Patients' and Nurses' Perceptions of the Effectiveness of an Oral Cancer Agent Education Process: A Mixed-Methods Study.

BACKGROUND: The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence. OBJECTIVE: To describe the patients' and nurses' perceptions on the effectiveness of the educational process in oral cancer treatment. METHODS: A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis. RESULTS: One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses' skills, and educational process barriers. CONCLUSIONS: Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects. IMPLICATIONS FOR PRACTICE: This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone.

Feasibility of Nurse Consultation in Oral Tumor Therapy: A Web-Based Survey among Physicians and Nonmedical Specialists.

BACKGROUND: Oral antiproliferative therapies have become increasingly important in the treatment of tumors. To ensure patient safety, medical care is focused on adherence and side effects. OBJECTIVES: To meet increased personnel and time requirements, delegation of tasks to nonmedical specialists (NMS) may be a solution; however, presently, little is known about the options in Germany. METHOD: At least 3,300 members of the German Society for Hematology and Medical Oncology (DGHO), 580 members of the Professional Association of Office-Based Hematologists and Oncologists in Germany (BNHO), and 1,500 members of the Conference on Oncology Nursing and Pediatric Nursing (KOK) were contacted via a web-based survey. The survey focused on the feasibility of oncology nurse consultation as an additional consulting service for patients undergoing oral tumor therapy. RESULTS: In total, 255 (physicians) and 206 (NMS) questionnaires were evaluable; 90.9% of the physicians were hematologists/oncologists, 87.8% advocated oncology nurse consultation, 34.1% had previously implemented/scheduled such consultations, 58.3% of the NMS were nursing staff, 46.1% had advanced training in oral tumor therapy, 94.2% were interested in further qualifications, 37.8% worked at facilities with established/planned nurse consultations, and 62.1% personally conducted/preferred conducting consultations. CONCLUSIONS: Throughout Germany, there seems to exist a group of qualified NMS who are motivated to provide care to patients undergoing oral tumor therapy. Particular physicians actively support these nurse consultations. Extensive implementation of delegation concepts in standard care of patients undergoing oral tumor therapy is not yet underway.

Manifestações clínicas e sociodemográficas em trabalhadores com câncer bucal / Clinical and sociodemographic manifestations in workers with oral cancer

Objetivo: descrever o perfil das manifestações clínicas e sociodemográficas correlacionados aos diagnósticos de Enfermagem segundo a North American Nursing Diagnosis Association (NANDA), em trabalhadores expostos a substâncias carcinogênicas, que foram assistidos na consulta de Enfermagem ambulatorial, com base na Filosofia de Clínica Ampliada, no ambulatório da Seção de Cirurgia de Cabeça e Pescoço. Método: trata-se de estudo quantitativo, descritivo, seccional utilizando dados secundários de um instrumento de coleta de dados, com análise estatística. Apresentaram-se os resultados em figura e tabelas. Resultados: analisaram-se 36 casos, a maioria masculina, idade entre 41 e 89 anos, brancos, casados, educação fundamental, tabagistas etilistas, estágio avançado, tratados com radioterapia exclusiva ou cirurgia com radioterapia, maioria com provedores da família, com vínculo previdenciário autônomo e renda familiar até dois salários mínimos. Conclusão: demonstrou-se a importância da Clínica Ampliada para a produção do cuidado centrada no cliente/trabalhador na detecção precoce da doença com ações de cuidados preventivos no próprio ambiente laboral das empresas de modo geral e lidar com os efeitos causados pela doença, contribuirá para o avanço do conhecimento científico.(AU)

Objective: to describe the profile of clinical and sociodemographic manifestations correlated to Nursing diagnoses according to the North American Nursing Diagnosis Association (NANDA), in workers exposed to carcinogenic substances, who were assisted in outpatient nursing consultation, based on the Expanded Clinical Philosophy, in the Outpatient Section of Head and Neck Surgery. Method: this is a quantitative, descriptive, sectional study using secondary data from a data collection instrument, with statistical analysis. Results were presented in figures and tables. Results: 36 cases were analyzed, most of them male, aged between 41 and 89 years, whites, married, primary education, smokers, advanced stage, treated with exclusive radiotherapy or surgery with radiotherapy, majority with family providers, with a social security bond autonomy and family income up to two minimum wages. Conclusion: the importance of the Expanded Clinic for the production of client/worker care in the early detection of the disease with preventive care actions in the workplace of the companies in general and dealing with the effects caused by the disease, has been demonstrated the advancement of scientific knowledge.(AU)

