[The dual competence profile: A support of collaboration between practice and science. A qualitative descriptive study]. / Das doppelte Kompetenzprofil: Ein Beitrag für die Zusammenarbeit von Praxis und Wissenschaft.

The dual competence profile: A support of collaboration between practice and science. A qualitative descriptive study Abstract. Background: To ensure orientation towards needs existing in the realm of practice, the dual competence profile is mandatory at universities of applied sciences (UAS): in addition to academic qualifications, entrenchment in professional practice is demanded. However, it is unclear how needs, attitudes, and expectation of clinical practice regarding the interface between UAS and practice looks like. Thus, it is necessary to shed light on the cross-institutional and cross-divisional cooperation as well as on its participants. Aim: This article shows what needs and attitudes people from clinical practice have with regard to cooperation with the UAS and what they expect from persons with a dual competence profile. Methods: Guided individual and focus group interviews with 24 selected representatives from acute, rehabilitation and geriatric care institutions took place. The interviews address the following five block themes: "current state", "need for change", "areas for action", "needs" and "sustainability". Results: Practice institutions demonstrated a clear need for networking and knowledge circulation with the UAS, with a bilateral influence of four subcategories: overall goal, staff development, resources and general regulations. Conclusions: Persons with dual competency profiles provide a valid way for interconnecting higher education and practice institutions in a concrete manner. Their complex work environments require meaningful frameworks, shared goals, and the inclusion of key stakeholders.

Implementation of a nurse-led self-management support intervention for patients with cancer-related pain: a cluster randomized phase-IV study with a stepped wedge design (EvANtiPain).

BACKGROUND: Pain self-management support interventions were effective in controlled clinical trials and meta analyses. However, implementation of these complex interventions may not translate into identical effects. This paper evaluates the implementation of ANtiPain, a cancer pain self-management support intervention in routine clinical practice according to the Reach Efficacy-Adoption Implementation Maintenance framework. METHODS: In this cluster randomized study with a stepped wedge design, N = 153 adult patients with cancer-related pain were recruited from 01/17 to 05/18 on 17 wards of 3 hospitals in Vienna, Austria. ANtiPain entailed a face-to-face in-hospital session by a trained nurse to prepare discharge according to key strategies, information on pain self-management, and skills building. After discharge, cancer-pain self-management was coached via phone calls. Patient-level data were collected at recruitment, and 2, 4 and 8 weeks after discharge via postal or online questionnaire. Primary outcome was pain interference with daily activities. Secondary outcomes included pain intensity, self-efficacy, and patient satisfaction. Organizational-level data (e.g., on implementation procedures) were collected by study or intervention nurses. The mixed model to analyze patient-level data included a random intercept and a random slope for individual and a random intercept for ward. RESULTS: Recruitment was slower than expected and unevenly distributed over wards and hospitals. The face-to-face session was clinically feasible (mean duration = 33 min) as well as the mean amount (n = 2) and duration of phone calls (mean = 17 min). Only 16 (46%) of 35 trained nurses performed the intervention on nine wards. To deal with the loss of power, analyses were adapted. Overall effects on pain interference were not significant. However, effects were significant in sub analyses of the nine wards that recruited patients in the intervention period (p = .009). Regarding secondary outcomes, the group-by-time effect was significant for self-efficacy (p = .033), and patient satisfaction with information on pain-self-management (p = .002) and in-hospital pain management (p = .018). CONCLUSIONS: The implementation of ANtiPain improved meaningful patient outcomes on wards that applied the intervention routinely. Our analyses showed that the implementation benefited from being embedded in larger scale projects to improve cancer pain management and that the selection of wards with a high percentage of oncology patients may be crucial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02891785 Date of registration: September 8, 2016.

Experiences of patients with colorectal cancer from diagnosis until completion of treatment: A meta-ethnography approach.

OBJECTIVE: The purpose of this meta-synthesis was to explore the experience of living with symptoms caused by colorectal cancer (CRC) and its treatment from the perspectives of those affected. METHODS: In a systematic search of qualitative studies published up to September 2017, 21 relevant papers were identified. The meta-ethnography followed the approach developed by Noblit and Hare. To relate key themes from one paper to similar themes of different papers, a "reciprocal translation" was carried out. RESULTS: Through synthesis, a new model was developed during treatment ("lines-of-argument synthesis"). Two constructs of experiences took place before the illness. Six third-order constructs were developed to capture patients' experiences during treatment, including "disruption in life through CRC" as well as the complex and circular experiences summarized as "experiences of symptoms and challenges by CRC". In contrast, experiences in dealing with changes that CRC and the treatment imply were "making sense of the experience", "sharing the experience", "experiences with controlling ones' body", and "experiences with reforming life". CONCLUSIONS: This meta-ethnography clarifies fundamental aspects of patients' experience in very different settings or starting points by specifying a more complete and holistic spectrum of experiences with CRC and its treatment.

