The Nurse Practitioner Role in Complex Malignant Hematology: A Qualitative Descriptive Study.

OBJECTIVES: Internationally, there is limited evidence about the role and impact of nurse practitioners (NPs) in complex malignant hematology (CMH). In one Canadian CMH program, NPs have existed for 20 years but not been evaluated. This study aimed to understand stakeholder perceptions of CMH NP role structures, processes, and outcomes and the extent to which the role meets patient and health service needs. METHODS: A qualitative descriptive study was conducted, guided by the PEPPA-Plus framework. Purposive sampling was used to recruit stakeholders who participated in focus groups and interviews. Content analysis was used to analyze the data. RESULTS: Participants included patients (n = 8) and healthcare professionals (n = 27). Themes about structures related to evolution of the CMH Program, model of care, and need for strategic vision. Process themes related to provision of accessible, comprehensive, and holistic care and NP workload. Positive and negative outcomes and lack of outcome measurement were identified. CONCLUSION: Structures related to patient and NP characteristics, organizational change, staffing, and how NP work is organized impacts on NP role implementation and outcomes. Organizational structures can be strengthened to improve the model of care and NP role implementation and workload. Value-added NP contributions related to providing comprehensive care with attention to safety and social determinants of health. Research is needed to evaluate NP role outcomes in CMH. IMPLICATIONS FOR NURSING PRACTICE: The results can inform role design and organization policies and strategies to promote the recruitment, retention, and optimization of NP roles in CMH settings. Priorities for future research are also identified.

Nursing measures to support the needs of haematological cancer survivors post-treatment: a literature review.

BACKGROUND: Patients with haematological cancers are surviving longer due to increasingly effective treatments. Many patients continue to need support and advice after treatment ends. AIMS: To review the support needs of patients after treatment for haematological cancer, in order to establish nursing measures for supporting them. Methods: A literature review and thematic analysis of six primary research articles. FINDINGS: Three themes were identified: a sense of abandonment, education about late effects, and becoming a survivor. CONCLUSION: Understanding an individual's support needs after treatment for haematological cancer enables nurses to offer sensitive, individualised care to patients. A tailored survivorship plan, led by a specialist nurse, helps to meet the ongoing holistic needs of haematological cancer patients.

Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer.

BACKGROUND: The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES: This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS: NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS: Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Investigating the self-perceived educational priorities of haematology nurses.

PURPOSE: To identify the educational priorities of haematology nurses in relation to nursing care of patients with haematological conditions. METHOD: We used an online survey questionnaire to identify educational priorities and preferences for learning in haematology nurses across a European setting. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between educational needs and demographic variables. RESULTS: 265 nurses from 21 countries responded, the majority being Staff Nurses (37.7%), with >5 years experience in haematology (77.3%) and educated to degree level or above (66.0%). The top 5 educational priorities were disease specific information for lymphoma, disease specific information for leukaemia, management of long-term side effects, understanding the immune system and new treatments in haematology. Demographic variables such as length of experience and patient group cared for influenced some educational priorities. Attending educational conferences was the preferred learning method. CONCLUSIONS: This study provides insight into self-perceived educational priorities for haematology nurses and priorities to inform development of educational initiatives.

Prácticas alternativas al modelo de salud occidental utilizadas por cuidadores de pacientes con neoplasia hematológicas / Alternative practices to the conventional healthcare model used by caregivers of patients hematologic malignancies / Alternativas práticas ao modelo de saúde ocidental, utilizadas pelos cuidadores de pacientes com neoplasia hematológicas

INTRODUCCIÓN: Las neoplasias hematológicas tienen la carga cultural de la palabra cáncer lo cual lleva a los cuidadores a buscar diversas alternativas. OBJETIVO: Describir las prácticas consideradas alternativas al modelo de salud occidental utilizadas para el cuidado de la salud, desde la experiencia de los cuidadores de pacientes adultos con neoplasias hematológicas en un Servicio de Hematología. METODOLOGÍA: Estudio cualitativo descriptivo. Participaron 17 cuidadores de pacientes adultos con neoplasias hematológicas, seleccionados por conveniencia del registro del servicio de Hematología.como técnica de recolección se realizaron dos grupos de DISCUSIÓN: Las sesiones fueron grabadas y transcritas en su totalidad. El análisis se hizo de acuerdo con la propuesta de Janice M. Morse y se efectuó triangulación por parte de investigadores. RESULTADOS: Emergieron tres tipos de prácticas.1. Prácticas espirituales: la voluntad de Dios como influyente en la recuperación. 2. Las prácticas afectivas: los lazos familiares hacen más llevadera la enfermedad y el tratamiento, y 3. Prácticas Corporales: productos de origen, vegetal, animal, semisintético y farmacológicos no convencionales. CONCLUSIÓN: Los cuidadores de la población con Cáncer utilizan prácticas alternativas al tratamiento convencional, por tanto, el equipo de salud no puede ignorarlas y necesita fortalecer la orientación al paciente y sus cuidadores

