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. 2025 Mar 1;52(2):1–67. doi: 10.1188/25.ONF.E12

Podium Abstracts

PMCID: PMC12404697

Footnotes

Each abstract has been indexed according to first author. Abstracts appear as they were submitted and have not undergone editing or the Oncology Nursing Forum’s review process. Only abstracts that will be presented appear here. For ONS Congress® scheduling information, visit https://www.ons.org/education-hub/events/ons-congress.

Data published in abstracts presented at the 50th Annual ONS Congress are embargoed until the conclusion of the presentation. Coverage and/or distribution of an abstract, poster, or any of its supplemental material to or by the news media, any commercial entity, or individuals, including the authors of said abstract, is strictly prohibited until the embargo is lifted. Promotion of general topics and speakers is encouraged within these guidelines.

Oncology Nursing Forum. 2025 Mar 1;52(2):3.

01. Implementation of the Respiratory Distress Observation Scale for End-of-Life Patients in the Inpatient Setting

Kristi Adams 1

Significance & Background

Effectively caring for an end-of-life patient requires acute inpatient nurses to shift their paradigm from curing to caring. The goal of facilitating a peaceful death leaves nurses feeling unequipped and distressed in providing appropriate nursing care. With no objective assessment tool to assess patients at the end of life, nurses inexperienced in end-of-life care have limited guidance on symptom identification and treatment, leading to a fear of administering the last dose. Using a standardized assessment tool gives nurses the ability to identify and treat dyspnea at the end of life, eliminating the fear of the last dose.

Purpose

To determine if the implementation of the Respiratory Distress Observation Scale (RDOS) effects nurse’ confidence in treating dyspnea at the end-of-life.

Interventions

The Palliative Care Self-Efficacy Scale (PCSES) was selected as a validated and reliable tool to evaluate nurse confidence in treating terminal dyspnea before and after the implementation of the RDOS. The PCSES is a 12-question survey aiming to assess healthcare professionals’ self-efficacy in communication, patient symptom management, and multidisciplinary teamwork when caring for a palliative care patient.

Results

23 eligible nurses successfully completed both the pre and post PCSES. The paired t-test was selected to further evaluate the mean changes in nurse confidence as reported in the pre- and post-PCSES. The mean responses to Question 9 on the pre-PCSES for group one was lower than the mean responses to Question 9 on the post-PCSES for group two, indicating an increase in the rated level of nurse confidence in treating dyspnea at the end of life. A very statistically significant difference was noted in PCSES scores before and after the implementation of the RDOS.

Discussion

The data analysis proves that utilization of the RDOS has a significant and positive impact on nurses’ confidence in treating dyspnea at the end-of-life. Providing nurses with a standardized tool to assess dyspnea at the end-of-life can greatly impact patient care and decrease suffering. As national trends in hospice care continue to increase, acute inpatient units should expect to continue to experience hospice general inpatients. Inpatient nurses must be provided with the tools to care for these patients accurately and consistently. The RDOS provides nurses with a standardized tool that increases their confidence in managing dyspnea at the end-of-life, improving patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):3–4.

02. Implementing a Safe and Cost-Effective Outpatient Desensitization Protocol for Platinum Drugs: Transitioning from ICU to Outpatient Setting - An Evidence-Based Practice Project

Tahani Al Dweikat 1, Mary Shields 2

Significance & Background

Desensitization therapy allows patients to safely receive medications to which they have developed hypersensitivity reactions (HSRs). This approach is crucial for platinum-based chemotherapeutic agents, which induce HSRs. Traditionally, desensitization were administered in intensive care units (ICUs). However, high ICU bed demand necessitates exploring alternative settings while maintaining patient safety. Few studies show that desensitization protocols are safe and effective with success rates of 95–99% in various settings (Kendirlinan et al., 2019), however with limited information about the setting and implementation required to perform this safely. Recent research has demonstrated the feasibility of outpatient platinum desensitization with continuous cardiac monitoring (Vetter et al., 2019).

Purpose

This project evaluates the safety, feasibility, and cost-effectiveness of implementing an outpatient desensitization protocol for platinum drugs in patients with HSR history.