Objetivo: describir el perfil de las manifestaciones clínicas y sociodemográficas correlacionadas a los diagnósticos de Enfermería según la North American Nursing Diagnosis Association (NANDA), en trabajadores expuestos a sustancias carcinogénicas, que fueron asistidos en la consulta de Enfermería ambulatoria, con base en la Filosofía de Clínica Ampliada, en el ambulatorio de la Sección de Cirugía de Cabeza y Cuello. Método: se trata de estudio cuantitativo, descriptivo, seccional utilizando datos secundarios de un instrumento de recolección de datos, con análisis estadístico. Se presentaron los resultados en figura y tablas. Resultados: se analizaron 36 casos, la mayoría masculina, edad entre 41 y 89 años, blancos, casados, educación fundamental, tabaquistas etilistas, fase avanzada, tratados con radioterapia exclusiva o cirugía con radioterapia, mayoría con proveedores de la familia, con vínculo de seguridad social autónoma y renta familiar hasta dos salarios mínimos. Conclusión: se demostró la importancia de la Clínica Ampliada para la producción del cuidado centrado en el cliente/trabajador en la detección precoz de la enfermedad con acciones de atención preventiva en el propio ambiente laboral de las empresas de modo general y hacer frente a los efectos causados por la enfermedad, contribuirá al avance del conocimiento científico.(AU)

Caring for patients with oral cancer in Taiwan: The challenges faced by family caregivers.

Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers' primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face-to-face, semi-structured and tape-recorded interviews to collect data and employed qualitative content analysis to elicit caregiving-related themes. Six task-related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers' ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so.

Inter-rater reliability of the Oral Assessment Guide for oral cancer patients between nurses and dental hygienists: the difficulties in objectively assessing oral health.

PURPOSE: Perioperative oral care is effective for the prevention and reduction of complications following surgery. However, oral cancer patients' oral health is often poor. During hospitalization, oral cancer patients frequently receive oral care from ward nurses as well as professional oral care from dental hygienists. Maintenance of good oral hygiene in these patients ideally requires cooperation between nurses and dental hygienists. Consequently, communication tools used to share information about the status of patients' oral health are needed. One such tool is the Oral Assessment Guide (OAG). However, the inter-rater reliability of the OAG has not been consistently reported; therefore, we examined this between nurses and dental hygienists. METHODS: Participants comprised 76 patients hospitalized for oral cancer treatment. After surgery, a nurse and a dental hygienist performed oral assessments using the OAG. Comparative statistical analyses were conducted to examine differences and consistencies in the scores of nurses and dental hygienists. RESULTS: Although almost all patients' oral health status was poor, none were given the worst score in the mucous membrane or gingiva categories. Further, the tongue, saliva, mucous membrane, gingiva, and teeth/denture categories had low κ coefficients, indicating poor nurse-dental hygienist inter-rater reliability. In contrast, the κ coefficients and agreement rates for voice and swallowing were high. Dental hygienists' scores were significantly higher for the tongue, gingiva, and teeth/denture categories than were nurses' scores. CONCLUSIONS: This study showed low nurse-dental hygienist inter-rater reliability for the OAG and highlighted the difficulties in objectively assessing patients' symptoms and oral health conditions. Therefore, rather than only relying on an objective assessment of symptoms by a clinician, assessments should also include patients' subjective reporting of symptoms. OAG will likely be used until a new assessment tool is developed. Objective assessment training and/or user manual development may be required to improve the reliability of OAG. The present training of one lesson a year is insufficient, and efforts should be made to improve this to get more reliable outcomes.

Necessidades humanas de cuidado no homem em tratamento cirúrgico oncológico: implicações para a enfermagem / Necesidades humanas de cuidado en el hombre en tratamiento cirúrgico oncológico: implicaciones para la enfermería / The human care needs for men undergoing oncological surgical treatment: implications towards the nursing profession