INTRODUÇÃO: As neoplasias hematológicas têm carga cultural da palavra câncer, levando aos cuidadores das pessoas que o sofrem a procurar diversas alternativas. OBJETIVO: Descrever as práticas consideradas alternativas ao modelo de saúde Ocidental usado para cuidados de saúde, a partir da experiência de cuidadores de pacientes adultos com doenças hematológicas malignas no servicio de Hematologia Hospital San José de Bogotá. METODOLOGIA: Estudo qualitativo descritiva. Participaram 17 cuidadores de pacientes adultos com neoplasias hematológicas, seleccionados por conveniência dos registos do servicio Hematologia.como uma técnica de coleta de informações dois grupos de discussão foram realizadas. As sessões foram gravadas e transcritas em sua totalidade. A análise foi feita de acordo com a proposta Janice M Morse e se efectou uma triangulação foi realizado por pesquisadores. RESULTADOS: Surgiram três tipos de práticas utilizadas para cuidar de pessoas afectadas pela doença hematológica maligna; 1. As práticas espirituais: a vontade de Deus tão influente na recuperação;.2. práticas Affective: laços familiares tornar mais suportável a doença e o tratamento, e 3. práticas corporais: produtos de origem vegetal, animal, semi-sintético e farmacológico não convencional. CONCLUSÃO: Os cuidadores de pessoas com câncer muitas vezes usam alternativa às práticas convencionais de tratamento, assim, a equipe de saúde não pode ignorar esta realidade e precisa de reforçar a orientação aos pacientes e seus cuidadores

INTRODUCTION: Hematological neoplasms have the cultural burden of the word cancer which leads caregivers to look for different alternatives. OBJECTIVE: To analyse the anthropological link between care and tenderness to potentiate care as an essential "way to be" of the human being, who ontological way was born of care and needs care. METHODOLOGY: Descriptive qualitative study. The participants were 17 caregivers, who were selected by convenience. Two discussion groups' sessions were performed. The sessions were recorded and transcribed in full. The analysis followed the Janice M. Morse framework. RESULTS: The findings that emerged permitted an approach toward understanding the practices used to care for patients affected by malignant hematological disease. The practices were organized in three types: 1. Spiritual practices: God's Will as determinant in the recovery process; 2. Emotional Practices: the familiar ties make more bearable the illness and the treatment, and, 3. Corporal practices: origin products, vegetal, animal, semi-synthetic and no conventional pharmacological products. CONCLUSIONS: The utilization of alternative practices is very common by caregivers. Healthcare practitioners cannot ignore this reality and need tools to adequately guide and inform patients and caregivers

How Do Blood Cancer Doctors Discuss Prognosis? Findings from a National Survey of Hematologic Oncologists.

Background: Although blood cancers are accompanied by a high level of prognostic uncertainty, little is known about when and how hematologic oncologists discuss prognosis. Objectives: Characterize reported practices and predictors of prognostic discussions for a cohort of hematologic oncologists. Design: Cross-sectional mailed survey in 2015. Setting/Subjects: U.S.-based hematologic oncologists providing clinical care for adult patients with blood cancers. Measurements: We conducted univariable and multivariable analyses assessing the association of clinician characteristics with reported frequency of initiation of prognostic discussions, type of terminology used, and whether prognosis is readdressed. Results: We received 349 surveys (response rate = 57.3%). The majority of respondents (60.3%) reported conducting prognostic discussions with "most" (>95%) of their patients. More than half (56.8%) preferred general/qualitative rather than specific/numeric terms when discussing prognosis. Although 91.3% reported that they typically first initiate prognostic discussions at diagnosis, 17.7% reported routinely never readdressing prognosis or waiting until death is imminent to revisit the topic. Hematologic oncologists with ≤15 years since medical school graduation (odds ratio [OR] 0.51; confidence interval (95% CI) 0.30-0.88) and those who considered prognostic uncertainty a barrier to quality end-of-life care (OR 0.57; 95% CI 0.35-0.90) had significantly lower odds of discussing prognosis with "most" patients. Conclusions: Although the majority of hematologic oncologists reported discussing prognosis with their patients, most prefer general/qualitative terms. Moreover, even though prognosis evolves during the disease course, nearly one in five reported never readdressing prognosis or only doing so near death. These findings suggest the need for structured interventions to improve prognostic communication for patients with blood cancers.