Interventions

An Evidence-Based Practice project was developed from January 2024 with multidisciplinary teams & stakeholders (medical director, pharmacy, infusion nursing).The outpatient desensitization protocol, implementation process included:

  • ■ Telemetry monitoring to assess rhythm changes

  • ■ Nurse training in telemetry use and monitoring, BLS is enough

  • ■ Treatments on Tuesdays, Wednesdays, and Thursdays, which designated for 24-hour operation service

  • ■ Nurse-to-patient ratio 1:1

  • ■ Guidelines developed for escalation of EKG changes during therapy

  • ■ Premedication regimens as per protocol

The first outpatient desensitization was conducted on June 24, 2024, initiating of therapy, data collection and evaluation of the project.

Results

From June 24 to present, 10 patients were treated as outpatients and still ongoing. One experienced a grade 1 HSR but continued treatment safely. No ryhtem changes were reported. Telemetry monitoring and escalation guidelines allowed early detection and management of potential reactions with process to call for rapid response team if occurred. All patients completed treatments without transfer to inpatient or ICU. This approach reduced ICU resource burden while maintaining high-quality care, suggesting cost-effectiveness. Our success rates align with studies showing 95–99% of patients receiving full target doses, with 20–40% experiencing mild to moderate breakthrough reactions (Kendirlinan et al., 2019).

Discussion

Our findings suggest that outpatient desensitization therapy can be safely administered with appropriate measures. This approach addresses better utilization of ICU beds while providing necessary cancer treatment in outpatient settings. This project demonstrates effective management outside the ICU setting, with success rates. This strategy improves resource utilization, reduces healthcare costs, and enhances patient experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):4.

03. Navigating Change: Normal Saline as the Preferred Choice for Port Maintenance

Suzie Allen 1, Kate Burkhart 2

Significance & Background

The use of implanted ports is an integral part of daily clinical routine in an oncology setting, facilitating timely administration of therapy and reducing interruptions in treatment due to access issues. However, complications exist due to the use of these central lines, such as occlusion, which can lead to costly catheter replacement. Traditionally, nursing indwell low-dose heparin to maintain catheter patency and prevent thrombosis.

Purpose

The use of only normal saline (NS) for flushing ports has gained attention as a potential alternative to heparin, reducing costs and the risk of heparin-induced thrombocytopenia. Nurses questioned the continuing use of heparin while other academic centers have discontinued it and converted to NS-only with push-pause method. The aim was to evaluate the efficacy and safety of a push-pause technique using NS for flushing ports instead of heparin at a NCI-designated Comprehensive Cancer Center.

Interventions

CLABSI system, CheQS, and leadership approved the EBP change project. An e-learning module with pre-test, post-test and CE were completed by nursing. Flushing champions were assigned to support education and implementation. Patients were provided with an education sheet. Fall 2023, five sites converted all port patients to NS flushing and monitored, using tPA pulls to assess occlusion rates. Retrospective data was collected for 12-months of tPA use prior and 10-months post implementation.

Results

A total of 404 patients received alteplase over 8 months post intervention at a total cost of $210.08, compared to potential heparin cost of $1050.40, for a potential cost savings of $839.72. An unpaired t-test found no significant difference between utilizing heparin (M=1.742, SD 0.26) versus normal saline with the push/pause method (M=1.938, SD 0.22); t(18) = 1.73, p=0.10.

Discussion

Consistent with other literature, our findings indicate that NS, with the push-pause method, is equally effective in maintaining catheter patency while significantly reducing the risk of heparin-induced complications. Normal saline flushing is a viable and cost effective alternative to heparin, promoting improved patient outcomes and a shift in standard care practices. Oncology nurses should be cognizant of best clinical practice, evaluate the literature, and follow with updating policy and clinical practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):4–5.

04. Remote Monitoring for Neutropenic Fever: A New Era in Outpatient Care Innovation

Whitney Archer 1, Sunny St John 2

Significance & Background

Neutropenic fever (NF) is a common and anticipated complication for hematology oncology patients, often leading to hospitalization due to its potential impact on patient mortality. However, with proper resources in the outpatient setting, NF can effectively be managed reducing the need for hospitalization. To enhance resource utilization and patient experience, innovative approaches to care delivery are essential.

Purpose

To enhance care for hematology oncology patients with NF through nurse monitoring in the outpatient setting. This approach aimed to identify vital sign trends that might otherwise go unrecognized, connect patients with their primary care team for timely intervention, and prevent prolonged hospitalizations.

