Stigma, Communication, and Clinical Oncology Care: Three Case Studies.

BACKGROUND: Health-related stigma can contribute to health inequities and poor outcomes. To address stigma-related issues in clinical oncology care, healthcare providers can identify stigma in clinical practice and apply strategies that reduce stigma. OBJECTIVES: The aim is to identify stigma-related issues experienced by patients with cancer and to present strategies that address stigma-associated barriers to quality clinical oncology care. METHODS: This article presents three case studies that illustrate stigma-associated issues and strategies to address those issues in clinical oncology care. FINDINGS: Identifying intersectional stigmas in clinical care, each case study includes the patient's background information, a social assessment, and a clinical update, as well as an example of dialogue between the nurse and patient. Each case study ends with commentary and questions to further illustrate stigma-related issues in clinical oncology care. Finally, supporting the case studies, the toolbox includes inclusive language; principles of universal precautions to apply to stigma in clinical oncology care; and communication components, strategies, and resources to reduce stigma in clinical oncology care.

Change-of-Shift Report.

This is my final editorial as editor of the Clinical Journal of Oncology Nursing (CJON). And, as with any change of shift, I give this report to the next CJON editor, who will cover this assignment.

Establishing Clinical Evidence to Support Integrative Therapies in Clinical Oncology Care.

Integrative, alternative, and complementary treatments (also referred to as complementary and alternative medicine [CAM]) for patients with cancer are staples of supportive care to manage patient symptoms and enhance patient.

Tackling the Next Pandemic: An Infodemic in Clinical Oncology Care.

While oncology clinicians manage variations of the COVID-19 virus and other infectious threats to their patients, another pandemic has gained momentum and become a core concern of clinical oncology nursing practice.

Rising Prostate Cancer Incidence Rates: What Can We Do About It?

The latest American Cancer Society (ACS, 2023) incidence rates for prostate cancer report an uptick of 3% for the years 2014-2019 after several years of decreased incidence rates; this is the first ACS-reported increase in.

Clinical Oncology Nursing: Will You Leave or Stay?

Anyone who works in clinical oncology care sees it, experiences it, or feels it on a daily basis: a real or perceived shortage of nurses and, specifically, experienced clinical oncology nurses.

Clinical Oncology Nurse Best Practices: Palliative Care and End-of-Life Conversations.

BACKGROUND: Clinical oncology nurses (CONs) support and guide patients and caregivers by encouraging open dialogue and using effective communication skills. Palliative care (PC) and preparing for the end of life require that CONs apply experienced communication skills that are focused, nuanced, and helpful. OBJECTIVES: The aim of this article is to review communication methods and competencies, which can contribute to a best practices foundation for PC-focused conversations with patients and caregivers. METHODS: Expert CONs provided case studies and responded to clinical scenarios, which illustrated and highlighted communication competencies as applied to PC-focused conversations. FINDINGS: To establish communication competencies applied during PC-focused conversations with patients and caregivers, CONs can develop, enhance, and apply timely and effective communication skills in clinical oncology practice. To build a foundation for PC-focused communication competencies, nurses can access PC and communication skill resources, including mentoring by expert interprofessional practitioners from PC teams.

Palliative Care: Building a Foundation for Clinical Oncology Nursing Practice.

As we close out 2022, we offer knowledge and encouragement to oncology nurses to clarify gains, gaps, and guidelines in palliative care.

Introducing the DNP Projects Department.

In 2004, to advance the credibility and education of the advanced practice nurse, member schools affiliated with the American Association of Colleges of Nursing (AACN) began a process to endorse a position statement on the practice doctorate in nursing. With this endorsement of advanced clinical practice nursing education at the doctoral level-an alternative to research-focused doctoral programs-the credential of doctor of nursing practice (DNP) began.

Oncology Nurses: Influencers on Social Media.

As oncology nurses, we know that we can provide our patients and caregivers with fact-based information to help them manage symptoms, support their coping, and provide clarity for their decision-making (Gaguski et al., 2017). The credibility of nurses has been confirmed by multiyear surveys, placing nurses at the top of trusted professions in the United States (Saad, 2020). Our ability as nurses to provide accurate information is one of our nursing superpowers-a way to counteract the slurry of misinformation that unfortunately permeates societal discourse of late.