Objective: The study's goal has been to identify the basic human needs of men undergoing oncologic surgical treatment and its implications for nursing care. Methods: It is a descriptive study with a qualitative approach. The scenario is the Nursing Consultation Ambulatory, INCA-RJ. The participants were 25 men bearing mouth neoplasm under exclusively surgical treatment. Study approved by the Research Ethics Committee under the CAAE No. 52647116430015274. Data collection was carried out through a semi-structured interview. The Bardin's thematic content analysis was used. Results: Three thematic categories emerged, as follows: the human needs for health care of the physical body; the human needs for social health care and the human needs for spiritual health care. Conclusion: The human needs affected by organic imbalances point to the importance of planning a care service that provides an effective result to human health necessities

Objetivo: Identificar as necessidades humanas básicos da saúde do homem em tratamento cirúrgico oncológico e suas implicações para o cuidado de enfermagem. Método: Estudo descritivo, qualitativo. Cenário ambulatório de Consulta de Enfermagem, INCA-RJ. Participantes foram 25 homens com neoplasia de boca em tratamento exclusivamente cirúrgico. Após aprovação do CEP n°52647116430015274. A coleta de dados foi à entrevista semiestruturada. Utilizou-se a análise temática de conteúdo de Bardin. Resultados: Emergiram três categorias temáticas: as necessidades humanas de cuidado à saúde do corpo físico; as necessidades humanas de cuidado a saúde social e as necessidades humanas de cuidado a saúde espiritual. Conclusão: Deste modo, as necessidades humanas afetadas com desequilíbrios orgânicos, aponta a importância de planejar um cuidado que proporcione resultado efetivo às necessidades à saúde do homem

Objetivo: Identificar las necesidades humanas básicas de la salud del hombre en tratamiento quirúrgico oncológico y sus implicaciones para el cuidado de enfermería. Método: Estudio descriptivo, cualitativo. Escenario ambulatorio de Consulta de Enfermería, INCA-RJ. Los participantes fueron 25 hombres con neoplasia de boca en tratamiento exclusivamente quirúrgico. Tras la aprobación del CEP n ° 52647116430015274. La recolección de datos fue a la entrevista semiestructurada. Se utilizó el análisis temático de contenido de Bardin. Resultados: emergieron tres categorías temáticas: las necesidades humanas de cuidado de la salud del cuerpo físico; Las necesidades humanas de cuidado de la salud social y las necesidades humanas de cuidado de la salud espiritual. Conclusión: De este modo, las necesidades humanas afectadas con desequilibrios orgánicos, apunta la importancia de planificar un cuidado que proporcione resultado efectivo a las necesidades de la salud del hombre

Oral Anticancer Agents: An Intervention to Promote Medication Adherence and Symptom Management
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Symptom burden and poor adherence to oral anticancer agents remain significant clinical problems. This study examined feasibility, preliminary efficacy, and satisfaction with ADHERE, a nurse practitioner intervention that promotes symptom management and adherence among patients prescribed oral agents. The intervention group (which received one semistructured, face-to-face session followed by three weekly telephone sessions using motivational interviewing, brief cognitive-behavioral therapy, and a toolkit to promote self-management) had significantly lower symptom severity postintervention. Self-reported adherence was high and did not differ by group. Patients reported being highly satisfied with the ADHERE intervention.
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Complexities of Medication Management Across Care Transitions: A Case Report.

PURPOSE: The purpose of this article is to identify medication-related considerations for clinical nurse specialist practice by presenting a case report detailing the complexities of medication management, unresolved medication discrepancies, and reconciliation across care transitions. BACKGROUND: Care transitions are a vulnerable time for medication-related problems to occur. Unresolved medication discrepancies can lead to adverse drug events and other poor health outcomes, including hospital readmissions and increased healthcare costs. Reconciling medication discrepancies during care transitions has been identified as a national patient safety goal to prevent medication-related problems. Clinical nurse specialists are uniquely qualified to lead and manage efforts to mitigate these problems during care transitions. CASE PRESENTATION: A 72-year-old male patient diagnosed with oral cancer underwent 8 weeks of chemotherapy and radiation treatments. Throughout these 8 weeks, the patient was seen by 4 providers and admitted to the hospital for neutropenia. As a result, a total of 19 new medications were prescribed and 5 medications were discontinued. Medication reconciliation was completed at each visit and at admission and discharge at the hospital. At discharge, the patient's medication regimen was complex, with 38 separate doses of 17 different medications per 24-hour period. Understanding and organizing the daily medication regimen were a consistent challenge for the patient during his illness. DISCUSSION: This case highlights the complexities of medication regimens and opportunities to improve medication management and reconciliation across care transitions. This case underscores the need for and importance of quality patient-provider communication, assessing and managing medication regimen complexity, evaluating medications against the American Geriatrics Society Beers Criteria, evaluating potential drug-drug or drug-food interactions, and recognizing at-risk behaviors that may lead to medication discrepancies and errors at care transitions. Potential opportunities where clinical nurse specialists could intervene to promote safe and effective medication management across care transitions are presented. CONCLUSION/IMPLICATIONS: Clinical nurse specialists have the unique ability to make key contributions and influence medication management and reconciliation across care transitions to promote medication effectiveness and safety.

