Cultural adaptation of the Pan-Canadian Oncology Symptom triage and remote support practice guide for cancer-related fatigue in China: Integration of traditional Chinese medicine nursing evidence.

Objective: This study aimed at culturally adapting pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Cancer-related fatigue (CRF) Practice Guide to enable its use in China. This article focuses on presenting the key cultural adaptation step: supplementing traditional Chinese medicine (TCM) nursing recommendations for CRF symptom management according to evidence. Methods: Guided by A Guideline Adaptation and Implementation Planning Resource (CAN-IMPLEMENT), the process for cultural adaptation of the CRF guide in the COSTaRS project included translation, expert committee review, acceptability and feasibility assessment, and targeted adaptation to include TCM nursing techniques for CRF management via the Delphi method. Results: First, an expert committee of nurses, nurse leaders, and researchers was established. The practice guide was translated and verified by the members of the expert committee. Nurses then rated the practice guide for acceptability and feasibility. Concurrently, 83 stakeholders (nurses and patients) identified five relevant TCM nursing techniques: acupuncture, moxibustion, acupressure therapy, Taijiquan, and auricular acupoint embedding. A systematic review of literature identified three clinical practice guidelines and four systematic reviews. Through two rounds of Delphi expert consultation, five TCM care strategies were added into the culturally adapted COSTaRS practice guide. Conclusions: Cultural adaptation of the Canadian CRF practice guide involved not only language translation but also the addition of relevant TCM evidence. Combining TCM evidence and the Delphi method was a novel aspect of the cultural adaptation process. Further research is needed to investigate the implementation of the guide in appropriate settings in China.

Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management.

Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.

Approaches to considering sex and gender in continuous professional development for health and social care professionals: An emerging paradigm.

Consideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.

Getting a Picture.

Delivery of care by nurses in virtual environments is rapidly increasing with uptake of digitally mediated technologies, such as remote patient monitoring (RPM). Knowing the person is a phenomenon in nursing practice deemed requisite to building relationships and informing clinical decisions, but it has not been studied in virtual environments. PURPOSE OF STUDY: The intent of this study was to explicate the processes of how nurses come to know the person using RPM, one form of telehealth technology used in a virtual environment. STUDY DESIGN AND METHOD: The study was informed by Charmaz's constructivist grounded theory and included 33 interviews and 5 observational experiences of nurses using RPM in 7 different settings. FINDINGS: Getting a Picture evolved as the core category to a theoretical conceptualization of nurses knowing the person through use of RPM and other technologies, such as telephone and electronic medical records. Getting a Picture reflected a dynamic flow and integration of seven processes, such as Connecting With the Person and Recording and Reflecting, to describe how nurses strove to attain a visualization of the person. CONCLUSIONS: While navigating disparate and disconnected information and communication technologies, Getting a Picture was important for providing safe, holistic, person-centered care.

Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer.

PURPOSE: For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms. METHODS: The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data. RESULTS: Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management. CONCLUSIONS: High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.

Training oncology nurses to use remote symptom support protocols: a retrospective pre-/post study.

PURPOSE/OBJECTIVES: To evaluate the impact of training on nurses' satisfaction and perceived confidence using symptom protocols for remotely supporting patients undergoing cancer treatment. DESIGN: Retrospective pre-/post-study guided by the Knowledge-to-Action Framework. SETTING: Interactive workshops at three ambulatory oncology programs in Canada. SAMPLE: 107 RNs who provide remote support to patients with cancer. METHODS: Workshops included didactic presentation, role play with protocols, and group discussion. Post-training, a survey measured satisfaction with training and retrospective pre-/post-perceived confidence in the ability to provide symptom support using protocols. One-tailed, paired t-tests measured change. MAIN RESEARCH VARIABLES: Satisfaction with the workshop and perceived confidence in the ability to provide symptom support and use protocols. FINDINGS: Twenty-two workshops, 30-60 minutes each, were conducted with 107 participants. Ninety completed the survey. Compared to preworkshop, postworkshop nurses had improved self-confidence to assess, triage, and guide patients in self-care for cancer treatment-related symptoms, and use protocols to facilitate symptom assessment, triage, and care. Workshops were rated as easy to understand, comprehensive, and provided new information on remote symptom management. Some specified that the workshop did not provide enough time for role play, but most said they would recommend it to others. CONCLUSIONS: The workshop increased nurses' perceived confidence with providing remote symptom support and was well received. IMPLICATIONS FOR NURSING: Subsequent workshops should ensure adequate time for role play to enhance nurses' skills in using protocols and documenting symptom support.

Developing an operational model for an integrative oncology program: a qualitative descriptive feasibility study.

