Oncology telepractice orientation program.

Telepractice in oncology is an evolving practice for nurses and cancer patients. Understanding the needs of our patients led the nursing leaders of a large academic teaching centre to undertake the challenge of creating a measurable and sustainable Telephone Readiness Assessment and Orientation Program. The experiences of patients and families regarding telephone interactions triggered the launch of Live Voice Answer, a centre-wide telepractice change. To support the transition from clinic practice to telepractice with the introduction of Live Voice Answer, an orientation program was created to lay the foundation for nurses to provide excellent standardized telepractice care. A Practice Training Process map was designed to depict three stages required to successfully complete the orientation: Telephone Readiness Assessment, Telephone Practice Training session, and Practical Application. The frameworks used to support the Practice Training Process includes COSTaRS, College of Nurses of Ontario Practice Guideline: Telepractice, Cancer Care Ontario: Oncology Nursing Telepractice Standard, Cancer Care Ontario - Symptom Management Guides as well as our organizational policies. Benner's Novice to Expert Theory is also embedded to guide the skill/competency development. The purpose of this manuscript is to describe the telephone practice orientation program and share lessons learned that have contributed to its current evolution.

The implementation of a novel patient symptom screening tool: The Odette Cancer Centre (OCC) experience.

AIM: In 2017, as part of a readiness plan for the launch of a novel symptom screening tool for prostate cancer patients, an interprofessional working group was assembled at Odette Cancer Centre (OCC). A provincial Phase II pilot for the tool had stated (based on stakeholder feedback) that there was a need to: "Develop training and resources for patients and clinicians that facilitate the interpretation of patient reported outcomes measures (PROMs) …." With this recommendation in mind, the working group aimed to develop and implement a training and education plan. The plan would support healthcare professionals (HCPs) in their clinical response to the PROM tool symptom screening scores.The aim was to encourage evidence based symptom management and therefore improve care for patients. PROCESS: A questionnaire was developed to elicit information regarding HCP's comfort level and knowledge related to issues experienced by prostate cancer patients. The issues were categorised according to the domains identified within the screening tool, i.e., bowel, urinary, sexual and hormonal/vitality domains. The questionnaire was emailed to all identified stakeholders via institutional email. Feedback from the questionnaire was utilised to develop an education work plan. Five education sessions were developed with pre session materials shared via email. Each session was evaluated via an anonymous and voluntary three item questionnaire completed at the end of each session. Chart audits of 20 prostate cancer patients' electronic medical records (EMR) were carried out pre and post launch of the education program and the novel screening tool. The audit process was to support assessment of any changes in HCPs clinical response to prostate cancer patient issues. RESULTS: There were 50 responses to the preliminary needs assessment questionnaire (approximately 29% response rate). The sexual health domain was identified as the one with which HCPs had the least knowledge and comfort level. Five education sessions were developed and carried out with an average attendance of 14 HCPs from a variety of disciplines. Feedback demonstrated that the majority of attendees agreed or strongly agreed that the sessions increased their knowledge on each of the topics and that they were deemed useful for their clinical practice.The audit data showed differences in documentation of patient issues pre and post education program and implementation of the novel screening tool. CONCLUSIONS: Employing a systematic approach, with interprofessional engagement, can support successful adoption of new initiatives such as a novel site specific screening tool. Ongoing assessment of HCPs education needs can be carried out using this process. Establishing a database of resources to facilitate independent education may be useful for some HCPs.

Validation of the MENQOL for use with women who have been treated for gynecologic or breast cancer.

PURPOSE: To conduct a psychometric evaluation of the MENQOL, a condition-specific, self-report instrument to assess menopausal symptoms in women with gynecologic and breast cancers. METHODS: Identify face and content validity of the MENQOL with experts, and reliability and construct validity with a group of women diagnosed with cancer who are suffering from treatment-induced menopause. RESULTS: Eighty-two women with treatment-induced menopause completed the MENQOL, EORTC-C30, and the SVQ. The MENQOL was shown to have good face and content validity, and acceptable reliability (homogeneity and test-retest) and validity (concurrent and construct). Additionally, 85.5% of the women reported experiencing hot flashes. However, the most bothersome symptoms were weight gain and fatigue (feeling worn out). IMPLICATIONS: The MENQOL can be used to assess treatment-induced menopausal symptoms in women diagnosed with breast or gynecologic cancer.

A Canadian online survey of oncology nurses' perspectives on the defining characteristics and assessment of breakthrough pain in cancer.

This paper explores oncology nurses' recognition of breakthrough pain in cancer (BTPc), methods they used for identification and assessment, and their perception of the burden to patients. An online questionnaire was distributed to 688 oncology nurses across Canada, and 201 participated. Sixty-four per cent of nurses surveyed reported that 41% to 80% of their patients experience BTPc, but many were unsure of the basic characteristics of the profile of a BTPc episode. Although a minority of respondents (33%) reported they did not use pain assessment tools/guidelines to help diagnose BTPc, those who did largely endorsed their use. Survey findings support the debilitating impact of BTPc, but further education is needed to advance the quality and consistency in pain assessment.

A Canadian online survey of oncology nurses' perspectives on the management of breakthrough pain in cancer (BTPc).

This paper explores Canadian oncology nurses' perception of management of breakthrough pain in cancer (BTPc). An online questionnaire was distributed to 668 oncology nurses across Canada, and 201 participated. More nurses reported that patients used hydromorphone (99.5%), morphine (97.0%), codeine (88.1%), or oxycodone (88.1%) for BTPc, than fentanyl preparations (64.7%). Problems with opioid administration reported by nurses included failure to work quickly enough (35.7%), difficulty swallowing (16.6%), need for caregiver assistance (13.2%), mouth sores (12.6%) and dry mouth (11.5%). Although most nurses discussed BTPc management with their patients, the vast majority (72.2%) were not very satisfied with current treatment modalities. Effective dialogue with patients and access to educational resources/tools may help optimize therapy and enhance concordance with BTPc medications.

Experience of young women diagnosed with breast cancer who undergo fertility preservation consultation.

BACKGROUND: Fertility preservation (FP) is of increasing concern to young patients with breast cancer. The American Society of Clinical Oncology has recommended referral to a reproductive specialist as early as possible before beginning systemic adjuvant therapy. AIM: To gather information from young patients with breast cancer about their experiences with FP referral, consultation, and decision making. METHODS: An anonymous questionnaire was mailed to consecutive patients with breast cancer who were referred, from January 2005 to January 2010, from our center to the CReATe fertility clinic. Topics included demographics; cancer stage and treatment; previous fertility problems; referral source and timing; options presented and chosen; and satisfaction with the referral, consultation, and decision-making processes. RESULTS: Of the 53 women identified, 27 (51%) participated. The mean age was 31 years (range, 24-41 years). Fifteen (56%) women opted for embryo or oocyte cryopreservation, 2 for ovarian suppression, and 10 for no FP. The choice was not affected by disease stage or by already having a child. Of the 22 women who responded, 14 (64%) were satisfied or very satisfied overall. Eighteen out of 23 (78%) respondents felt that the right amount of information was given. Thirty-nine percent had difficulty with decision making, but only 1 (4%) woman indicated that cost was a deciding factor. A common theme among respondents was inadequate time for decision making. A common complaint was the lack of written material before and/or after their consultation. Sixty-three percent expressed an interest in meeting with a psychosocial counselor. CONCLUSIONS: (1) FP referral should be initiated by the surgeon as soon as a diagnosis of invasive cancer is made, (2) women need written materials before and after FP consultation is needed, and (3) a FP counselor who is able to spend additional time after the consultation could help with decision making.