Instruments for Evaluating Student Learning Outcomes in Palliative Care: A Literature Review.

Primary palliative care is a core component of nursing practice for which all students must receive formal education. Through competency-based education, nursing students develop the knowledge, attitudes, and skills to deliver quality primary palliative care before they transition to practice. Nurse educators in academic and practice settings should use reliable and valid means to evaluate student learning across cognitive, affective, and psychomotor domains. Expert faculty conducted a literature review to identify published instruments that evaluate primary palliative care student learning outcomes. Selected articles were required to include instrument reliability, validity, or both. The literature search yielded 20 articles that report on the development and testing of 21 instruments. Findings are organized into 3 learning domains that encompass 5 outcomes. Four instruments assess knowledge within the cognitive domain. In the affective domain, 3 instruments assess attitudes about caring for seriously ill or dying patients, 7 assess attitudes about death, and 5 assess self-efficacy. Competence and competency are evaluated in the psychomotor domain with 4 tools. Instrument implementation considerations within each domain are discussed. Faculty are encouraged to use robust evaluation measures such as those identified in the literature review to measure primary palliative care learning outcomes within a competency-based education framework.

Evaluation of an educational program for nurses providing cancer symptom management: The pan-Canadian Oncology Symptom Triage and Remote Support Online Tutorial.

Purpose: To evaluate the acceptability of the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) open-access online tutorial and its impact on nurses' knowledge and perceived confidence in symptom management. Methods: Retrospective pre-/post-test evaluation of nurses who completed the tutorial knowledge test and/or acceptability survey. The tutorial was modeled after the previously evaluated in-person workshop to prepare nurses providing cancer symptom management using COSTaRS practice guides. Results: From 2017-2021, 743 nurses completed the knowledge test, and 749 nurses evaluated the tutorial. Mean knowledge score was 4.4/6 and 83% of participants achieved passing scores. Compared to pre-tutorial, nurses improved their perceived confidence in assessing, triaging, guiding patients in self-care (p<0.001), and ability to use the COSTaRS guides (p<0.001). Nurses rated the tutorial as easy to understand (95%), just the right amount of information (92%), providing new information (75%), overall good to excellent (89%), and would recommend it to others (83%). Conclusions: More than 700 nurses accessed the tutorial. After completion, nurses demonstrated good knowledge and improved perceived confidence in cancer symptom management.

Enhancing Care of Older Adults Through Standardizing Palliative Care Education.

Nursing skill in caring for persons with serious chronic illness is increasingly in demand as the proportion of older adults in the United States increases. There is robust evidence that palliative care education among health care providers influences the reduction of death anxiety and avoidance behavior, while positively impacting self-efficacy and comfort, when caring for persons with serious illness or those nearing death. The international recognition of access to palliative care as a universal human right drives the need for education to adequately prepare nurses who have not been properly prepared for this work. The development of national competencies in palliative care education for nurses is an important step in synthesizing and disseminating available evidence in support of palliative care nursing education. These recently published competencies can lead to policy innovations at local, state, and national levels. Identifying competencies that lead to more clearly defined curricula will ultimately improve standardizing education and improve nursing practice in caring for older adults with serious chronic illness and their families. [Journal of Gerontological Nursing, 49(6), 6-12.].

Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care.

INTRODUCTION: With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals. METHODS: Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews. RESULTS: Three themes emerged from the four focus groups (N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices. DISCUSSION: Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.

Updated palliative care competencies for entry-to-practice and advanced-level nursing students: New resources for nursing faculty.

American Association of Colleges of Nursing's Essentials: Core Concepts for Professional Nursing Education (2021) established four spheres of care across the lifespan with diverse populations, one of which is hospice/palliative/supportive care. A team of palliative nursing leaders and nurse educators sought to evaluate alignment of the new Essentials with existing palliative care competency statements. The rigorous process resulted in the revision of these palliative care competency statements to align with the new Essentials more accurately. The second edition of the Competencies And Recommendations for Educating nursing Students (CARES) reflect updated palliative care expectations for entry-to-practice nursing students. Similarly, second edition Graduate Competencies And Recommendations for Educating nursing Students (G-CARES) statements describe advanced-level student competency. The team also aligned CARES/G-CARES (2nd ed.) with the Domains, Competencies, Sub-Competencies, and Concepts of the new Essentials. The updated palliative care competency statements can guide faculty in integrating palliative care education into their programs and assessing alignment of programmatic outcomes with AACN's Essentials hospice/palliative/supportive care sphere of care.

Perceptions, Beliefs, and Experiences of Asians and Micronesian Islanders on Family Health History Genetic Cancer Screening Community Outreach.

