mentored nursing experience. The ONMP connects each student with an oncology nurse mentor and places them in a six-week, four-day-per-week paid experience on nursing units, in chemotherapy clinics, and didactic presentations. The researchers described the success of the program to date. Finally, C. McCann and J. Itano (2140) discused a Hawaiian mentoring program for senior student nurses intended to recruit them into oncology nursing. Mentees who completed all requirements were eligible for grants to attend the 2007 ONS Congress. The speakers reviewed the program details and its positive outcomes.

C. O'Leary (2192) and colleagues showed that a comprehensive oncology orientation program can not only contribute to recruitment but to retention. They described the Fundamentals of Oncology Nursing program, a 16-week educational project that addresses psychosocial issues, critical thinking, and skill acquisition. Nurses receive CEUs for participation, and at the end of the program, they have enough to qualify for the OCN examination. The speakers described program details and outcomes, especially regarding job satisfaction and retention.

J. Lockhart and M. Oberleitner (2244) presented information important to nurses who will be expected to serve as preceptors for nursing students or new oncology nurses. They reviewed evidence-based strategies for strengthening preceptor skills, including assessment, feedback, documentation, and more.

Culturally Appropriate Breast Cancer Screening

Oncology nurses are increasingly aware of the importance of culturally appropriate communication between healthcare providers and patients – both potential and present. A significant session focused on the provision of culturally appropriate breast cancer screening in order to maximize the benefits across the population. Q. Edwards et al. reported their findings on health behavior patterns and disparities of mammography use in a multi-ethnic cohort (2291). Their project sought to describe repeat mammography among women in the Hawaii & Los Angeles Multiethnic Cohort to determine if ACS and NCI recommendations are being met, identify any racial or ethnic disparities, and assess demographic, medical history, or body mass index influences on health behaviors. They found that while most women report a prior mammogram, the percent who report an annual or biannual exam is low and differs with race and ethnicity.

C. Hegert & T.-Y. Wu (2158) have explored attitudes about breast health among Asian Indian women living in the U.S. They found that active breast care among these women was low (9% practicing breast exam, fewer than half having mammograms). After provision of an educational program designed for this group, the women reported higher confidence in their knowledge about breast self-care and 80% indicated they would do monthly self-exams.

In a similar study, E. Suh (2191) examined the health beliefs and perceptions about breast cancer screening of Korean immigrant women living in the U.S. Suh found that Korean health beliefs do limit the women's use of breast cancer screenings. Details were described. In addition, T.V. Ho described the effects of an educational intervention on breast cancer screening and early detection in Vietnamese American women. Both of these papers apply the Health Belief Model in their analysis. Ho found that a culturally sensitive educational intervention, given by an oncology nurse, had a positive effect on the breast cancer screening beliefs and practices of this group.

The Role of the Telephone in Oncology Practice

In the age of the computer, nurses may be tempted to play down the importance of the telephone in their practices. Three papers reminded them that the telephone remains a key component of communication with patients. M. Flannery, J. Wilmot, & S. Phillips determined to actually describe telephone calls and nursing triage in an oncology practice: volume, distribution, nursing workload. They collected data for four months, and their findings were reported. They concluded that call volume represents a large component of nursing workload, and that the call volume distribution requires flexible assignments. Telephone triage is a complex undertaking, reflecting independent nurse functioning.

A different paper described the steps taken at an outpatient gynecologic oncology center to improve telephone service (2198). Receptionists had difficulty managing the calls, calls needing rapid response were sometimes mis-triaged, and calls were often misdirected. The efforts of a multidisciplinary team (details available today) resulted in significant improvements and higher staff morale.

At an NCI-designated Cancer Center, the nursing staff developed a comprehensive telephone triage program to address symptom management, follow-up, and coordination of care for patients treated in the ambulatory setting and home setting (2216). The methods used to create the program were described, as well as the details of the triage practices and policy that were developed. The authors believe that the standardized method for telephone triage could be adapted by other nurses in other practice settings.

Other topics of interest today:

The development of a telecommuting model for outpatient oncology nurses (2255)

Professional bereavement and resiliency for oncology nurses (2204)

Symptom management, including pain, fatigue, nausea, hives, bloodless interventions to treat cancer-related anemia (2014, 2296, 2398, 233, 2318). Two papers examine symptom management in the palliative care setting (1987, 2366).

Thursday, April 27, 2007

Surgical Advances

A great deal of attention is given to chemotherapy and biological therapies for cancer, but for many cancers, surgery remains the definitive treatment. In a session presented today, four papers reviewed developments in surgery. C. Hughes and A. Giallo-Uvino (2365) described the oncology nurse's role in partial nephrectomy, removal of only part of the kidney when tumors are small. The procedure is becoming more and more common. It is challenging, and it requires that nurses be prepared for preoperative teaching and postoperative care. The authors reviewed the surgical care plan and described the model of patient education at Memorial Sloan-Kettering Cancer Center, as well as the inpatient/outpatient nurse liaison.