Assistência de enfermagem a clientes com câncer na cabeça e no pescoço com ênfase nos tumores de cavidade oral no Estado do Rio de Janeiro / Cuidados de enfermería para los clientes con el cáncer de cabeza y cuello, con énfasis en los tumores de cavidad oral en el estado de Río de Janeiro / Nursing care for clients with cancer in the head and neck wi th emphasis on tumors of the oral cavity in the state of Rio de Janeiro

Objective: To raise nursing diagnoses (ND) in patients with oral cavity cancer (OCC) and analyze age, gender, drinking, smoking, residence (urban or rural), schooling, topography of the disease. Method: Retrospective and analytical Study on 36 patients with OCC, seen in the Outpatient Nursing Section of Head and Neck Surgery, in the period from July to December 2008. Results: The main ND were identified impaired swallowing, pain, impaired verbal communication related to the tumor; dysfunctional family process due to alcohol and tobacco, tension in the caregiver role, risk of low self-esteem among others. Conclusion: It was observed that nursing care is crucial for maintaining the quality of life of these individuals. Accurate recording on patient and caregiver can minimize suffering. Another important factor is the monitoring of the cancer symptoms and their deleterious effects on the body of patients. The professional nurse is essential in the evaluation of patients.

Objetivo: Levantar Diagnósticos de Enfermagem (DE) em portadores de Câncer de Cavidade Oral (CCO) e analisar idade, sexo, etilismo, tabagismo, domicílio (urbano ou rural), escolaridade, topografia da doença. Método: Estudo retrospectivo e analítico sobre 36 portadores de CCO, atendidos no Ambulatório de Enfermagem da Seção de Cirurgia de Cabeça e Pescoço, no período de julho a dezembro de 2008. Resultados: Principais DE identificados foram deglutição prejudicada, dor, comunicação verbal prejudicada relacionados ao tumor; processo familiar disfuncional por álcool e tabaco, tensão do papel de cuidador, risco de baixa auto-estima entre outros. Conclusão: Observou-se que assistência de enfermagem é determinante para manutenção da qualidade de vida desses indivíduos. Registro acurado sobre paciente e cuidador pode minimizar sofrimento. Outro fator importante é a monitorização dos sintomas do câncer e seus efeitos deletérios no corpo dos pacientes. O profissional enfermeiro é imprescindível na avaliação dos pacientes.

Objetivo: Levantar los Diagnósticos de Enfermería (DE) en pacientes con cáncer de la cavidad oral (CCO) y analizar la edad, el sexo, el alcoholismo, el tabaquismo, el domicilio (urbano o rural), la educación, la topografía de la enfermedad. Método: Estudio retrospectivo y analítico de 36 pacientes con CCO, atendidos en el Ambulatorio de Enfermería de la Sección de Cirugía de Cabeza y Cuello, en el período de julio a diciembre de 2008. Resultados: Principales DE identificados fueron impedimentos para tragar, dolor, comunicación verbal perjudicada relacionada con el tumor, entre otros. Conclusión: Se observó que la atención de enfermería es crucial para el mantenimiento de la calidad de vida. Registro preciso del paciente y el cuidador puede minimizar el sufrimiento, el control de los síntomas del cáncer y sus efectos perjudiciales. La enfermera profesional es imprescindible en la evaluación de pacientes.

Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia.

Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.

Unmet supportive care needs and characteristics of family caregivers of patients with oral cancer after surgery.

OBJECTIVE: The aim of this study was to identify factors associated with unmet supportive care needs in family caregivers of patients with oral cancer after surgery. METHODS: In a cross-sectional study, we recruited patient-family caregiver dyads from the otolaryngology head and neck surgery wards of a medical center in northern Taiwan. Patients were assessed using a set of structured questionnaires to measure symptom distress, sleep quality, and depression. Social support and supportive care needs of family caregivers were measured. RESULTS: Of the 102 dyads surveyed, needs for supportive care in information domain and healthcare professional/healthcare services domain were highest. Patients with more severe symptoms and family caregivers who received less social support from family were associated with greater overall unmet supportive care needs. CONCLUSIONS: Family caregivers report the need for more information and healthcare services after a family member has had oral surgery. Caregiving training programs should be developed for caregivers on the basis of meeting reported needs.