Cancer carries stigma, taboos, and shame including, for diverse communities, who can have difficulty understanding and communicating about family health history genetic cancer screening (GCS). The Oregon Health Authority ScreenWise Program reached out to our academic-community research team to explore Asians and Micronesian Islanders (MI) perceptions on public health education outreach on GCS due to having previously only worked with the Latinx community. The purpose of the qualitative description pilot study was to elicit perceptions, beliefs, experiences, and recommendations from Asian and MI community leaders and community members regarding family health history GCS outreach in communities. Twenty Asians (Chinese and Vietnamese) and Micronesian Islanders (Chuukese and Marshallese) were recruited from the US Pacific Northwest. Nineteen participants are immigrants with an average 21.4 and 18.5 years having lived in the USA, respectively. Individual in-depth interviews were conducted using a semi-structured, open-ended interview guide and analyzed using conventional content analysis. Three main transcultural themes were identified: (1) degree of knowing and understanding cancer screening versus family health history GCS, (2) needing culturally relevant outreach messaging on family health history GCS, and (3) communication and decision-making regarding discussing with family and health care providers about cancer screening and GCS. Culturally relevant messaging rather than generic messaging is needed for inclusive outreach. Healthcare providers are encouraged to assess a client's family health history routinely because Asian and MI clients may not understand the information requested, may be hesitant to offer, or unable to provide information about their personal or family history of cancer.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned.

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

Nurse-Led Telephonic Symptom Support for Patients Receiving Chemotherapy.

PROBLEM STATEMENT: The use of evidence-informed symptom guides has not been widely adopted in telephonic support. DESIGN: This is a descriptive study of nurse-led support using evidence-based symptom guides during telephone outreach. DATA SOURCES: Documentation quantified telephone encounters by frequency, length, and type of patient-reported symptoms. Nurse interviews examined perceptions of their role and the use of symptom guides. ANALYSIS: Quantitative data were summarized using univariate descriptive statistics, and interviews were analyzed using directed descriptive content analysis. FINDINGS: Symptom guides were viewed as trusted evidence-based resources, suitable to address common treatment-related symptoms. A threshold effect was a reported barrier of the guides, such that the benefit diminished over time for managing recurring symptoms. IMPLICATIONS FOR PRACTICE: Telephone outreach using evidence-based symptom guides can contribute to early symptom identification while engaging patients in decision making. Understanding nurse activities aids in developing an economical and high-quality model for symptom support, as well as in encouraging nurses to practice at the highest level of preparation.

The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial.

BACKGROUND: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)-a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. OBJECTIVE: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. METHODS: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. RESULTS: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. CONCLUSIONS: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.

Development of a new undergraduate palliative care knowledge measure.

Compassionate, competent, and holistic care is at the core of palliative care nursing. Knowledge of primary palliative care concepts is a fundamental expectation of graduating nursing students. The release of updated national educational competencies in palliative care coupled with a new palliative care curriculum for prelicensure nursing students created a need to measure acquisition of new knowledge. The purpose of this paper is to describe development and psychometric evaluation of a new palliative care measure. Development of the new measure was guided by an expert team of palliative care educators, incorporating existing knowledge measures as well as content from the newly developed curriculum. A 4-step process resulted in development of a 27-item measure reflecting the 17 new core competencies for undergraduate palliative care education. Initial pilot testing in a sample of 262 nursing students demonstrated good internal consistency (Cronbach's α = 0.70), with a 2-factor model that aligns with multiple national expectations for primary palliative care. This study is the first to align knowledge items with national palliative care competencies and care domains. Further psychometric testing will be conducted as well as large multisite research collaborations to test curriculum implementation and use this knowledge measure in prelicensure nursing education.

Development of a New Measure to Assess Primary Palliative Care Perceived Competence.

BACKGROUND: Many nursing schools have begun to address the gap in palliative care education. Recently released entry-to-practice competencies in palliative care can guide educators as they incorporate such material into their curriculum. In an effort to evaluate learning, educators need a reliable instrument that aligns with the updated competencies. PURPOSE: This article describes the development of a new instrument to evaluate perceived competence to provide primary palliative care. METHODS: The psychometric properties and performance of the new instrument in evaluating perceived competence were tested via an interprofessional palliative care simulation with medical, nursing, and social work students. Perceived competence was measured before and after the simulation. RESULTS: The new instrument demonstrates strong reliability and validity, represents a unidimensional construct, and captures changes in perceived competence across time and disciplines. CONCLUSIONS: The new instrument is acceptable for assessing perceived competence to provide palliative care, particularly for nursing students.

Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers.