D. Dell and colleagues (1896) have undertaken a study of the assessment of patient recovery after transverse rectus abdominis myocutaneous (TRAM) flap breast surgery. They set out to describe the duration and intensity of pain, to identify interventions that help recovery, and to determine the effect of nursing education on patient satisfaction. They described their findings, including effective pain interventions. They concluded that nurses can positively influence patient outcomes by educating patients about recovery and useful interventions.

Hepatic artery chemoembolization (HACE) is used to treat unresectable hepatocellular carcinoma, but many nurses are unfamiliar with the procedure that entails a complex protocol. It is a low-volume, high-risk procedure. J. Imler and J. Itano described a project intended to improve patient outcomes by increasing nurses' knowledge about HACE. A 30-minute in-service was developed and presented three times. 50% of staff nurses attended, and evaluations indicated that levels of knowledge increased in all groups. The authors described the program and its continuing stages.

Finally, A. Jackson (2122) reviewed a project intended to enhance nurse understanding of postoperative care and improve RN-MD collaboration. In this project, post-operative care nurses were scheduled for day-long rotations in the operating room. Each nurse followed a particular patient through the surgery, post-surgical procedures, post-anesthesia care, and then the surgical unit. Ms. Jackson described the nurse responses to an evaluative questionnaire, noting their reactions to the surgical procedures, pain control, and interactions with the physicians and nurses.

Applying Evidence to Practice

One of the key principles ONS supports is evidence-based practice. Several papers presented reviewed various methods of supporting the implementation of evidence-based practice. In an important presentation, C. Brown, L. Nicholson, & J. Ponto (2193) described the history of oncology nursing certification through the Oncology Nursing Certification Corporation, described the geographical distribution of certified nurses, and summarized the results of a survey on the perceived value of certification and future research questions of importance to certification. They also examined the benefits of and barriers to certification.

A. Delengowski (2469) described a nurse-initiated and coordinated multidisciplinary group charged with identifying, developing, and implementing standards of oncology care based on interdisciplinary evidence. The group has produced standards for some areas that demonstrate high risk and high volume across disciplines, and it continues its work. Ms. Delengowski reviewed the challenges the group faced and discussed the benefits of its study.

The experience of another institution was reviewed by C. Briola et al. They will describe the Evidence-Based Practice (EBP) Council at Fox Chase Cancer Center. The council intended to support a culture shift from tradition to EBP, educate nurses about EBP, help nurses learn to access EBP resources, and incorporate evidence into clinical practice. The four-phase program began in January 2006, and the speakers described its progress to date and its projected next steps.

At Memorial Sloan-Kettering (2028), an EBP initiative involved the creation of a Departmental Practice Committee, and an Ambulatory Practice Council was designated to develop and oversee EBP in the outpatient setting. The council embarked on an educational program for nurses based on four practice questions. The project has been evaluated, and the speakers reviewed the outcomes. The speakers expect this project to serve as a demonstration for other nurses of successful implementation of an EBP model of care at the bedside.

The importance of developing and supporting nurse leaders and advanced practice nurses was discussed in a session that also included a paper on the creation of a fast-track BS-PhD program in health policy research to address diversity issues in oncology nursing (2376, 2459, 2425, 2220).

Most cancers are diagnosed in patients older than 60 years. One session today emphasized oncology nursing in the older population (2069, 2237, 2280, 2230). Two of the papers addressed the particular problems and challenges of incorporating/recruiting older patients into clinical trials and the unique roles oncology nurses can play. Another looked at treatment challenges in the older patient with cancer, and the last described patterns and predictors of complementary therapy use among U.S. patients with cancer.

Prevention and community care were the dual foci of a session that included a paper on an educational program about human papilloma virus and cervical cancer (2208), two presentations on tobacco/smoking cessation training programs, and a paper on the meaning and experience of dignity to urban poor patients with advanced cancer.

Influences on patient experience of symptoms were described in several papers (2075, 2308, 1917, 2182). Topics included oral food intake and oral mucositis following allogeneic stem cell transplantation, alternative methods for delivering nonpharmacologic interventions for dyspnea for patients with lung cancer, the influence of gender and ethnicity on the experience of cancer pain, and a one-year follow-up report on the Mucositis Project.

Improving the patient experience of radiotherapy was the focus of another session (2258, 2174, 2088, 2079). These papers discussed optimizing combined modality outcomes, preventing vaginal stenosis after pelvic radiation, patient and caregiver education prior to radiation therapy, and assessing patient flow in an ambulatory oncology setting.