Cognitive Dysfunction: Common Side Effect.

For cognitive dysfunction, standards of care are based on established evidence-based practice. Cognitive dysfunction is the decline in function in one or more cognitive domains, including attention and concentration, executive function, information processing speed, language, visuospatial skill, psychomotor ability, and/or learning and memory. Cognitive dysfunction occurs in 80% of patients with brain tumors, 40% of patients with acute myeloid leukemia, and as many as 75% of patients with breast cancer.

Constipation: Common Side Effect.

For constipation, standards of care are based on established evidence-based practice. Constipation is the decreased passage of stool characterized by infrequent bowel movements, hard stool, a sensation of abdominal bloating or cramping, straining with bowel movements, and the feeling of incomplete evacuation. Constipation occurs in 43%-58% of people with a diagnosis of cancer.

Distress: Common Side Effect.

For distress, standards of care are based on established evidence-based practice. Distress is a multifactorial and unpleasant emotional experience of a psychological (e.g., cognitive, behavioral, emotional), social, and/or spiritual nature that can interfere with the ability to effectively cope with a cancer diagnosis, physical symptoms and treatment, and long-term consequences of treatment. All patients are expected to experience some level of distress at some point in the cancer trajectory.

Fatigue/Lack of Endurance: Common Side Effect.

For fatigue/lack of endurance, standards of care are based on established evidence-based practice. Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function. Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time. From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.

Genitourinary Distress: Common Side Effect.

For genitourinary distress, standards of care are based on established evidence-based practice. Genitourinary distress is accidental urine leakage that can dampen underwear or saturate clothes. It is a sense of urgency, frequent urination, and/or pain or discomfort when urinating. Genitourinary distress is found in 35%-75% of patients with prostate cancer.

Hot Flashes: Common Side Effect.

For hot flashes, standards of care are based on established evidence-based practice. Hot flashes are a sensation of heat that can be accompanied by facial flushing, perspiration, chills, heart palpitations, night sweats, and anxiety. Hot flashes occur in 51%-82% or women treated for breast cancer and 80% of men treated for prostate cancer with surgical or chemical castration.

Lymphedema: Common Side Effect.

For lymphedema, standards of care are based on established evidence-based practice. Lymphedema is the accumulation of lymph fluid that obstructs the flow of the lymphatic system, causing persistent swelling of the affected body part. Lymphedema is most commonly seen after lymph node dissection or radiation therapy. It occurs in 10%-40% of patients with breast cancer and 80% of patients with lymph node dissection in the groin.

Pain: Common Side Effect.

For pain, standards of care are based on established evidence-based practice. Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain can be acute or chronic. Syndromes include neuropathic pain, chronic pain syndromes, arthralgias, skeletal pain, and gastrointestinal, genitourinary, and pelvic pain. Pain occurs in 59% of patients undergoing treatment and almost 100% of those with advanced disease.

Skin Toxicities: Common Side Effect.

For skin toxicities, standards of care are based on established evidence-based practice. Cancer treatment-related skin toxicities are a frequent and distressing side effect of antineoplastic therapies, particularly chemotherapy and targeted therapies. Toxicities associated can appear as rashes, hand-foot skin reaction, hand-foot syndrome, and hair loss. As many as 90% of patients will experience some skin toxicity at some point in their therapy.

Peripheral Neuropathy: Common Side Effect.

For peripheral neuropathy, standards of care are based on established evidence-based practice. Peripheral neuropathy is disease or dysfunction of one or more peripheral nerves (i.e., motor, sensory, or autonomic), resulting in numbness or weakness. Peripheral neuropathy occurs outside of the brain and spinal cord and is caused by cancer, treatment, or both. Chemotherapeutic agents that can cause peripheral neuropathy include epothilones, platinum analogs, taxanes, and vinca alkaloids, as well as immunomodulating drugs and proteasome inhibitors.