RESUMO
INTRODUCTION: Patient education can facilitate early cancer diagnosis, enhance treatment adherence, and improve outcomes. While there is increasing cancer burden in low- and middle-income countries (LMICs), there is little research to inform successful patient education in these regions. This systematic review summarizes the existing literature on oncology education and evaluation strategies in LMICs, identifies best practices, and highlights areas which require further investigation. METHODS: The review was conducted using PRISMA guidelines and an a priori protocol. Four databases (Ovid Medline, Cochrane Libraries, Embase, and Cabi) were searched in December 2021. Two independent reviewers evaluated studies for inclusion. Using a coded data extraction form, information was collected about the study site, intervention characteristics, and evaluation methods. RESULTS: Of the 2047 articles generated in the search, 77 met the inclusion criteria. Twenty-four countries were represented; only 6 studies (8%) were in low-income countries. The most common education methods included technology-based interventions (31, 40%) and visual pamphlets or posters (20, 26%). More than one education method was used in 57 (74%) studies. Nurses were the most frequent educators (25, 33%). An evaluation was included in 74 (96%) studies, though only 41 (55%) studies used a validated tool. Patient knowledge was the most common measured outcome in 35 (47%) studies. CONCLUSIONS: There is limited empiric research on oncology patient education in LMICs. The available data show heterogeneity in education approaches and gaps in evaluation. Further research to determine successful patient education and evaluation strategies is urgently needed to improve treatment cancer outcomes in LMICs.
Assuntos
Países em Desenvolvimento , Neoplasias , Humanos , Educação de Pacientes como Assunto , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapiaRESUMO
PURPOSE: The study assesses the current state of global oncology (GO)/hematology training opportunities in US fellowship programs. METHODS: We developed a comprehensive survey of 64-Likert multiple-choice and open-ended questions. The survey was electronically distributed to fellowship program leaders at Accreditation Council for Graduate Medical Education-accredited adult hematology/oncology fellowships. Program directors received three reminders after which survey was sent to assistant program directors or division heads for programs not represented. RESULTS: A total of 171 programs were eligible for the survey. We received 42 (24.6%) responses; 40 were included in the analysis, and two were excluded for declined consent and incomplete responses. The programs include large academic (81.6%) and community hospitals (10.5%). Of the respondents, 18 (48.6%) reported offering some opportunities for global health training, and half reported interest among current fellows. Most programs (29, 82.9%) had three or fewer faculty engaged in GO research. Institutional training grants were available in 15 (39.5%) programs, of which six (40%) allowed for global health research. Of the 18 programs offering global health training activities, most (15, 83.3%) report less than a quarter of their trainees currently participate in GO experiences. The most commonly perceived barriers to GO opportunities include competing priorities (85.3%) and lack of faculty mentors with GO-related experience (82.4%). Conversely, the most commonly perceived facilitators include established partnerships outside the United States (97.0%) and dedicated institutional funding (93.9%). CONCLUSION: Our survey demonstrates that although there is significant interest among fellowship trainees, a minority of the fellowship programs offer GO opportunities. Providing GO opportunities would require programs to establish partnerships with institutions outside the United States and to have systematic approaches of addressing other barriers, including enhancing funding and mentorship.
Assuntos
Bolsas de Estudo , Saúde Global , Hematologia , Oncologia , Humanos , Oncologia/educação , Inquéritos e Questionários , Hematologia/educação , Estados Unidos , Educação de Pós-Graduação em Medicina , Liderança , Equidade em SaúdeRESUMO
Psychosocial care is considered an important component of quality cancer care. Individuals treated for cancer can experience biologic or physical, emotional, spiritual, and practical consequences (eg, financial), which have an impact on their quality of living. With the establishment of cancer centers in Africa, there is growing advocacy regarding the need for psychosocial care, given the level of unmet supportive care needs and high emotional distress reported for patients. Nurses are in an ideal position to provide psychosocial care to patients with cancer and their families but must possess relevant knowledge and skills to do so. Across Africa, nurses are challenged in gaining the necessary education for psychosocial cancer care as programs vary in the amount of psychosocial content offered. This perspective article presents competencies regarding psychosocial care for nurses caring for patients with cancer in Africa. The competencies were adapted by expert consensus from existing evidenced-based competencies for oncology nurses. They are offered as a potential basis for educational program planning and curriculum development for cancer nursing in Africa. Recommendations are offered regarding use of these competencies by nursing and cancer program leaders to enhance the quality of care for African patients with cancer and their family members. The strategies emphasize building capacity of nurses to engage in effective delivery of psychosocial care for individuals with cancer and their family members.
Assuntos
Neoplasias , Reabilitação Psiquiátrica , Família , Humanos , Neoplasias/terapia , Enfermagem Oncológica , Qualidade da Assistência à SaúdeRESUMO
A long-term partnership among the Butaro Cancer Center of Excellence (BCCOE) in Rwanda, Partners in Health (PIH)/Inshuti Mu Buzima, and Dana-Farber Cancer Institute (DFCI) supports the development of oncology nurses through a clinical nurse educator role. Two senior Rwandan oncology nurses at BCCOE were hired as nurse educators and were mentored by a PIH/DFCI oncology nurse educator using the accompaniment approach. The formalized mentorship process included long-term accompaniment for all educator projects spanning staff training, quality improvement, research, and clinical practice, as well as development of nurse educator competencies and creation of a repository of resources.
Assuntos
Mentores , Enfermeiros Clínicos , Docentes de Enfermagem , Humanos , Melhoria de Qualidade , RuandaRESUMO
Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country's 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.
