RESUMO
Patient education (PE) is vital in reducing anxiety, increasing satisfaction with treatment, helping with self-management, and creating a sense of control for cancer patients. Patients access much of their material from health care providers through in-person visits, patient libraries, and in-person classes. Due to reductions in in-person visits throughout the pandemic, we sought to understand how PE programs responded under varying levels of COVID-19 restrictions to meet the information needs of patients and families. A cross-sectional survey was distributed to members of the Cancer Patient Education Network (CPEN) and the Health Care Education Association (HCEA) via the respective listservs. The survey consisted of five sections that included closed and opened questions. Participants were asked questions to describe their PE programs and how their duties were affected during the pandemic. Forty-two CPEN members completed the survey (N = 42, 66%) with a 35% response rate and a 55% completion rate, and 19 HCEA members completed the survey (N = 19, 30%) with a 5% response rate and 16% completion rate. The majority of staff surveyed were not furloughed (N = 57/64, 89%). Just under half reported a change in daily PE program activities (N = 23/52, 44%) and most reported a change in developing PE materials (e.g., pamphlets) (N = 10/26, 63%), finding information for patients/families (N = 11/19, 58%), and delivering classes (N = 12/21, 57%). COVID-19 has ushered in a new era in the delivery of PE with the rapid deployment of digital cancer patient education. Results can inform future directions for the delivery of PE post-pandemic.
Assuntos
COVID-19 , Neoplasias , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Inquéritos e Questionários , Ansiedade , Neoplasias/terapiaRESUMO
PURPOSE: Patient education is critical for management of advanced cancer pain, yet the benefits of psychoeducational interventions have been modest. We used mobile health (mHealth) technology to better meet patients' needs. METHODS: Using the Agile and mHealth Development and Evaluation Frameworks, a multidisciplinary team of clinicians, researchers, patients, and design specialists followed a four-phase iterative process to develop comprehensive, tailored, multimedia cancer pain education for a patient-facing smartphone application. The target population reviewed the content and provided feedback. RESULTS: The resulting application provides comprehensive cancer pain education spanning pharmacologic and behavioral aspects of self-management. Custom graphics, animated videos, quizzes, and audio-recorded relaxations complemented written content. Computable algorithms based upon daily symptom surveys were used to deliver brief, tailored motivational messages that linked to more comprehensive teaching. Patients found the combination of pharmacologic and behavioral support to be engaging and helpful. CONCLUSION: Digital technology can be used to provide cancer pain education that is engaging and tailored to individual needs. A replicable interdisciplinary and patient-centered approach to intervention development was advantageous. mHealth interventions may be a scalable approach to improve cancer pain. Frameworks that merge software and research methodology can be useful in developing interventions.
Assuntos
Dor do Câncer , Aplicativos Móveis , Neoplasias , Autogestão , Telemedicina , Tecnologia Biomédica , Dor do Câncer/terapia , Humanos , Neoplasias/complicações , Neoplasias/terapia , Educação de Pacientes como Assunto , Projetos de PesquisaRESUMO
BACKGROUND: Oncology nurses are challenged to coordinate an effective, evidence-based approach to comprehensive patient education, symptom management, and psychosocial support for patients with pancreatic and colorectal cancers during chemotherapy. OBJECTIVES: The purpose of the study was to develop and evaluate a nurse-led psychoeducational intervention using a multimedia tool. METHODS: Development and testing of the intervention was grounded in the Science and Practice Aligned Within Nursing model for evidence-based practice implementation. FINDINGS: Forty-five participants completed the study (29 with pancreatic cancer and 16 with colorectal cancer). Patient knowledge increased significantly in patients with pancreatic cancer following the intervention (p = 0.05).
