Values Assessment Tools in Advanced Cancer: A Clinical Literature Review.

BACKGROUND: Patients with advanced cancer may receive cancer treatment that does not reflect their values because they may not be completely aware of what is important to them regarding treatment-related decisions when they are diagnosed. OBJECTIVES: The purpose of this review was to determine whether existing values assessment tools can improve awareness of treatment-related decisional values in patients with advanced cancer. METHODS: PubMed®, CINAHL®, and PsycINFO® databases were searched for original English-language articles evaluating values assessment tools that could be used to assess patients with advanced cancer. The quality of the identified tools was evaluated using selected International Patient Decision Aid Standards instrument, version 3.0, criteria. FINDINGS: All tools identified are appropriate for use in patients with advanced cancer. Two scored at least 80% on the selected International Patient Decision Aid Standards criteria. The Short Graphic Values History Tool was developed with patient and clinician input and may be particularly useful for low-literacy patient populations with advanced cancer. No values assessment tools have been identified specifically for use in patients with advanced cancer.

Screening for the social determinants of health: Referring patients to community-based services.

BACKGROUND: Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. LOCAL PROBLEM: Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. METHODS: A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. INTERVENTIONS: Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. RESULTS: Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. CONCLUSION: The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.

Gender-Affirming Sexual Assault Nurse Examiner Care: A Program Evaluation and Quality Improvement Project at a Community-Based Rape Crisis Center.

BACKGROUND: Transgender and non-binary (trans*) individuals face disproportionately high rates of sexual violence yet experience discrimination at rape crisis centers (RCCs). Sexual assault nurse examiners (SANEs) who receive targeted education are better equipped to care for the trans* community. AIMS: This quality improvement project aimed to increase SANEs' self-perceived competence in caring for trans* assault survivors. The secondary purpose was to promote a trans*-inclusive environment at an RCC based on an environmental assessment. METHODS: The project involved creating and implementing a virtual continuing education course on providing gender-affirming and trans*-specific care for sexual assault survivors and an environmental evaluation at an RCC. A questionnaire measured SANEs' perceived competency pretraining and posttraining, and paired t tests were conducted to examine the change in competencies. A modified assessment tool was used to evaluate the RCC's capacity for addressing trans* survivors needs. RESULTS: The training increased self-perceived competency in all four components measured ( p < 0.005). More than one third of participants (36.4%, n = 22) indicated having no expertise, and 63.7% reported having some expertise in caring for trans* clients. Two thirds (66.7%) had prior trans*-specific training; however, only 18.2% received trans*-specific content in their SANE training. Most strongly agreed (68.2%) they would benefit from additional training. The organizational assessment identified key areas for improvement. CONCLUSIONS: Trans*-specific training can significantly impact SANEs' self-perceived competency in caring for trans* assault survivors and is feasible and acceptable. This training could have a global impact on SANEs if disseminated more widely, particularly with inclusion in SANE curriculum guidelines.

Assess and address: Screening and management of depression in patients with chronic heart failure.

BACKGROUND: About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF. LOCAL PROBLEM: Depression screening was not being systematically implemented in an outpatient cardiology clinic. METHODS: To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms. INTERVENTION: A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan. RESULTS: Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan. CONCLUSIONS: We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.

A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting.

Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45-60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.