Interventions

A nurse within the outpatient hematology oncology department proactively screened patients to identify program candidates. Eligible patients were enrolled in a remote patient monitoring program from various access points within the healthcare system, including the immediate care clinic (ICC), emergency room (ED), and inpatient units (IP). Each patient received a remote monitoring toolkit, which included a device to transmit vital signs and symptom updates to a telenursing team throughout the day. A neutropenic fever-specific decision tree guided the escalation of any changes in vital signs or symptom concerns. Initial enrollment was set for 30 days but could be extended if needed or ended early if the patient opted to discontinue.

Results

During the program’s first year, 24 patients were enrolled: 1 from ICC, 5 from ED and 18 from IP. Of the 24 patients enrolled, 18 patients completed monitoring, and 6 patients did not participate after enrolling. Of the patients who were monitored, 17% were readmitted to the hospital within 30 days compared to 67% who enrolled but did not participate. On average, patients had 3 escalation calls called during the program, ranging from 0 to 9 calls, and an average enrollment duration of 31 days, ranging from 6 to 72 day.

Discussion

Oncology telehealth nurses effectively identified vital sign trends and enhanced patient connections with their care teams, as demonstrated by increased escalation calls and prolonged enrollment. The comparison in readmission rates for patients who participated in monitoring would suggest enhanced NF management in the outpatient setting. Comprehensive engagement across the healthcare continuum is essential for promoting patient enrollment and evaluating outcomes. Adaptability to patient needs will be crucial for expansion of remote patient monitoring services.

Oncology Nursing Forum. 2025 Mar 1;52(2):5.

05. Chairs and Chats: Elevating Communication in Oncology Care

Joel Ryan Armamento 1

Significance & Background

Effective communication between oncology nurses and patients is crucial for delivering high-quality care and achieving positive health outcomes. Feedback from patients and survey data indicated that the 4NW unit had opportunities to enhance its communication practices. Evidence suggests that sitting down with patients, allowing for eye-to-eye interaction, positively impacts patient perception of care. (Zehner L. Implementation of a nurse communication strategy to improve perception of nurse-patient communication at the bedside on an inpatient oncology unit. Journal of Clinical Oncology 2017) To address this, we launched a project aimed at encouraging hematology oncology nurses to use designated chairs at the bedside to improve communication and patient care. (see Article 1 for an image of the chairs and Tip Sheet).

Purpose

To evaluate how the use of designated chairs by inpatient caregivers affected communication rates with hematology-oncology patients during their admission.

Interventions

Several key strategies were implemented to promote the use of chairs, including:

  • ■ Encouraging staff to use chairs during various patient interactions, such as blood draws, IV insertions, admission assessments, goal-setting discussions, chemotherapy and CAR-T education, discharge instructions, and team rounds with physicians.

  • ■ Providing a set dialogue and tip sheet to assist staff in initiating and maintaining patient conversations, particularly for those who needed additional support.

Results

The effectiveness of the intervention was assessed by comparing Press Ganey patient satisfaction scores related to the frequency of nurses sitting during care discussions and HCAPS Nurse Communication Domain scores before and after the introduction of the chairs. On a scale of Always, Usually, Sometimes and Never :

  • ■ “Nurses explain in a way you understand” increased from a score of 59 at baseline, to 76 post implementation. Patients answer “Always” at 99%

  • ■ “Nurses listen carefully to you” increased from a score of 41 at baseline, to 77 post implementation. Patients answer “Always” at 99%

  • ■ “Nurses treat you with courtesy and respect” increased from a score of 60 at baseline to 64 at baseline. Patients answer “Always” at 99%,

  • ■ Lastly, “Nurse always or usually sat when discussing care” increased from 50% to most recently 70% as of August 2024

Discussion

By integrating chairs into routine patient interactions and ensuring their availability in every room, we aim to facilitate eye-to-eye communication that enhances engagement and support for patients and their families.

Oncology Nursing Forum. 2025 Mar 1;52(2):5–6.

