Translation of Evidence-Based Interventions Into Oncology Care Settings: An Integrative Review.

BACKGROUND: Adoption of evidence remains slow, leading to variations in practices and quality of care. Examining evidence-based interventions implemented within oncology settings can guide knowledge translation efforts. OBJECTIVE: This integrative review aimed to (1) identify topics implemented for oncology-related evidence-based practice (EBP) change; (2) describe frameworks, guidelines, and implementation strategies used to guide change; and (3) evaluate project quality. METHODS: PubMed and CINAHL were searched to identify published practice change projects. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. Fifty articles met the inclusion criteria. Data were extracted; content analysis was conducted. The Quality Improvement Minimum Quality Criteria Set guided quality assessment. RESULTS: Topics included infection control/prevention (n = 18), pain/palliative care (n = 13), psychosocial assessment (n = 11), and medication adherence (n = 8). Among the projects, Plan, Do, Study, Act (n = 8) and Lean Six Sigma (n = 6) frameworks were used most. Thirty-six projects identified guidelines that directed interventions. Multiple implementation strategies were reported in all articles with planning, education, and restructuring the most common. Reach, sustainability, and ability to be replicated were identified as quality gaps across projects. CONCLUSION: The EBP topics that emerged are consistent with the oncology nursing priorities, including facilitating integration of EBP into practice. The studies identified used national guidelines and implementation strategies to move evidence into practice. Heterogeneity in measurement made synthesis of findings difficult across studies, although individual studies showed improvement in patient outcomes. IMPLICATIONS FOR PRACTICE: Development of an interprofessional oncology consortium could facilitate a standardized approach to implementation of high-priority topics that target improved patient outcomes, harmonize measures, and accelerate translation of evidence into practice.

Current status and future directions of U.S. genomic nursing health care policy.

BACKGROUND: As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care. PURPOSE: To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation. METHODS: We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health. FINDINGS: Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed. DISCUSSION: Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas. CONCLUSIONS: To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Gender Differences in the Use of Engagement and Disengagement Coping Strategies in Patients With Cancer Receiving Chemotherapy.

OBJECTIVES: To evaluate the relationship between gender and coping strategies in patients with cancer undergoing chemotherapy in outpatient settings. SAMPLE & SETTING: Women (N = 277) and men (N = 293) were recruited from two comprehensive cancer centers, one Veterans Affairs hospital, and four community-based oncology programs. METHODS & VARIABLES: Coping data were obtained from patients with gastrointestinal (n = 412) or lung (n = 158) cancer through the Brief COPE scale. RESULTS: In terms of engagement coping strategies, women reported higher scores for positive reframing, religion, and using instrumental support. Men reported higher scores for humor. In terms of disengagement coping strategies, women reported higher scores for denial, venting, and self-distraction. Men reported higher scores for substance use. IMPLICATIONS FOR NURSING: Gender-based stereotypes of emotional expectations may affect how patients express themselves and the ways in which support is offered. Clinicians should be aware of their own preconceived notions about sex and gender and reflect on how these may influence the psychosocial care they provide.

Glycosylated Hemoglobin A1c and Lack of Association With Symptom Severity in Patients Undergoing Chemotherapy for Solid Tumors.

PURPOSE/OBJECTIVES: To assess the effects of high blood sugar at the levels of diabetic or prediabetic states during cancer treatment because patients undergoing chemotherapy (CTX) experience multiple symptoms that vary among individuals and may be affected by glucose levels. DESIGN: Descriptive, cross-sectional. SETTING: Two comprehensive cancer centers, one Veterans Affairs hospital, and four community-based oncology programs. SAMPLE: 244 outpatients with breast, gastrointestinal, gynecologic, and lung cancers. METHODS: Patients completed demographic and symptom questionnaires. Glycosylated hemoglobin A1c (HbA1c) was evaluated to determine diabetic state. Descriptive statistics and one-way analyses of variance were used in the analyses. MAIN RESEARCH VARIABLES: HbA1c, symptom severity scores, patient and clinical characteristics (e.g., age, gender, comorbidities, sociodemographic information, body mass index [BMI], lifestyle factors). FINDINGS: HbA1c results showed 9% of the sample in the diabetic and 26% in the prediabetic state. Patients in the diabetic state reported a higher number of comorbid conditions and were more likely to be African American. Patients in the prediabetic state were older aged. Patients in the diabetic and prediabetic states had a higher BMI compared to nondiabetic patients. No differences in symptom severity or quality-of-life (QOL) scores were found among the three diabetic states. CONCLUSIONS: This study is the first to evaluate for associations between diabetic states and symptom severity and QOL scores in patients receiving CTX. This study confirmed that older age, as well as having higher BMI and having multiple comorbidities, were associated with increased mean glycemic levels. IMPLICATIONS FOR NURSING: Clinicians should assess and identify patients with diabetes or prediabetes undergoing treatment for cancer. Patients who are older aged, those with a high BMI, and those with multiple comorbid conditions may be at increased risk for higher glycemic states.

Self-management for adult patients with cancer: an integrative review.

BACKGROUND: Individuals with cancer are surviving long term, categorizing cancer as a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. OBJECTIVE: Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. METHODS: PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. RESULTS: Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. CONCLUSIONS: Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. IMPLICATIONS FOR PRACTICE: Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.

Associations between multiple chronic conditions and cancer-related fatigue: an integrative review.

PROBLEM IDENTIFICATION: To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy. LITERATURE SEARCH: A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity.Data Evaluation: The studies were appraised for the clarity and focus of the research question and the appropriateness of the method and research design. A 13-item quality criteria checklist evaluated the data from each article on a 0-2 scale (0 = poor, 1 = fair, 2 = good). DATA ANALYSIS: Of 329 abstracts, 21 studies were included in the analysis. The association of MCC and CRF was mostly reported in aggregate, with a mean of three MCCs per patient.Presentation of Findings: Having one or more other comorbidities was significantly associated with the prevalence and severity of CRF. Specifically, arthritis, hypertension, and cardiac disease, although not consistently or clinically defined across studies, are associated with an increased prevalence and severity of CRF. The association of MCC and CRF prevalence and severity was inconsistent because of the variability in the measures used and the time span identified to measure changes. IMPLICATIONS FOR NURSING PRACTICE: Awareness of the prevalence of MCCs is essential to support patients experiencing CRF. Holistic nursing assessment of the patient's symptoms-with an awareness of MCCs-would help improve symptom management to limit the effect of CRF.

Glycemic control among older adult hematopoietic cell transplant recipients.

Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short-and long-term effects of glycemic status on immune function.