SEEK™: A Program to Implement Evidence-Based Practice and Transform Oncology Nursing Practice.

BACKGROUND: Evidence-based practice (EBP) uses current and best evidence, clinical expertise, and patient values to drive clinical decisions. Organizations struggle with building and sustaining an EBP-focused culture. OBJECTIVES: This article shares the development and implementation of SEEK™ (Spirit of Inquiry, Expanding EBP Knowledge), an educational initiative on how to apply EBP processes at a Magnet®- and National Cancer Institute- designated comprehensive cancer center. METHODS: Participants learned principles of the EBP process using didactic sessions, small group exercises, and article critiques. With mentor guidance, participants searched for and appraised evidence, proposed interventions, designed an implementation plan, and developed metrics to measure results. FINDINGS: To date, 56 SEEK projects are in various stages of development and implementation. Based on postprogram survey results, SEEK participants and mentors demonstrated increased EBP knowledge.

What Are the Ethical Obligations Related to a Request for Nonbeneficial Treatment?

It is common for a headline to proclaim promising results of a new cancer drug and for medical oncology offices to be flooded with calls from patients hoping that this new "miracle" drug offers them a chance of cure. Conf.

Ethics Education: Using Storytelling to Teach Ethics to Novice Oncology Nurses.

BACKGROUND: Oncology nurses face unique challenges in the care of patients from culturally diverse backgrounds. Culture, values, and preferences play important roles in patient decision-making regarding goals of care and treatment. OBJECTIVES: This article describes the content and outcome of an educational seminar for nurse residents, which uses storytelling to highlight the relationship between dynamic cultural influences and ethical decision-making. METHODS: A 75-minute didactic seminar using storytelling, role-playing, and simulation was incorporated into a nurse residency program. Stories illustrate the role of oncology nurses in protecting and advocating for vulnerable patients, respecting and accommodating cultural differences, and increasing self-awareness of personal values that may influence decisions. Tests were administered to participants before, immediately after, and three months after the seminar to measure changes in knowledge. FINDINGS: Over one year, 107 novice oncology nurses, in five cohorts, attended the seminar. Results demonstrated an overall increase and sustainment of knowledge regarding ethical decision-making in nurse residents and illustrated the effectiveness of storytelling as a method to promote ethical decision-making among staff.

What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably?

Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.

Safe and Effective Standards of Care: Supporting the Administration of T-VEC for Patients With Advanced Melanoma in the Outpatient Oncology Setting
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BACKGROUND: Talimogene laherparepvec (T-VEC) is the first oncolytic virus (OV) to demonstrate therapeutic benefit for the treatment of advanced melanoma. As a live virus, the use of T-VEC in medical and surgical outpatient clinics posed challenges. 
. OBJECTIVES: The purpose of this article is to describe the challenges faced when introducing an OV treatment into outpatient clinics and the processes implemented to ensure safety for patients, caregivers, and staff across the care continuum. 
. METHODS: An interdisciplinary team of experts developed and implemented new practices and workflows to support the administration of T-VEC in the outpatient setting. Clinical staff were educated on this new treatment, its indications and side effects, and the practice standards created to support its use. 
. FINDINGS: T-VEC posed safety and logistical challenges that were successfully addressed and implemented. To date, 16 patients with locoregionally advanced melanoma have been treated with T-VEC. No adverse events occurred related to preparation or administration, which opens the door for similar therapies in the future.