Assuntos
Assistência Ambulatorial , Cuidados Paliativos , Prática Clínica Baseada em Evidências , Humanos , Enfermagem OncológicaRESUMO
The purpose of this article is to share one institution's intervention to improve oral chemotherapy patient education. The overall aim was to provide clinicians with a single source of educational materials that would meet a diverse group of patients' educational needs and be consistent with published guidelines.â©.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Materiais de Ensino/provisão & distribuição , Acesso à Informação , Administração Oral , Antineoplásicos/efeitos adversos , CD-ROM , Feminino , Humanos , Masculino , Gestão da Qualidade Total , Estados UnidosRESUMO
BACKGROUND: Oncology care is delivered largely in ambulatory settings by interdisciplinary teams. Treatments are often complex, extended in time, dispersed geographically and vulnerable to teamwork failures. To address this risk, we developed and piloted a team training initiative in the breast cancer programme at a comprehensive cancer centre. METHODS: Based on clinic observations, interviews with key staff and analyses of incident reports, we developed interventions to address four high-risk areas: (1) miscommunication of chemotherapy order changes on the day of treatment; (2) missing orders on treatment days without concurrent physician appointments; (3) poor follow-up with team members about active patient issues; and (4) conflict between providers and staff. The project team developed protocols and agreements to address team members' roles, responsibilities and behaviours. RESULTS: Using a train-the-trainer model, 92% of breast cancer staff completed training. The incidence of missing orders for unlinked visits decreased from 30% to 2% (p<0.001). Patient satisfaction scores regarding coordination of care improved from 93 to 97 (p=0.026). Providers, infusion nurses and support staff reported improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of care, and more respectful behaviour (92%, 79%, 83%) and improved relationships among team members (91%, 85%, 92%). Although most clinicians reported a decrease in non-communicated changes, there was insufficient statistical power to detect a difference. CONCLUSIONS: Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination.
Assuntos
Neoplasias da Mama/prevenção & controle , Planejamento Ambiental , Capacitação em Serviço/métodos , Oncologia/normas , Equipe de Assistência ao Paciente/normas , Instituições de Assistência Ambulatorial/normas , Assistência Integral à Saúde , Feminino , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Projetos Piloto , Pesquisa Qualitativa , Medição de RiscoAssuntos
Enfermagem em Saúde Comunitária/organização & administração , Cuidados Paliativos , Preferência do Paciente , Assistência Terminal , Cuidadores , Comunicação , Enfermagem em Saúde Comunitária/economia , Tomada de Decisões , Inglaterra , Feminino , Necessidades e Demandas de Serviços de Saúde , Cuidados Paliativos na Terminalidade da Vida/economia , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Humanos , Masculino , Cuidados Paliativos/economia , Cuidados Paliativos/organização & administração , Satisfação do Paciente , Relações Médico-Paciente , Assistência Terminal/economia , Assistência Terminal/organização & administraçãoRESUMO
Ultraviolet (UV) radiation contained in sunlight is considered a major risk in the induction of skin cancer. While mast cells are best known for their role in allergic responses, they have also been shown to play a crucial role in suppressing the anti-tumour immune response following UV exposure. Evidence is now emerging that UV may also trigger mast cell release of cutaneous tissue remodelling and pro-angiogenic factors. In this review, we will focus on the cellular and molecular mechanisms by which UV recruits and then activates mast cells to initiate and promote skin cancer development.
Assuntos
Mastócitos/efeitos da radiação , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Cutâneas/etiologia , Luz Solar/efeitos adversos , Animais , Histamina/fisiologia , Humanos , Tolerância Imunológica/efeitos da radiação , Interleucina-10/fisiologia , Interleucina-4/fisiologia , Mastócitos/imunologia , Mastócitos/patologia , Mastócitos/fisiologia , Modelos Biológicos , Neoplasias Induzidas por Radiação/imunologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/fisiopatologia , Fator de Crescimento Neural/fisiologia , Neuropeptídeos/fisiologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/fisiopatologia , Fator de Crescimento Transformador beta/fisiologia , Microambiente Tumoral/fisiologia , Fator de Necrose Tumoral alfa/fisiologia , Raios Ultravioleta/efeitos adversos , Fator A de Crescimento do Endotélio Vascular/fisiologiaRESUMO
The cellular and molecular mechanisms by which UV radiation modulates inflammation and immunity while simultaneously maintaining skin homeostasis is complex and not completely understood. Similar to the effects of UV, IL-33 has potent immune-modulating properties that are mediated by the downstream induction of cytokines and chemokines. We have discovered that exposure of mice in vivo or human skin samples ex vivo to inflammatory doses of UVB induced IL-33 expression within the epidermal and dermal skin layers. Using a combination of murine cell lines and primary human cells, we demonstrate that both UV and the oxidized lipid platelet activating factor induce IL-33 expression in keratinocytes and dermal fibroblasts. Highlighting the significance of these results, we found that administering IL-33 to mice in vivo suppressed the induction of Th1-mediated contact hypersensitivity responses. This may have consequences for skin cancer growth because UV-induced squamous cell carcinomas that evade immunological destruction were found to express significantly higher levels of IL-33. Finally, we demonstrate that dermal mast cells and skin-infiltrating neutrophils closely associate with UV-induced IL-33-expressing fibroblasts. Our results therefore identify and support a role for IL-33 as an important early danger signal produced in response to inflammation-inducing UV radiation.