PURPOSE: We describe a descriptive qualitative study with the purpose of assessing the feasibility of developing an integrative oncology program in our region. METHODS: We conducted 39 interviews and two focus groups (n = 20) with cancer patients, their caregivers and complementary and conventional (n = 15) healthcare professionals. RESULTS: One primary theme emerged, acceptance or tolerance of an integrative oncology program, which represents concepts within four emergent categories: (1) operational model; (2) values to guide an integrative oncology program; (3) physical location and design; and (4) facilitators and barriers to establishing an integrative oncology program. CONCLUSIONS: The study was instrumental in establishing support for an integrative oncology program in our region, including a feasible model. Based in part on the results of this study, the Ottawa Integrative Cancer Centre ( www.oicc.ca ) opened in November 2011. We recommend a similar process of stakeholder engagement for others who wish to develop an integrative program in their location.

Evaluation of a natural health product decision aid: a tool for middle aged women considering menopausal symptom relief.

OBJECTIVE: To evaluate the effectiveness of a self-administered decision aid for menopausal women facing decisions about natural health products. STUDY DESIGN: This pre-/post-test study included peri- or post-menopausal women, aged 45-64 considering the use of a natural health product for management of menopausal symptoms. They were recruited from a Women's Health Center. OUTCOME MEASURES: The primary outcome was decisional conflict and secondary outcomes included knowledge, strength of values, and decision preference. RESULTS: Of 24 women, the typical participant was 50-64 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 24% (p<0.001) and knowledge improved from 76% to 87% (p=0.001). Of the 24 women, 10 were unsure of their choice at baseline and 3-post use of the decision aid (p=0.015). There was a trend for women preferring natural health products (n=12) to be more likely to rate the non-chemical aspect as important and the cost of the natural health product as less important; women who preferred not to take natural health products (n=3) rated the non-chemical aspect as less important and the costs as more important. CONCLUSIONS: The natural health product decision aid improved the quality of decisions by enhancing knowledge and reducing decisional conflict. As well, women were more likely to make a choice that was consistent with their values.

Patient decision aid on natural health products for menopausal symptoms: randomized controlled trial.

OBJECTIVE: To evaluate the impact of a patient decision aid (PDA) regarding the use of natural health products (NHPs) at menopause on decisional conflict, knowledge of NHPs, congruence between values and choice, persistence with an option, intention to disclose the use of NHPs to a physician or a pharmacist and intention to use decision support interventions in the future. STUDY DESIGN: A randomized controlled trial in which 90 women, aged 45-64 years, facing a decision about using NHPs for menopausal symptoms, received a PDA (experimental group) or a general information brochure about menopause (control group). Main outcome Decisional conflict. Measures Women were evaluated at baseline and after a two-week period using the decisional conflict scale (DCS). Analysis of covariance was used to determine the differences between both groups on the DCS. RESULTS: Both groups experienced a statistically significant reduction on the DCS (-0.55 +/- 0.59, P < 0.0001 versus -0.52 +/- 0.73, P < 0.0001). However, there was no statistically significant difference between the groups (P = 0.32). Both groups experienced a statistically significant improvement in knowledge of NHPs (0.86 +/- 1.77, P = 0.002 versus 0.51 +/- 1.47, P = 0.031). However, there was no statistically significant difference between the groups (P = 0.162). CONCLUSION: A PDA regarding the use of NHPs for menopausal symptoms impacted favourably on women's decisional conflict, but was not superior to a general information brochure on menopause.

Women's decision making about the use of natural health products at menopause: a needs assessment and patient decision aid.

OBJECTIVE: To identify the decision-making needs of women about the use of natural health products (NHP) at menopause and to develop a decision aid responsive to their needs. DESIGN: A qualitative study using focus groups, key informant interviews and group consultation. Content analysis was guided by the Ottawa Decision Support Framework. METHODS: Six focus groups with menopausal women aged 45 to 64 (n = 40) and key informant interviews (n = 15; physicians, nurses, women' s advocacy group, NHP stores owners, pharmacists, policy makers) were conducted in two Canadian cities. Two groups of menopausal women (n = 11) were consulted to obtain feedback on the acceptability of the new patient decision aid. RESULTS: The most common difficult decisions identified by women were: whether or not to take NHP; which NHP to choose; and whether or not to take anything for menopausal symptoms. In addition, key informants identified the challenge of choosing between hormone therapy and NHP for menopausal symptoms. The main sources of difficulty in making these decisions were the following: (1) inadequate knowledge and unrealistic expectations associated with NHP; (2) closed mindedness of physicians to discussion about NHP; (3) conflicting opinions of others; (4) inadequate resources to support NHP decision-making (e.g., information, finances, time); and (5) menopausal symptoms interfering with decision-making (e.g., lack of sleep due to hot flashes). To facilitate decision making, participants suggested the need for information about available choices, tighter regulation of NHP by the government, and access to health professionals conversant in NHP and medical options. The patient decision aid was developed according to the International Patient Decision Aid Standards and based on women' s identified needs. Women described the aid as easy to understand and useful for considering the decisions about NHP. CONCLUSIONS: Middle-age women reported difficulty when facing decisions about the use of NHP. Many sources of difficulty could be addressed in the patient decision aid. Subsequent studies should evaluate the effect of this decision aid on the decision-making process of women.