Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses.

OBJECTIVES: This discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. METHODS: Relevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. RESULTS: TGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. CONCLUSION: APNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. IMPLICATIONS FOR NURSING PRACTICE: APNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.

Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review.

Background: There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims: This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods: A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results: We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion: Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.

Addressing vaccine hesitancy and resistance for COVID-19 vaccines.

The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.

Outcome measures of palliative care programs and interventions implemented in nursing homes: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and map the outcomes reported from evaluations that measure the effectiveness and acceptability of palliative care programs and interventions in residential aged care facilities. INTRODUCTION: As the population ages, there is increasing attention on implementing new interventions and programs to improve palliative care in residential aged care facilities. However, there is no standard evaluation for intervention implementation. Mapping the outcome measures used in evaluations of diverse palliative care interventions in residential aged care facilities has not been explored recently. INCLUSION CRITERIA: This review will consider studies involving older adults (aged 50 years and above) in any country living and receiving care in residential aged care facilities. This review will exclude literature that focuses on other age groups, and people receiving palliative care in other care settings, such as hospitals, palliative care inpatient units, sheltered housing, cancer centers, own homes, and hospices. METHODS: This scoping review will follow the JBI methodology for scoping reviews. This scoping review will identify both published and unpublished (eg, gray literature) primary studies, as well as reviews. The databases to be searched for published studies will include MEDLINE, Emcare, ProQuest, Embase, PsycINFO, Web of Science, Scopus, and the Cochrane Library. The search will be limited to evidence published in English from 2008 to the present. Visual, tabular, and accompanying narrative summaries will be used to present the results.

Culturally safe, high-quality breast cancer screening for transgender people: A scoping review protocol.

AIM: To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people. DESIGN: The scoping review will follow the JBI methodological guidance for scoping reviews. METHODS: A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion. Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020. DISCUSSION: There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female. IMPACT: It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people.

Nurse-initiated protocols in the emergency department management of pediatric oncology patients with fever and suspected neutropenia: a scoping review protocol.

OBJECTIVE: The objective of this review is to provide an overview of the existing evidence regarding nurse-initiated protocols in the emergency department management of pediatric oncology patients with fever and suspected neutropenia. INTRODUCTION: Febrile neutropenia in pediatric oncology patients poses a significant burden of increased morbidity and mortality. Prompt, efficient emergency care and rapid antibiotic administration within 60 minutes of presentation to hospital is required to prevent clinical deterioration and reduce rates of intensive care admission and mortality. Efficient emergency department care delivery is impacted by modern day challenges, such as increasing user-demand, limited resources, and lack of flow. In response to this, to expedite care provision, practice guidelines have been developed to include nurse-initiated protocols that guide nurses to initiate specific predetermined investigations and interventions for patients meeting certain criteria. Febrile neutropenic pediatric patients may be a specific group that can benefit from nurse-initiated protocols due to the time-critical nature of required care. INCLUSION CRITERIA: The scoping review will consider literature that reports on nurse-initiated protocols in the management of pediatric febrile oncology patients with suspected neutropenia in the emergency department setting. METHODS: JBI methodology for scoping reviews will guide the review process. English-language literature from 2000 to present will be searched in Embase, MEDLINE, Scopus, Emcare, CINAHL Plus, and gray literature in Google Scholar, Open Grey, and Theses Global. Critical appraisal will not be performed. A tabular and accompanying narrative summary of the information will present extracted evidence aligned to the review's objective and questions.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis.

OBJECTIVES: To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority. METHODS: A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis. RESULTS: Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum. CONCLUSIONS: Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.

Management of skin toxicity caused by epidermal growth factor receptor inhibitors: an evidence-based implementation project.

BACKGROUND: Epidermal growth factor receptor inhibitors (EGFRIs) bind to and inhibit epidermal growth factor receptors (EGFRs) in cancer cells, slowing/preventing tumor growth. As a type of "targeted therapy", they have demonstrated therapeutic effects on solid tumors including colorectal, lung, and head and neck cancers. While effective, various skin reactions are associated with EGFRI therapy which can lead to dose modification or discontinuation as well as discomfort, pain and reduced quality of life. With adequate knowledge and skills, EGFRI-induced skin toxicity can be effectively managed collaboratively by clinicians and people affected by cancer. OBJECTIVES: This project aimed to improve management of skin toxicity caused by EGFRIs by implementing evidence-informed practice within a chemotherapy department. METHODS: Evidence-informed recommendations for practice and corresponding audit criteria were developed based on a series of literature reviews. Current practice was reviewed against these criteria with 19 nurses and 21 patients within a chemotherapy department. Barriers to adherence to evidence-informed practice were identified and strategies to improve compliance were implemented with clinicians and patients. A follow-up audit against the criteria was used to measure changes in clinical practice. RESULTS: Multiple strategies for getting research into practice appear to have been successful. The follow-up audit demonstrated large improvements in compliance across all audit criteria in comparison with baseline results with all but one criterion achieving 100% compliance. Low rates of suspected infection meant that clinical practice could not be measured for criterion 7. CONCLUSIONS: Auditing current practice and implementation of strategies to improve compliance with evidence-informed practice were effective. Sustaining these improvements is vital to ensure clinical practice continues to support better patient outcomes.