An oral care self-management support protocol (OrCaSS) to reduce oral mucositis in hospitalized patients with acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation: a randomized controlled pilot study.

INTRODUCTION: Oral mucositis (OM) is a common and debilitating side effect of chemoradiotherapy in patients awaiting allogeneic hematopoietic stem cell transplantation (aHSCT). PURPOSE: The aim of this pilot RCT was to compare an oral care self-management support protocol (OrCaSS) to usual pre-aHSCT care. Feasibility was tested, effect sizes calculated for OM (primary outcome), and patient adherence was measured (secondary outcome). METHODS: Eighteen AML patients awaiting aHSCT and hospitalized between August 2012 and April 2013 were randomized 1:1 to usual care (UCG) and intervention (IG) groups. The OrCaSS protocol consisted of two sessions of educational and behavioral interventions, the first delivered 1 week pre-admission (T1), the second on admission day (T2). Via field notes, practicability and acceptability were evaluated to explore the feasibility of intervention and study procedures. OM data were collected at T1, T2, and daily for 28 days using the WHO scale. The effect size r was calculated (r less than -0.1 ≙ small and greater than or equal to -0.3 ≙ medium). Patients' adherence to the protocol was assessed at T1, T2, and 8-10 days post-HSCT (T3). RESULTS: Research and intervention procedures were feasible. OM incidence was 100 %. The IG's median highest OM grade was 2.0 (IQR = 2); the UCGs was 3.0 (IQR = 2; r = -0.1). Median OM durations were 12 days in the IG and 14 days in the UCG (r = -0.1). OM onset was 2 days later in the IG than in the UCG (r = -0.1). Over the course of the study, patient adherence decreased in both groups. CONCLUSIONS: OrCaSS is a promising intervention to delay and reduce OM. These results can serve to plan a larger RCT.

Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

PURPOSE: To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. APPROACH: A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. FINDINGS: A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. CONCLUSIONS: A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. CLINICAL RELEVANCE: The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes.

Using a Mobile Messenger Service as a Digital Diary to Capture Patients' Experiences Along Their Interorganizational Treatment Path in Gynecologic Oncology: Lessons Learned.

A digital diary in the form of a mobile messenger service offers a novel method for data collection in cancer research. Little is known about the things to consider when using this data collection method in clinical research for patients with cancer. In this Viewpoint paper, we discuss the lessons we learned from using a qualitative digital diary method via a mobile messenger service for data collection in oncology care. The lessons learned focus on three main topics: (1) data quality, (2) practical aspects, and (3) data protection. We hope to provide useful information to other researchers who consider this method for their research with patients. First, in this paper, we argue that the interactive nature of a digital diary via a messenger service is very well suited for the phenomenological approach and produces high-quality data. Second, we discuss practical issues of data collection with a mobile messenger service, including participant and researcher interaction. Third, we highlight corresponding aspects around technicalities, particularly those regarding data security. Our views on data privacy and information security are summarized in a comprehensive checklist to inform fellow researchers on the selection of a suitable messenger service for different scenarios. In our opinion, a digital diary via a mobile messenger service can provide high-quality data almost in real time and from participants' daily lives. However, some considerations must be made to ensure that patient data are sufficiently protected. The lessons we learned can guide future qualitative research using this relatively novel method for data collection in cancer research.

Distress associated with adverse effects of immunosuppressive medication in kidney transplant recipients.

CONTEXT: For kidney transplant patients, a lifelong intake of medication is mandatory. Health care workers' prioritization of adverse effects often differs from that of their patients, although patients' experience of adverse effects of medication can trigger nonadherence. Understanding how patients experience symptoms is therefore important. OBJECTIVE: To present a new method to be used in research to evaluate symptom experience related to adverse effects in adult kidney transplant recipients on maintenance immunosuppressive therapy. DESIGN: Cross-sectional secondary data analysis. PATIENTS AND SETTING: Three hundred fifty-six adult kidney transplant recipients from 2 Swiss transplant outpatient clinics. MAIN OUTCOME MEASURES: Symptom experience was measured with the Modified Transplant Symptom Occurrence and Symptom Distress Scale. For each item, ridit scores were calculated. A coordinate system with occurrence and distress ratings of each symptom classified symptoms into 4 quadrants: symptoms could have high occurrence/high distress, low occurrence/high distress, high occurrence/low distress, and low occurrence/low distress symptoms. Items farther from the origin represented more extreme profiles. RESULTS: The proposed method arranges symptoms clearly in sequence of their importance. In our study, fatigue and joint and back pain were the most frequent and distressing symptoms. Symptom profiles for men and women differed: for men impotence and anxiety were key whereas for women listlessness and changed appearance seemed to play important roles. CONCLUSIONS: The 2-dimensional diagram of symptom profiles enables researchers and clinicians to evaluate the impact of symptoms associated with immunosuppressive medications.