Improving Transitional Care: The Role of Handoffs and Discharge Checklists in Hematologic Malignancies.

BACKGROUND: Transitional care from inpatient to outpatient settings is a high-risk time for medical errors and missed follow-up appointments. Discharge checklists and handoffs are effective tools that lead to improved quality of care and outcomes. OBJECTIVES: The purpose of this project was to implement an evidence-based discharge checklist and handoff template to improve and standardize transitional care from hospital to home for patients with hematologic malignancies. METHODS: The advanced practice providers (APPs) completed the discharge checklist at least 24 hours prior to discharge. The APPs requested appointments through the electronic health record using the discharge handoff tool. Chi-square analysis and descriptive statistics were used to analyze the data. FINDINGS: Implementation of the discharge checklist resulted in a statistically significant increase in the number of patients who had a follow-up appointment scheduled prior to discharge. The discharge handoff tool standardized communication between inpatient and outpatient providers.

Harnessing the power of clinician judgement. Identifying risk of deteriorating and dying in people with a haematological malignancy: A Delphi study.

AIM: To provide expert consensus on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. BACKGROUND: Identification of people who are at risk of deteriorating and dying is essential to facilitate patient autonomy, appropriate treatment decisions, and effective end-of-life care. DESIGN: A three-step modified Delphi approach. METHODS: The study was conducted over 6 months (September 2015-March 2016) to gather opinion from an international panel of experts (N = 27) on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. The first round was informed by a systematic review of prognostic factors present in the final months of life for people with a haematological malignancy. Consensus was achieved if 70% of responses fell within two points on a seven-point Likert-type scale. FINDINGS: Consensus was achieved on the following 11 clinical indicators: (a) advancing age; (b) declining performances status; (c) presence of co-morbidities; (d) disease status; (e) persistent infections (bacterial and viral); (f) fungal infections; (g) severe graft versus host disease; (h) requiring high care; (i) signs of frailty; (j) treatment limitations; and (k) anorexia and/or weight loss. Consensus was also achieved on associated themes and statements for each indicator. CONCLUSION: The findings of this study indicate that subjective clinician-assessed indicators that are contextually relevant to the nature of haematological malignancies are markers of risk. This study has provided valuable preliminary findings on the topic and will inform future research.

Care Coordination: Overcoming Barriers to Improve Outcomes for Patients With Hematologic Malignancies in Rural Settings.

BACKGROUND: Most patients with cancer experience financial, emotional, and logistical barriers to care that significantly affect their adherence to and successful completion of treatment. However, patients with hematologic malignancies, particularly those who live in rural settings, must also contend with additional challenges. OBJECTIVES: This article aims to synthesize the literature about barriers to timely access to care and to coordination of this care for patients with hematologic malignancies, particularly those in rural settings, as well as identify strategies to improve cancer care delivery for those patients. METHODS: A search of the literature from 2008-2018 pertaining to rural health disparities for patients with hematologic malignancies, along with ways to overcome these disparities, was conducted. FINDINGS: Patients with hematologic malignancies, particularly those who reside in rural settings, face complex barriers to care. These barriers cause emotional and physical distress. A team approach to care coordination that is focused on eliminating these barriers and improving outcomes is needed.

Being on the Frontline: Nurses' Experiences Providing End-of-Life Care to Adults With Hematologic Malignancies.

The aim of this study was to explore the experiences of nurses providing end-of-life care to patients with hematologic malignancies, in a hematology oncology setting, in an acute general hospital. A qualitative hermeneutic phenomenological design was used, and 2 sets of semistructured interviews were conducted with 5 female nurses. The transcribed texts were analyzed using Interpretative Phenomenological Analysis. Two main themes emerged: "battling against medical futility" and "struggling with the emotional burden of care." Nurses perceived that the transfer of these patients at end of life to intensive critical care settings, coupled with the particularly aggressive treatments and corresponding symptom burden, prevented them from experiencing a dignified death. Consequently, nurses struggled with a gamut of emotions that included feelings of helplessness, distress, and compassion fatigue. Providing nursing care at end of life was perceived to be particularly challenging with the younger patients or with those who reminded them of family members. The findings highlight the unique challenges experienced by these nurses and the need to support them in their work with patients having hematologic malignancies at end of life within a well-resourced setting.