Friday, April 28, 2007

Improving Medication Safety

Friday's sessions opened with a topic of critical interest to oncology nurses and their patients: medication safety. A team of nurses from the NYU Hospitals Center (2350) described an Interdisciplinary Medication Safety Committee created to develop and implement a system to improve communication and facilitate the detection of errors before medication reaches a patient. Analyses were conducted on the medication system that revealed the sources of errors, and weekly meetings addressed ongoing changes in the systems. The speakers report edon improved communication, better staff satisfaction, improved productivity, and a lower rate of errors.

K. Roesser (2101) reported on an effort at the Thomas Johns Cancer Center to decrease the risk of chemotherapy errors through a Failure Modes and Effects Analysis (FMEA) and a Focus PDCA (Plan, Do, Check, Act) quality improvement model. The effort resulted in a new chemotherapy ordering form that has been error-free.

The Patient Assessment, Care, & Education (PACE) System™ was the subject of a talk by G. Johnson, T. Mark, and B. Fortner (2442). This system was created to address under-identification and treatment of chemotherapy-related symptoms. It uses a pen-based eTablet operating on a wireless network and administers the Patient Care Monitor™, a patient symptom severity report. The system was designed and is supported by Cancer Support Network™. The speakers described the use of the system and its benefits in identifying and treating symptoms.

Z. Lesko et al. (2371) described the development of a clinical trial tracking tool at NYU Cancer Institute. A task force created the tool to describe all elements of clnical trials and identify the members of the interdisciplinary who are responsible for each element. The goal of the effort was to clarify each member's role and to promote optimal use of each member's skills. In turn, duplication of effort would be reduced and communication increased. The speakers revealed the steps taken in the process and the benefits of the system.

Cancer Survivorship and Caregivers

As more and more patients with cancer live longer and receive treatments as outpatients or at home, the meaning of cancer survivorship and the role of the caregiver have emerged as important issues for oncology nurses. W. Landier and colleagues reviewed the development of an innovative tool to streamline health education for childhood cancer survivors (2189). Many childhood cancer survivors are at risk for late effects of their cancer treatment and/or the development of other cancers. Thus, their nursing care must include education regarding screening, protective interventions, and changes in behavior. The City of Hope Childhood Cancer Survivorship Program has created an educational template, available on computer, that permits nurses to customize materials for each patient, including English or Spanish versions.

Two papers examined the experience of survivorship for women who have had breast cancer (2247, 2148). F. Cartwright-Alcarese presented a study designed to describe baseline symptoms among breast cancer survivors and explore the relationship among the dimensions of symptom experience: number, severity, distress caused, and symptom clusters. This information was used to identigy interventions to target specific problems. E. Caplan, J. Becker, A. Schlener, & A Crivelli Kovach discussed their pilot study of a self-management program as a potential strategy for long-term breast cancer survivors. The goal of the program was to increase the survivors' health information seeking and to influence their health behaviors to decrease their chances of developing other cancers or serious health conditions. The speakers described the implementation and evaluation of their project.

Another educational project at the City of Hope was designed to train health professionals in a survivorship care curriculum (2335). It recruited participants, conducted the training, and evaluated and followed participants' goal achievement over time. The speakers described the development of the curriculum, its implementation, and outcomes. First six-month follow-up data were presented.

The importance of the nurses' relationship with caregivers and patients was described in a paper on implementing relationship-based care in a comprehensive cancer center (2413 – Karmanos Cancer Center Detroit). In this project, relationship-based care was defined as the care provider's relationship with patients and families, self, and colleagues that creates a healing relationship. These concepts were the focus of the 2006 nurse practice retreat, and their implementation and resulting institutional changes were described.

Other papers exploring the caregiver role included: an innovative program to support family caregivers of brain tumor patients (2284); the gender differences in quality of life of caregivers of patients with advanced cancer (2301); and the development of an oncology-specific discharge form, intended to smooth the transition between hospital and home for both caregivers and patients (1902). Finally, a paper explored empowering the oncology nurse and caring for the family caregiver through establishing a formal program of bereavement support on inpatient oncology wards (1941).

In a session on breast and ovarian cancer, speakers reviewed a practitioner's experience counseling and testing women at risk for hereditary breast and ovarian cancer syndrome (2038); implementing evidence-based symptom management for breast cancer patients using clinical pathways (2212); the experience of hope in women with advanced ovarian cancer and suggestions for improvements in provider communication and screening to asses distress (1979); and the experiences and distress levels of women with or without family histories of breast cancer during diagnosis and treatment for breast cancer (2227).

Nursing leadership development was the focus of one session. Speakers described the development of a nursing research fellowship program, the development of an advanced practice oncology nursing fellowship, implementing evidence-based practice with Leadership Development Institute Project Plan V.2, and the role of nurse educators as facilitators for implementing and evaluating evidence-based guidelines (2251, 1932, 2458, 2154).

A variety of other topics filled out the day's program, with an emphasis on bone marrow or stem cell transplantation.