Psychometric Evaluation of the Patient-Related Nausea and Vomiting Management Barriers Questionnaire.

CONTEXT: The Nausea and Vomiting Management Barriers Questionnaire (NVMBQ) measures patient-related barriers to antiemetic medication. OBJECTIVES: The primary aim of this study was to test the construct validity, internal consistency, and content validity of the NVMBQ. The secondary aim was to develop a shortened version of the NVMBQ. METHODS: A quantitative secondary data analysis from a previous cross-sectional study of the NVMBQ (n = 299) was performed. It included analyses of descriptive data, factor structure, internal consistency, and patient comments. Content validity was established with 10 experts (including patients, nurses, physicians, and scientists) using the item-wise content validity index and the scale CVI (S-CVI). RESULTS: The exploratory factor analysis revealed eight underlying dimensions that were mostly congruent with the hypothesized structure when developing the NVMBQ. Internal consistency was high (α = 0.90). More than 70% of the items were estimated as relevant by the experts. However, the S-CVI was moderate (S-CVI = 0.74). A 14-item short version of the NVMBQ was identified. Qualitative analysis suggested the inclusion of additional clinically relevant items (e.g., the inability to take oral antiemetics if nausea was already present). CONCLUSION: The NVMBQ provides a good basis for assessing patient-related barriers to chemotherapy-induced nausea and vomiting management. We will use the resulting and translated NVMBQ in a larger study to assess the relationships between chemotherapy-induced nausea and vomiting, patient-related barriers, and current antiemetic regimens.

Developing a Short Form of the German Barriers Questionnaire II: A Validation Study in Four Steps.

CONTEXT: Patient-related barriers to cancer pain management are most commonly assessed with the Barriers Questionnaire II (BQII; 27 items). OBJECTIVES: The aim of this study was to develop a valid short form of the BQII-German version (BQII-G) to increase usability in clinical routines and reduce patient burden. METHODS: The validation study comprised a stepwise approach. In the first step, the linguistic validated version of the BQII-G was psychometrically tested for internal consistency and factor structure (N = 207). The second step included an independent peer review in terms of expert ratings (four nurses and two patients) of each of the BQII-G items regarding (rather) include or (rather) not include, according to the content validity index. The third step comprised a consensus process to integrate the expert ratings into a short form of the BQII-G (BQII-G12). The fourth step included a preliminary psychometric exploration of the short version of BQII-G12. RESULTS: Cronbach's α was 0.92 for the BQII-G. Steps 1-3 resulted in the BQII-G12 (12 items). The correlation showed that the BQII-G12 explains 84.3% (r = 0.92) of the variance of the BQII-G. Cronbach's alpha of the BQII-G12 was 0.833. CONCLUSION: The BQII-G12 showed excellent psychometric properties in the preliminary testing, providing a new option for practice and research. Patient-related barriers to cancer pain management are crucial for adequate pain treatment. The new valid and reliable short BQII-G12 supports clinical practice and research by substantially reducing patient burden and resources needed to measure these barriers.

Testing the Implementation of a Pain Self-management Support Intervention for Oncology Patients in Clinical Practice: A Randomized Controlled Pilot Study (ANtiPain).

BACKGROUND: In oncology, pain control is a persistent problem. Significant barriers to cancer pain management are patient related. Pain self-management support interventions have shown to reduce pain intensity and patient-related barriers. Comparative effectiveness research is a suitable approach to test whether effects are sustained in clinical practice. OBJECTIVE: In this pilot randomized controlled trial, the implementation of the ANtiPain intervention into clinical practice was tested to assess the effects on pain intensity, function-related outcomes, self-efficacy, and patient-related barriers to pain management to prepare a larger effectiveness trial. METHODS: Within 14 months, 39 adult oncology patients with pain scores of 3 or higher on a 10-point numeric rating scale were recruited in an academic comprehensive cancer center in Southern Germany. Patients in the control group (n = 19) received standard care. Patients in the intervention group (n = 20) received ANtiPain, a cancer pain self-management support intervention based on 3 key strategies: provision of information, skill building, and nurse coaching. An intervention session was performed in-hospital. After discharge, follow-up was provided via telephone calls. Data were collected at baseline and 1 and 6 weeks after discharge. Effect sizes were calculated for all outcomes. RESULTS: Large effects were found for activity hindrance (Cohen d = 0.90), barriers (d = 0.91), and self-efficacy (d = 0.90). Small to moderate effects were found for average and worst pain (Cohen d = 0.17-0.45). CONCLUSIONS: Key findings of this study involved function-related outcomes and self-efficacy. IMPLICATIONS FOR PRACTICE: Because these outcomes are particularly meaningful for patients, the integration of ANtiPain to routine clinical practice may be substantial. A larger study will be based on these findings.