OBJECTIVE: To identify the unique needs of lesbian, gay, bisexual, and transgender (LGBT) cancer patients and caregivers, and review recommendations supporting more effective and inclusive palliative and end-of-life care. DATA SOURCES: Published research and clinical guidelines. CONCLUSION: Transitions in care raise particular challenges for LGBT patients, including provider communication, perceptions of safety and acceptance, and assessing and respecting patients' definitions of family and spirituality. IMPLICATIONS FOR NURSING PRACTICE: LGBT patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers - and potentially all patients.

Systematic Review of Hospital Readmissions Among Patients With Cancer in the United States.

PURPOSE/OBJECTIVES: To review the existing literature on readmission rates, predictors, and reasons for readmission among adults with cancer.
. DATA SOURCES: U.S.-based empirical studies reporting readmission rates from January 2005 to December 2015 were identified using four online library databases-PubMed, CINAHL®, EconLit, and the online bibliography of the National Cancer Institute's Surveillance Epidemiology and End Results Program. Some articles were identified by the authors outside the database and bibliography searches. 
. DATA SYNTHESIS: Of the 1,219 abstracts and 271 full-text articles screened, 56 studies met inclusion criteria. The highest readmission rates were observed in patients with bladder, pancreatic, ovarian, or liver cancer. Significant predictors of readmission included comorbidities, older age, advanced disease, and index length of hospital stay. Common reasons for readmission included gastrointestinal and surgical complications, infection, and dehydration.
. CONCLUSIONS: Clinical efforts to reduce the substantial readmission rates among adults with cancer may target high-rate conditions, infection prevention, proactive management of nausea and vomiting, and nurse-led care coordination interventions for older adult patients with multiple comorbid conditions and advanced cancer. 
. IMPLICATIONS FOR NURSING: Commonly reported reasons for readmission were nursing-sensitivepatient outcomes (NSPOs), amenable to nursing intervention in oncology settings. These findings underscore the important role oncology nurses play in readmission prevention by implementing evidence-based interventions to address NSPOs and testing their impact in future research.

A Personal Health Network for Chemotherapy Care Coordination: Evaluation of Usability Among Patients.

Cancer is a top concern globally. Cancer care suffers from lack of coordination, silos of information, and high cost. Interest is emerging in person-centered technology to assist with coordination to address these challenges. This study evaluates the usability of the "personal health network" (PHN), a novel solution leveraging social networking and mobile technologies, among individuals undergoing chemotherapy and receiving care coordination. Early results from interviews of 12 participants in a randomized pragmatic trial suggest that they feel more connected to the healthcare team using the PHN, find value in access to the patient education library, and are better equipped to organize the many activities that occur during chemotherapy. Improvements are needed in navigation, connectivity, and integration with electronic health records. Findings contribute to improvements in the PHN and informs a roadmap for potentially greater impact in technology-enabled cancer care coordination.

Predictors of financial difficulties and work modifications among cancer survivors in the United States.

PURPOSE: The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors. METHODS: Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years. RESULTS: Among all survivors, 33.2% reported any financial concern, with 17.9% reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0% made any work modification and 15.3% made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR = 8.0; 95% CI 2.2-28.4]; income <200% of federal poverty level (FPL) [OR = 15.7; 95% CI 2.6-95.2] or between 200 and 400% of FPL [OR = 8.2; 95% CI 1.3-51.4]; residence in a non-metropolitan service area [OR = 6.4; 95% CI 1.6-25.0]; and good/fair/poor self-rated health [OR = 3.8; 95% CI 1.0-14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR = 4.1; 95% CI 1.6-10.2], being married [OR = 2.2; 95% CI 1.0-4.7], uninsured [OR = 3.5; 95% CI 1.3-9.3], or publicly insured [OR = 9.0; 95% CI 3.3-24.4]. CONCLUSIONS: A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance. IMPLICATIONS FOR CANCER SURVIVORS: Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.

A national survey of oncology content in prelicensure registered nurse programs.

The current and projected increase in newly diagnosed cancer patients and survivors supports the nation's need to prepare a nursing workforce that is skilled to meet the health care needs of these individuals. It is likely that cancer patients, especially survivors, will receive care from nurses without specialized oncology education who work in various nononcology clinical settings. Because of the lacking practice standards and educational guidelines for nurses who care for cancer survivors in nononcology settings, this article describes findings of a national survey that identified the importance and depth of cancer-care content included in accredited prelicensure registered nurse programs (diploma, associate and baccalaureate degrees). Findings revealed that a gap exists between respondents' reported importance and depth of cancer-care content currently taught and that importance rated consistently higher than depth taught. Lack of time was the most frequently cited barrier. Results will be used to design generalist oncology resources for nurse educators.