06. Nurse Driven Interventions to Reduce Catheter Associated Blood Stream Infections

Marina Barry 1, Sarah Byrne 2, Nicole Donato 3, Shauna Martin 4, Haley Psareas 5, Christine Stafford 6

Significance & Background

Central line associated blood stream infections (CLABSIs) are hospital-acquired infections associated with increased healthcare costs ranging from $3,700 to $39,000 per infection as well as mortality rates ranging from 12–25%. Hematology-Oncology patients are at increased risk for infection due to immunosuppression and prolonged central line use. From Q1 2022 to Q1 2023 Lunder 9, a 32-bed inpatient adult hematology-oncology unit, sustained zero lab confirmed blood stream infections per 1000 central line days. In Q2 and Q3 2023, 1.21 and 1.73 lab confirmed blood stream infections per 1000 central line days were attributable to Lunder 9, respectively. It is estimated that 65–70% of CLABSIs are preventable when following evidence-based guidelines.

Purpose

To decrease CLABSI rates on Lunder 9 to less than 1 infection per 1000 central line days by Q1 2024.

Interventions

  • ■ Patient and staff education on importance of chlorhexidine bathing and proper central line care as outlined by hospital policy

  • ■ Staff reminders and audits of compliance of central line cap changes and IV tubing maintenance

  • ■ Videos for staff demonstrating proper central line care

  • ■ Calendars to promote daily chlorhexidine bathing adherence

  • ■ Posters outlining proper central line care for providers above bed

Results

Lunder 9 achieved a rate of 0 lab confirmed blood stream infections per 1000 central line days by Q1 2024 and has sustained no CLABSIs since implementation of this multimodal educational approach.

Discussion

By using a multimodal approach to increase staff knowledge of and adherence to central line best practices as outlined by hospital policy, CLABSI rates in the inpatient oncology population can be decreased. Routine education and reminders of proper central line care are impactful to sustaining lower CLABSI rates.

Oncology Nursing Forum. 2025 Mar 1;52(2):6.

07. Leading the Way: RN-Performed Bone Marrow Biopsies

Makenna Bettin 1, Cassandra McDermott 2, Crystal Muir 3, Beth Gross 4

Significance & Background

For more than 15 years, registered nurses (RNs) at our institution have been conducting bone marrow aspiration and biopsy (BMBx) procedures. Before our RN-led team, there were issues with fragmented processes, inconsistencies in sample quality, and a rising demand for these services.

Purpose

Allowing our specialized BMBx Nursing team to perform this procedure promotes autonomy, enabling full scope practice and fostering consistency, belonging, and patient care quality. Collaborating with nurse anesthetists and pathology strengthens teamwork. When nurses handle the procedure, it also opens up clinic space, enabling providers to accommodate more patients.

Interventions

RNs complete an education program per state board of nursing requirements, followed by hands-on orientation with a preceptor and successful procedure check-offs. To maintain competency, RNs regularly perform the procedure, ensuring consistent skill application.

Results

Over the past three years, our BMBx RN team has successfully completed 5,000 bone marrow procedures, managing up to 10 patient cases each weekday. This role allows RNs to operate at the top of their scope of practice, making the work feel both meaningful and impactful for the team. Patient satisfaction remains exceptionally high with complication rates remarkably low: fewer than 1% of patients experienced post-procedure bleeding, and less than 1% required urgent medical attention within 24 hours of the procedure. Our analysis of these procedures during this period indicated that the RN team consistently met or exceeded an average clinical adequacy standard of 92% for good core quality. Additionally, 98% of patients rated the quality of their education as excellent.

Discussion

RNs can safely and effectively perform BMBx procedures, working at the top of their scope to achieve excellence in oncology nursing. They build trust and respect by advocating for patients and delivering holistic care throughout the process. Additionally, RNs drive innovation through continuous quality improvement, keeping patient safety a priority and fostering a collaborative environment with providers and other healthcare professionals.

Oncology Nursing Forum. 2025 Mar 1;52(2):6–7.

08. Development and Implementation of An Advanced Oncology Core Class for Experienced Nurses

Cindy Bohlin 1, Karla Lambson 2, Jacklyn Ornelas 3, Meg Helsley 4, Kerri Dalton 5, Martha Lassiter 6

Significance & Background

Continuing education (CE) is essential for experienced oncology nurses to stay updated with the latest advancements in cancer care. The health system traditionally offered an oncology core class series for new staff; however, it lacked dedicated CE courses for experienced nurses. Additionally, nursing education was needed for new and emerging topics in oncology care.