Supporting self-management of pain in cancer patients: methods and lessons learned from a randomized controlled pilot study.

PURPOSE OF THE RESEARCH: The purposes of this paper are to describe the methods used and the knowledge gained during a pilot study that evaluated the effects of a self-management intervention for cancer pain, as well as the adaptations that were made for a larger clinical trial. METHODS AND SAMPLE: In a randomized controlled trial, the adapted German version of the PRO-SELF(©) Plus Pain Control Program (PCP), a 10-week intervention to support self-management of pain in adult oncology outpatients and their family caregivers, was compared to attention control. Primary endpoints were average and worst pain measured at 6, 10, 14, and 22 weeks after enrollment. KEY RESULTS: A total of 39 patients (19 intervention, 20 control) were recruited over 18 months. During the study, inclusion criteria were expanded. Furthermore, the structured timing of the intervention visits was too static for a dynamic symptom like cancer pain. The intervention was expanded to include symptoms that severely impacted pain self-management including chemotherapy-induced nausea and vomiting. CONCLUSIONS: Apart from the provision of information and skills building, coaching cancer patients across a complex treatment is an important function of an intervention to support pain self-management. The pilot study proved to be highly useful in order to adapt planned study procedures, to balance burden and benefit for participants, and to customize the intervention to patients' needs and abilities in order to enhance feasibility and effectiveness. Findings from this pilot study will be fully integrated in a larger randomized controlled trial. CLINICAL TRIAL REGISTRATION NUMBER: NCT00920504.

Results of a randomized controlled pilot study of a self-management intervention for cancer pain.

PURPOSE OF THE RESEARCH: This paper reports findings from a randomized controlled pilot study evaluating the PRO-SELF Plus Pain Control Program, a U.S.-developed cancer pain self-management intervention, regarding feasibility and effect sizes in a German patient sample. METHODS AND SAMPLE: Thirty-nine German oncology outpatients were randomized to intervention (n = 19) and control (n = 20) groups. The intervention group received the PRO-SELF Plus Pain Control Program in 6 visits and 4 phone calls a 10-week period. The control group received standard education and care. The intervention employed three key strategies: information provision, skills building, and nurse coaching. Primary outcomes were changes in average and worst pain intensity. Secondary outcomes included changes in pain-related knowledge, opioid intake, and self-efficacy. Data were collected at enrollment, then at 6, 10, 14, and 22 weeks. KEY RESULTS: The group-by-time effect showed a statistically significant increase in knowledge (week 10: p = 0.04; week 22: p < 0.01). Despite slight reductions in average and worst pain, no statistically significant changes were found for pain, opioid intake, or self-efficacy. CONCLUSIONS: This study is the first to evaluate and demonstrate the feasibility of a U.S.-developed cancer pain self-management intervention in a German patient population. Pain self-management related knowledge improved significantly and effect sizes for pain reduction were determined. Findings from this pilot RCT provide the basis for planning a larger RCT. CLINICAL TRIAL REGISTRATION NUMBER: NCT00920504.

A systematic evaluation of content, structure, and efficacy of interventions to improve patients' self-management of cancer pain.

CONTEXT: Cancer pain continues to be extensively undertreated, despite established guidelines. Although the efficacy of interventions that support patients' self-management of cancer pain has been demonstrated in several studies, the most effective components of these interventions remain unknown. OBJECTIVES: The purpose of this review of experimental and quasi-experimental studies was to systematically describe the structure and content components, as well as the efficacy of various components, of interventions designed to improve patients' self-management of cancer pain. METHODS: A systematic review of the literature was done that supplemented the 2009 meta-analysis of Bennett et al. Intervention components were categorized using content analysis. The intervention components were compared based on their calculated largest effect sizes (ESs) within each study (i.e., Hedges G(u) for between-group differences in pain intensity scores). RESULTS: Based on 34 publications (i.e., 24 interventions), seven structure and 16 content components were identified. In 11 studies with statistically significant ESs, the largest ES within each study ranged from -1.87 to -0.44, which represented clinically meaningful effects. No single component was found to have a discernable influence on ES. CONCLUSION: This analysis provides researchers and clinicians with a detailed overview of the various structural and content components, as well as various combinations that were tested in intervention studies to improve cancer pain management. However, because of a variety of limitations, the most efficacious intervention components or combination of components remain to be determined in future studies.