Assuntos
Turismo Médico , África Oriental , Atenção à Saúde , Humanos , Papillomaviridae , Ruanda/epidemiologiaRESUMO
PURPOSE: The Butaro Cancer Centre of Excellence is the first comprehensive referral cancer center in Rwanda and at its inception did not have a standardized patient education program. Partners in Health/Inshuti Mu Buzima and the Rwandan Ministry of Health conducted a quality improvement project to increase patient knowledge by implementing a standardized oncology education program using picture-based and culturally appropriate materials designed for patients with cancer in low- and middle-income countries. METHODS: Four Rwandan nurses were trained to provide patient education using the Cancer and You education booklet created by Global Oncology. A pre- and post-test design was used to evaluate patients' knowledge of cancer, treatment, and management of adverse effects. Nurses administered a posteducation questionnaire in Kinyarwanda to determine patients' level of satisfaction with the education session and booklet. The four nurses were interviewed at the completion of the project for their feedback. A total of 40 oncology patients were included in the pilot project, of which 85% reported completing primary school or less. RESULTS: On average, participants improved 19% (95% CI, 13.9% to 24.1%; standard deviation, 16%) from pre- to postevaluation, demonstrating a significant increase in knowledge (P ≤ .001). Nearly all patients (97.5%) reported that they were either satisfied or very satisfied with the education program. Oncology nurses gave positive feedback, highlighting that it was helpful to have a standard tool for education with descriptive illustrations for those patients with low literacy. CONCLUSION: Implementation of a standardized patient education program demonstrated a statistically significant increase in patient knowledge and a high level of satisfaction among patients and nurses. The project serves as an example for other low- and middle-income countries looking to standardize oncology patient education.
Assuntos
Neoplasias/enfermagem , Papel do Profissional de Enfermagem/psicologia , Educação de Pacientes como Assunto/normas , Adulto , Retroalimentação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Folhetos , Projetos Piloto , Pobreza , Melhoria de Qualidade , RuandaRESUMO
The cancer burden in low- and middle-income countries (LMICs) has been well described in the literature (International Agency for Research on Cancer, 2012; Ott, Ullrich, Mascarenhas, & Stevens, 2011; Thun, DeLancey, Center, Jemal, & Ward, 2010). According to the World Health Organization ([WHO], 2015), about 14 million new cancer cases occurred in 2012, and more than 60% of those cases were in Africa, Asia, and Central and South America; of the 8.2 million cancer-related deaths in 2012, more than 70% occurred in these regions (Bray & Møller, 2006).â©.
Assuntos
Cooperação Internacional , Liderança , Neoplasias/enfermagem , Enfermagem Oncológica/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , Ruanda/epidemiologia , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVES: To examine accountability and performance measurement in health care and present a case study that illustrates the link between goal setting and measurement and how a strategic plan can provide a framework for metric selection. DATA SOURCES: National reports, literature review and institutional experience. CONCLUSION: Nurse leaders and clinicians in oncology settings are challenged to anticipate future trends in oncology care and create a culture, infrastructure, and practice environment that supports innovation, advancement of oncology nursing practice and excellence in patient- and family-centered care. Performance metrics assessing key processes and outcomes of care are essential to meet this challenge. IMPLICATIONS FOR NURSING PRACTICE: With an increasing number of national organizations offering their version of key quality standards and metrics, it is critical for nurses to have a formal process in place to determine and implement the measures most useful in guiding change for a particular clinical setting.
Assuntos
Atenção à Saúde , Enfermagem Oncológica , Humanos , Oncologia , Enfermeiras e Enfermeiros , Estudos de Casos OrganizacionaisRESUMO
PURPOSE: Hypofractionated chest radiotherapy regimens have provided excellent palliation of pulmonary symptoms in patients with inoperable non-small-cell lung cancer (NSCLC) and poor performance status in studies from Asia and Europe. We conducted a prospective study of this approach in patients from the United States. METHODS AND MATERIALS: Twenty-three patients with symptomatic NSCLC and an Eastern Cooperative Oncology Group performance status of > or =2 were enrolled between December 1994 and October 2001. Two "involved-field" fractions of 8.5 Gy were delivered 1 week apart. Patients were assessed for efficacy, toxicity, and tumor response at baseline, treatment completion, and 1 week, 1 month, and 4 months after completing radiotherapy. RESULTS: The median follow-up after treatment began was 4.3 months (range, 0.3-38). The median forced expiratory volume in 1 s and Eastern Cooperative Oncology Group performance status as measured at baseline was 1.05 L and 3, respectively. The most common presenting pulmonary symptoms were dyspnea (100%), cough (96%), anorexia/nausea (65%), and chest pain (52%). Between treatment completion and up to 4 months after treatment, dyspnea, cough, anorexia/nausea, chest pain, hoarseness, hemoptysis, and dysphagia had improved in 30%, 60%, 67%, 75%, 25%, 100%, and 100% of patients, respectively. No cases of treatment-related esophagitis, pneumonitis, or radiation myelopathy occurred. Progressive local disease was seen in only 1 (6%) of 18 assessable patients 4 months after treatment. CONCLUSION: For patients with poor performance status and inoperable NSCLC causing pulmonary symptoms, hypofractionated, involved-field radiotherapy, 8.5 Gy in two fractions, offers acceptable palliation with minimal toxicity. A clear advantage of the very short hypofractionated regimen is that it enables patients with a short expected survival time to spend more of their remaining time away from the hospital.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Prospectivos , Estados UnidosRESUMO
Recognizing that each nurse approaches patient education differently, a team of nurses at Dana-Farber Cancer Institute satellite facilities employed quality improvement strategies to develop a standardized approach to patient education. The goal was to eliminate variation in teaching and improve patient satisfaction scores.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Qualidade da Assistência à Saúde , Humanos , Avaliação de Processos e Resultados em Cuidados de SaúdeRESUMO
Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.