Purpose

The purpose of this project was multifold. We wanted to provide an oncology CE opportunity for experienced nurses and enhance the content of our existing oncology core curriculum. The existing oncology core classes were designed to align with the ONS Oncology Core Curriculum but did not include some of the 7th edition ONS Core Curriculum updates.

Interventions

A needs assessment was conducted to determine interest, and content. Staff were asked to select from a list of topics those that were most important to their educational need. An educational planning table was used to design a one day, in person course. Resources from ONS were reviewed to build objectives and presentations. Subject matter experts were selected to present content. The course agenda included cancer genetics/genomics, novel therapies, onco-fertility, nutritional complications, compassion fatigue, and an immuno-oncology game show. Multimodal education techniques were integrated into the course to create a dynamic learning environment and keep students engaged throughout the day. These included interactive posters, a hands-on nutrition tasting station, well-being awards, and a friendly competition between ambulatory and inpatient oncology staff during the game show.

Results

Due to significant demand, the maximum enrollment of 50 participants was reached. Nurses from a variety of oncology practice settings across the health system attended. This included inpatient and ambulatory medical and surgical units, oncology infusion centers, oncology research, radiation oncology, and hematology-oncology. The course was well received by participants, with high engagement and positive feedback. Evaluations indicated an increase in knowledge across all course objectives.

Discussion

Providing new and innovative continuing education for oncology nurses promotes professional development and enhances patient care. This new oncology course successfully provided experienced nurses with updated knowledge and skills in critical areas of oncology care. The inclusion of innovative teaching methods may serve as a model for future CE programs. The “Advanced Oncology Core” course has been added to the oncology core class series and will be offered again in the fall of 2024.

Oncology Nursing Forum. 2025 Mar 1;52(2):7–8.

09. Integration of Evidence-Based Practice for Taxane Titration

Amy S Boswell 1, Trisha Harmon 2, Anna McClenny 3, Katie Ortner-Henry 4, Zulma Rosado 5, Phuong Huynh 6

Significance & Background

Despite a 30% incidence of hypersensitivity reactions (HSRs) during the 1st and 2nd lifetime exposure, paclitaxel is a first line treatment for many cancers. Recently, a taxane titration study demonstrated a significant decrease in HSRs. Decreasing HSRs reduces associated clinical complications and improves patient ability to continue treatment, ultimately supporting best patient outcomes. At a large NCI-designated ambulatory cancer center, 1st and 2nd dose paclitaxel titration was not a standard practice, revealing a potential gap in HSR minimization.

Purpose

To reduce HSR incidence through the development and implementation of standardized paclitaxel titration.

Interventions

Frontline nurses and educators established a multidisciplinary workgroup, including nursing, pharmacy, and infusion providers. An initial literature review revealed limited evidence demonstrating the benefit of paclitaxel titration. Following a survey of NCI-designated centers currently using paclitaxel titration, the workgroup adopted a modified desensitization approach (Tuskan et al, 2023). An internal assessment was completed to determine tubing volumes, titration step durations, and utilization of nursing and bay space. Electronic health record (EHR) orders and pump medication libraries were updated to include the new paclitaxel titration steps. Dissemination and implementation of the new process was achieved through in-services, job aids, targeted rounding, and presentations at multidisciplinary committee meetings.

Results

The organization’s baseline paclitaxel HSR incidence was 17% (62/366) for 1st dose and 8.9% (28/316) for 2nd dose. For the first 5 weeks of titration, the HSR incidence was 18.6% (11/59) for 1st dose and 0% for 2nd dose. An unexpected finding during the 4-week evaluation revealed that 80% (8/10) of HSRs occurred during the Step 0 priming volume, which indicated patients were getting paclitaxel before titration began. This finding prompted discussion with organizations who also prime paclitaxel at the bedside. Manufacturer-listed tubing volumes and pump variances were reexamined to assess accuracy. Dye studies revealed a 35% tubing volume discrepancy. The priming volume was reduced, and 1-week evaluation showed no HSRs during Step 0 priming. Monitoring of HSR rates to determine efficacy of paclitaxel titration and priming volume reduction is ongoing with a continued goal of improving patient outcomes.