Factors influencing infection prevention self-care behaviors in patients with hematologic cancer after discharge.

PURPOSE: The purpose of this study is to investigate the conditions and influencing factors behind infection prevention self-care behaviors performed at home by hematologic cancer patients with a central venous catheter inserted before hospital discharge, and to identify additional external factors influencing these self-care behaviors. METHODS: This is a descriptive survey study conducted with 147 patients with hematologic cancer who were hospitalized and re-admitted to a university hospital in Korea. Infection prevention self-care behaviors, knowledge, and family support were measured using scales developed through a preliminary survey and validity testing. RESULTS: The score for infection prevention self-care behaviors was 3.67 ±â€¯0.81 (out of 5), knowledge was 68.8 ±â€¯18.2 (out of 100), and family support was 4.21 ±â€¯2.14 (out of 7). Infection prevention self-care knowledge (ß = 0.443, p < 0.001) and economic status (ß = 2.102, p = 0.05) both had a significant effect on infection prevention self-care behaviors. The total explanatory power for infection prevention self-care behaviors by two variables was 37.1%. CONCLUSIONS: Infection prevention self-care behaviors were found to be significantly affected by infection prevention self-care knowledge and economic status. Developing and applying effective educational programs to improve infection prevention self-care knowledge will increase self-care behaviors. Additionally, nursing interventions should assess patients' economic status, their performance of oral care and knowledge of central venous catheter management.

Percepção da satisfação profissional de trabalhadores de enfermagem do serviço de hemato-oncologia / Perception of professional satisfaction of nursing workers from a hematooncology unit

Objetivo: investigar a satisfação profissional dos trabalhadores de enfermagem de um serviço de hematooncologia. Método: estudo quantitativo, transversal, com 46 trabalhadores de enfermagem de um serviço de hemato-oncologia. Utilizou-se questionário sociodemográfico e laboral e o Índice de Satisfação Profissional. Realizou-se análise descritiva dos dados. Resultados: evidenciou-se que 80,4% dos trabalhadores referem possuir participação suficiente no planejamento da assistência; 76,1% afirmaram que existe cooperação com a equipe médica e 93,5% concordaram que existe ajuda entre a equipe de enfermagem. Conclusão: ressalta-se a importância de se observar as necessidades dos trabalhadores para realização de suas atividades de forma qualificada e satisfatória.(AU)

[The nurse and ethics in a diagnosis of a serious disease]. / L'infirmière et l'éthique lors d'une annonce de maladie grave.

In the context of the announcement of a diagnosis, a key element of the 2003-2007 cancer plan, nurses spend time with patients to support them and identify their needs. A nurse working in clinical haematology, discusses the specific ethical challenges facing nurses, during these diagnosis consultations and as part of a multidisciplinary team, supporting patients along their care pathway.

The Surprise Question and Identification of Palliative Care Needs among Hospitalized Patients with Advanced Hematologic or Solid Malignancies.

BACKGROUND: Little is known about quality of life (QOL), depression, and end-of-life (EOL) outcomes among hospitalized patients with advanced cancer. OBJECTIVE: To assess whether the surprise question identifies inpatients with advanced cancer likely to have unmet palliative care needs. DESIGN: Prospective cohort study and long-term follow-up. SETTING/SUBJECTS: From 2008 to 2010, we enrolled 150 inpatients at Duke University with stage III/IV solid tumors or lymphoma/acute leukemia and whose physician would not be surprised if they died in less than one year. MEASUREMENTS: We assessed QOL (FACT-G), mood (brief CES-D), and EOL outcomes. RESULTS: Mean FACT-G score was quite low (66.9; SD 11). Forty-five patients (30%) had a brief CES-D score of ≥4 indicating a high likelihood of depression. In multivariate analyses, better QOL was associated with less depression (OR 0.91, p < 0.0001), controlling for tumor type, education, and spiritual well-being. Physicians correctly estimated death within one year in 101 (69%) cases, yet only 37 patients (25%) used hospice, and 4 (2.7%) received a palliative care consult; 89 (60.5%) had a do-not-resuscitate order, and 63 (43%) died in the hospital. CONCLUSIONS: The surprise question identifies inpatients with advanced solid or hematologic cancers having poor QOL and frequent depressive symptoms. Although physicians expected death within a year, EOL quality outcomes were poor. Hospitalized patients with advanced cancer may benefit from palliative care interventions to improve mood, QOL, and EOL care, and the surprise question is a practical method to identify those with unmet needs.