Oral cancer: risk factors, treatment and nursing care.

Oral cancer occurs in a range of anatomical sites within the oral cavity and pharynx. Although oral cancer is relatively rare in the UK, it can have a significant effect on individuals, with treatment being associated with eating, drinking, speaking and breathing difficulties. Treatment may also result in alterations to body image and functionality, which can lead to depression. Therefore, nurses need to have knowledge of associated risk factors, treatment and nursing care to improve patient outcomes and enhance quality of life.

Head, neck, and oral cancer update.

Although the overall incidence of head, neck, and oral cancer has been decreasing, oral and neck cancer caused by the human papillomavirus (HPV) has risen. This article discusses statistics, risk factors, causes, pathophysiology, treatments, and the home healthcare and hospice nursing implications for these patients. A real-life patient's journey through neck cancer caused by HPV is presented.

The findings of a nurse-lead intervention for detection and prevention of oral cancer. A pilot study.

Despite the fact that South African men are among the group having the highest risk of developing oral cancer there is currently no population-based primary and secondary prevention services for oral cancer in South Africa. This study aimed to develop an intervention focusing on the prevention and detection of oral cancer and pilot test the intervention in a semi-urban resource-poor community in Tshwane. The intervention was assessed in terms of screening uptake, knowledge and awareness of oral cancer and perception of the educational material developed for the intervention. Statistics were used to calculate screening uptake while a pre- and post-intervention design was used to determine knowledge and awareness and perception of the educational material. Sampling was purposive and all people reporting for oral screening were recruited for the study. The sample totalled 65 (n= 65) and the participation rate was 100%. Notwithstanding a favourable report on the flyer as motivator to take up oral screening the number of people especially those in the high-risk group who reported for screening was disappointing. However, the strategy used to improve knowledge and awareness was successful. Ways to improve screening uptake should be explored and tested to improve the current intervention.

Food restrictions of patients who are undergoing treatment for oral and oropharyngeal cancer.

PURPOSE: Oral squamous cell carcinoma and its treatment are associated with facial disfigurement and functional inabilities that may lead to malnutrition or under nourishment. This study assessed the incidence of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. METHOD: We interviewed 120 patients in two hospitals in São Paulo, Brazil, using a structured food frequency questionnaire comprising the most commonly consumed foods in Brazil. This questionnaire was applied twice; the first time to inform dietary patterns prior to the diagnosis of cancer and the second time to assess recent modifications of diet that were associated with the disease and its treatment. Hospital files provided information on clinical status. Multivariate Poisson regression models assessed covariates with prognostic value. RESULTS: One third of patients suffered major food restrictions (i.e., they reduced substantially the intake of more than 50% of the most commonly consumed food items before the diagnosis); 39% suffered a less severe condition (they could not eat less than 50% of the most commonly consumed food items before the diagnosis, and they needed changes in food preparation). Larger tumour size (adjusted incidence ratio IR = 1.45), posterior location (IR = 1.33), radiotherapy (IR = 1.84), loss of tongue mobility (IR = 1.36) and loss of teeth (IR = 1.25) in the surgery were associated significantly with the study outcome. CONCLUSION: This study identified clinical predictors of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. This knowledge may contribute to improve patient care and management, and to develop interventions aimed at preventing nutritional depletion of these patients.

Attitudes and practices of Florida nurse practitioners on oral cancer prevention and early detection.

BACKGROUND: Oral cancer continues to have a relatively low survival rate because most tumors are diagnosed at late stages. Nurse practitioners may be optimally positioned for oral cancer prevention and early detection. METHODS: A statewide mail-based survey was conducted among 448 Florida nurse practitioners. Logistic regression was conducted to assess the independent relationships between nurse practitioners' attitudes and their practices in oral cancer prevention and early detection. RESULTS: Nurse practitioners' oral cancer practice behaviors were significantly affected by their attitudes. CONCLUSIONS: Effective strategies should be implemented to enhance positive attitudes about oral cancer early detection among Florida nurse practitioners.