Discussion

The value of ongoing evaluation is evidenced by the recognition of the unexpected variable of timing and occurrence of HSRs during priming. Comprehensive improvement efforts require close and frequent monitoring to assure changes support intended improvement outcomes. Next steps include docetaxel titration.

Oncology Nursing Forum. 2025 Mar 1;52(2):8.

010. Outpatient Triage 201: Oncology Education for Experienced Nurses

Jennifer Brackensick Grant 1, Alli Mullenbach 2

Significance & Background

Outpatient oncology nursing at an NCI designated cancer center, with extensive oncologic specialties, requires expert nursing skill and knowledge. Care is often driven by innovative new scientific modalities for which clinical education must anticipate and maintain relevance. Strong multidisciplinary communication is vital to ensure optimal patient outcomes. Nurses transitioning from other nursing modalities often require significant time to gain competence. Gaps can exist in care delivery relative to staff turnover and highlight the need to build competence quickly.

Purpose

To explain the details of programmatic curriculum/content in an ambulatory comprehensive cancer center for skill and knowledge for assuring best practice in a complex patient population.

InterventionS

Advance practice providers, nurse staff and leadership did an assessment, and designed a uniquely designed oncology curriculum with content and a skills development program to address gaps in knowledge and expertise. Content included advanced assessment of pain and fever, oral chemotherapy pearls, genetics, pathology, and disease specific education. Educational materials were formulated with guidance from providers, pharmacists and evidence-based resources. A nurse educator guided implementation of weekly classes attended by all nursing staff in the clinic. Six classes took place over 15–30 minutes weekly during standing meeting times to minimize coverage needs. Each class was supplemented with a tip sheet for reference and available to all staff in the clinic.

Results

Staff included in this program have expressed the topics are highly applicable to their nursing practice and skill acquisition and maintenance. Evaluation is ongoing to promote relevance and address innovations in care, all of which are supported by the organization.

Discussion

The outpatient oncology setting provides a unique environment requiring specialized knowledge and skills. Improving nursing knowledge and enhancing clinical competence has the potential to improve retention. It also enhances the nurse-provider relationship and patient satisfaction, while improving care outcomes. The content in nursing education is equally important to the context.

Oncology Nursing Forum. 2025 Mar 1;52(2):8–9.

011. Oncology Transitions of Care - Key to Preventing Avoidable ED Visits and Unplanned Hospitalizations

Victoria Bradford 1, Archana Ajmera 2, Shelly Kane 3, Ayad Hamdan 4, Delaney Serfling 5

Significance & Background

Transitions of care are an especially vulnerable time for oncology patients. Gaps in complex oncology care coordination, whether between treatment modalities or inpatient/outpatient services, can result in treatment delays, unplanned hospitalizations, increased lengths of stay and avoidable Emergency Department (ED) visits. Healthcare systems may be penalized financially if patients receiving outpatient cancer-related IV therapy visit the ED or are admitted for potentially preventable conditions. Effective transitions of care requires a multi-disciplinary team, including physicians, leaders and clinicians, in the design, implementation and evaluation of a multi-pronged Transitions of Care program.

Purpose

Reduce oncology patient risk along the continuum of care through an Oncology Transitions of Care program, including:

  • ■ Triage Services

  • ■ Symptom Management Early Identification Outreach Calls

  • ■ Discharge Coordination

  • ■ Same-Day Cancer Care Clinic

Interventions

  • ■ Triage Services:

    • Oncology RN-driven service available Monday-Friday 0800 to 2100

    • If the patient is unable to reach their primary oncology team, they can press #2 and immediately be connected

    • Patient assessment to determine if issue:

      • ■ Can be resolved by Triage RN through patient education

      • ■ Requires immediate 911

      • ■ Requires care by primary team; if not available, Triage RN schedules appointment with Same-Day Cancer Care Clinic team

    • Symptom Management Early Identification Outreach Calls

      • ■ Oncology RN-driven service contacting all patients within 24–48 hours after their first infusion visit

      • ■ Assessment of patient experience, symptoms and patient knowledge, including patient teach back of when, why and who to call at any time

    • Discharge Coordination

      • ■ Oncology RN-driven service contacting all patients who have been discharged from ED or hospital within 24–48 hours