Patient-reported outcomes following neoadjuvant chemotherapy or chemoradiotherapy treatment for esophageal cancer: a scoping review protocol.

REVIEW OBJECTIVE: The objective of this scoping review is to identify, describe and compare studies investigating patient-reported outcomes (PROs) in esophageal cancer patients following neoadjuvant (preoperative) chemotherapy (CT) and surgery or neoadjuvant chemoradiotherapy (CRT) and surgery.After preliminary searching of the literature and consultation with experts in the fields of esophageal cancer surgery, behavioral science, information systems and scoping review methodology, the following research objectives were defined as follows.

Pediatric tonsillectomy quality of life assessment instruments: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to investigate quality of life (QoL) questionnaires available to pediatric patients following tonsillectomies with or without adenoidectomies for chronic infection or sleep-disordered breathing (SDB). The scoping review will aim to map the components of each QoL questionnaire assessed including frequency of use, age parameters, respondent, domains assessed, format and psychometric properties. Questionnaire format will be summarized into respondent and administrator burden by identifying the number of questions present, scale utilized and time to completion. The scoping review will report on whether psychometric analysis in terms of test reliability and validity was assessed in the included papers as well as the results of those assessments.Specifically, the review question is: what QoL questionnaires are available for pediatric patients following tonsillectomies with or without adenoidectomies for chronic infections or SDB?

Scoping review of pediatric tonsillectomy quality of life assessment instruments.

OBJECTIVES/HYPOTHESIS: Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. STUDY DESIGN: A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. METHODS: Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. RESULTS: Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. CONCLUSIONS: This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. LEVEL OF EVIDENCE: NA Laryngoscope, 127:2399-2406, 2017.

Methotrexate-induced toxicity pharmacogenetics: an umbrella review of systematic reviews and meta-analyses.

PURPOSE: Methotrexate chemotherapy is associated with various toxicities which can result in the interruption or discontinuation of treatment and a subsequently raised risk of relapse. This umbrella systematic review was conducted to synthesize the results of all existing systematic reviews that investigate the pharmacogenetics of methotrexate-induced toxicity, with the aim of developing a comprehensive reference for personalized medicine. METHODS: Databases searched were PubMed, Embase, JBI Database of Systematic Reviews and Implementation Reports, DARE, and ProQuest. Papers were critically appraised by two reviewers, and data were extracted using a standardized tool. RESULTS: Three systematic reviews on methotrexate-induced toxicity were included in the review. Meta-analyses were reported across Asian, Caucasian, pediatric and adult patients for the MTHFR C677T and A1298C polymorphisms. Toxicity outcomes included different forms of hematologic, ectodermal and hepatic toxicities. Results varied considerably depending on the patient groups and subgroups investigated in the different systematic reviews, as well as the genetic models utilized. However, significant associations were found between the MTHFR C677T allele and; hepatic toxicity, myelosuppression, oral mucositis, gastrointestinal toxicity, and skin toxicity. Additionally, limited evidence suggests that the MTHFR A1298C polymorphism may be associated with decreased risk of skin toxicity and leukopenia. CONCLUSION: This umbrella systematic review has synthesized the best available evidence on the pharmacogenetics of methotrexate toxicity. The next step in making personalized medicine for methotrexate therapy a clinical reality is research on the effectiveness and cost-effectiveness of MTHFR genotype testing to enable the close monitoring of at-risk patients for the timely initiation of rescue therapies.

Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: A systematic review.

OBJECTIVES/HYPOTHESIS: Dysphagia is still a treatment-related morbidity, despite advances in treatment modalities for oral and oropharyngeal squamous cell carcinoma. This systematic review aimed to analyze the effects of swallowing outcomes of patients with oral or oropharyngeal squamous cell carcinoma treated with primary surgery with primary free flap reconstruction, with or without adjuvant therapy, for patients undergoing treatment with curative intent. STUDY DESIGN: A comprehensive search strategy was undertaken across MEDLINE, CINAHL, Embase, and Scopus. Gray literature was sought through Cochrane Central Register of Controlled Trials, MedNar, and ProQuest. METHODS: Studies included patients with oral cavity or oropharyngeal squamous cell carcinoma treated with primary surgery with primary free flap reconstruction. Swallowing function was the primary outcome, evaluated at 6 months or later following surgery. Methodological quality and data extraction was conducted as per the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and standardized data extraction tool. RESULTS: Fifteen articles comprising eight cohort studies and seven case series were included. Postoperative radiotherapy and oropharyngeal resections were demonstrated to be associated with increased dysphagia. CONCLUSION: Advanced tumor-node-metastasis stage and use of adjuvant radiotherapy has been shown to have negative impacts on swallowing function. The majority of patients were able to have gastrostomy tubes removed at 6 months following curative therapy. Larger flap mass for the reconstruction of oral and oropharyngeal defects appeared to improve swallowing outcomes. A protocol for the identification of patients at high and low risk of developing dysphagia is proposed. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:1572-1580, 2016.

Multidimensional rehabilitation programs for adult cancer survivors.

To assess the effectiveness of multidimensional rehabilitation programs (MDRPs) in terms of maintaining or improving the physical and psychosocial well-being of adult cancer survivors.