Palliative care in patients with haematological neoplasms: An integrative systematic review.

BACKGROUND: Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. AIM: To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. DESIGN: Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). DATA SOURCES: PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. RESULTS: The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. CONCLUSION: Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.

Oncology Nurse Navigation: Development and Implementation of a Program at a Comprehensive Cancer Center
.

BACKGROUND: Oncology nurse navigation programs enhance coordination of care and patient satisfaction. 
. OBJECTIVES: The objective was to evaluate the effect of oncology nurse navigation on access to care, patient and provider satisfaction, and clinical trial enrollment of patients with hematologic or gynecologic malignancies.
. METHODS: A descriptive cohort study with a historic control was undertaken. Data were collected from electronic health records and patient and provider surveys in two disease-specific groups.
. FINDINGS: A significant decrease in the mean days from first provider visit to first therapy was observed in the hematology population. In both groups, time from contact to first visit and from first visit to initiation of treatment decreased. Mean satisfaction survey scores for both groups were high regarding relationships with the navigator and care received. Providers were highly satisfied with the program, and the navigation program did not increase clinical trials enrollment.

Toxicity Management: Development of a Novel and Immune-Mediated Adverse Events Algorithm
.

BACKGROUND: Novel immunotherapy and biologic agents are being developed with the potential to improve outcomes and reduce long-term toxicities among individuals with hematologic malignancies. These emerging drugs affect neoplastic cells and the surrounding microenvironment, causing unique immune-mediated toxicities.
. OBJECTIVES: The aim was to develop an algorithm for clinical staff to manage unique toxicities associated with next-generation immunotherapies indicated in the hematologic population, using a system-focused approach.
. METHODS: Data were collected using specific toxicities based on the four major novel biologic classes. Immune-mediated adverse events were reported across studies. Based on published literature, institutional experience, and group consensus, a novel algorithm for managing immune-mediated toxicities was created.
. FINDINGS: The development of this treatment algorithm provides a more streamlined approach for managing common but unique toxicities and improves safety, compliance, patient outcome, and quality of life with novel immuno-oncologic agents.

Signs, Symptoms, and Characteristics Associated With End of Life in People With a Hematologic Malignancy: A Review of the Literature.

PROBLEM IDENTIFICATION: Identifying people with hematologic cancer who are at risk of deteriorating and dying is essential to enable open, honest discussions, leading to appropriate decision making and effective end-of-life care.
. LITERATURE SEARCH: PubMed, CINAHL®, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 2005 to December 2015 for descriptive observational studies.
. DATA EVALUATION: Critique of the studies was guided by the Critical Appraisal Skills Programme Cohort Study Checklist.
. SYNTHESIS: Twelve studies were included. The majority of studies (n = 8) sampled patients from palliative populations, and most were retrospective (n = 11). A number of signs, symptoms, and characteristics associated with end of life in people with a hematolgic malignancy were identified, including pain, hematopoietic dysfunction, dyspnea, and reduced oral intake.
. CONCLUSIONS: The studies described a clinical scenario of deterioration, largely in a palliative population. Findings indicate that people with a hematologic malignancy share certain clinical signs of deterioration with other populations and receive a high level of medical interventions at the end of life.
. IMPLICATIONS FOR PRACTICE: Nurses are well positioned to identify many of the signs, symptoms, and characteristics found in this review and can play a key role in identifying when a person is nearing the end of life.

Haematological cancers.

Essential facts Haematological malignancies are a diverse group of cancers that affect the blood, bone marrow and lymphatic systems. The main categories are lymphoma, leukaemia, myeloma, myelodysplastic syndromes and myeloproliferative neoplasms. In addition, there are subtypes of lymphoma and leukaemia, as well as more rare haematological cancers that have their own categories. There are also borderline conditions such as aplastic anaemia and other non-malignant bone marrow failure syndromes. The charity Bloodwise says 38,000 people in Britain are diagnosed every year with blood cancer or a related disorder, making it the country's fifth most common cancer.