      • ■ RN assessment: Understanding of Discharge AVS, wellbeing and symptom management, schedules follow up appointment with oncology team (MD or APP)

    • Same-Day Cancer Care Clinic

      • ■ Oncology APP-driven service available Monday-Friday 0900 to 2100 for established oncology patients

      • ■ Services offered include: Imaging (CT, Xray and ultrasound), Labs, IV therapies, paracentesis

      • ■ Patients can schedule directly, be referred by their primary oncology team or Triage

Results

  • ■ Outcomes include:

    • Prevented ED visit for 89% of patients seen in Same-Day Care Clinic

    • Development and improvement of standardized Infusion patient education information and workflows

    • Improvement in % of patients seen within 7–14 days by their primary oncology team after discharge from ED or hospital

Discussion

  • ■ Initial outcomes from multi-pronged Oncology Transitions of Care model are promising

  • ■ Ongoing analysis of missed opportunities (e.g. readmissions within 30 days, avoidable ED visits)

Oncology Nursing Forum. 2025 Mar 1;52(2):9–10.

012. Nurses’ Knowledge and Attitudes Towards the Healthcare Needs of Transgender Persons

Christopher Brooks 1

Significance & Background

Transgender persons have multiple complex health issues that require care that is accessible and equitable and meets their individual needs. Disparities in healthcare access and outcomes exist for transgender persons and are the result of myriad issues. One such issue is the lack of healthcare professionals who are knowledgeable about the unique needs of transgender persons and who have the skill to provide appropriate care. Research regarding healthcare professionals’ knowledge of and attitudes towards the healthcare needs of transgender persons is sparse. Almost no nursing studies have focused on this population, thus contributing to disparities in healthcare access, fear of being mistreated by healthcare professionals and staff in the healthcare environment, and denial of care.

Purpose

To explore nurses’ knowledge and attitudes of the healthcare needs of transgender persons.

Interventions

A quantitative descriptive cross-sectional design using survey methodology was used to answer the research questions. The Transgender Health Disparities Assessment web-based survey was distributed electronically to all study participants. Registered nurses living in the United States who were active members of the Oncology Nursing Society (ONS), The American Academy of Ambulatory Care Nurses (AAACN), and Sigma Theta Tau International Honor Society of Nursing (Sigma) were asked to participate.

Results

There was a statistically significant correlation between knowledge and attitude scores. Statistically significant differences between scores were found for sexual orientation, number of years practicing, age, religion, formal training, political affiliation, having experience caring for a transgender person, and for having a family member who identifies as transgender.

Discussion

This was the first national study to explore the knowledge and attitudes of nurses towards the healthcare needs of transgender persons. Findings from this study were like those of other studies that examined knowledge and attitudes of healthcare providers towards this population. There was a positive correlation between knowledge and attitudes, but there were also several nuances in study responses based on the questions that were asked. Overall, study participants expressed a need for further education on how to best care for this population as well as a strong desire to provide care that is compassionate, competent, and based on the needs of this group.

Oncology Nursing Forum. 2025 Mar 1;52(2):10.

013. Nurses Bridging the Gap: Fostering Collaboration to Combat Cancers Financial Toll

Amy Caramore 1, Bayley Sharma 2

Significance & Background

From the perspective of oncology patients throughout the United States, the financial burden of paying for cancer care is as concerning as their own potential mortality, if not more (ASCO, 2018). This is not just a matter of perception for cancer patients, we know approximately 40% of cancer patient will deplete their savings within 2 years of treatment, and that cancer patients declare personal bankruptcy at a rate 2.5 times higher than the general population – those who declare bankruptcy have a 2-fold higher mortality rate, regardless of disease stage (Ramsay et al, 2016).

Purpose

As healthcare professionals we agree that change is needed to improve health outcomes for our patients and yet time and again great ideas, great research, and great possibilities become trapped in the quagmire of our own systems. We sought to change the financial trajectory for cancer patients by leveraging the skills of a multi-professional group to proactively screen for financial toxicity and connect patients to available resources prior to financial decompensation and through the lens of nursing care, fostered the relationships and support needed to achieve the goal.

Interventions

To address this pressing issue, we implemented a nurse-led intervention aimed at proactively screening for financial toxicity and connecting patients to available resources. A multi-professional team developed a standardized screening tool and referral process, which was integrated into the oncology outpatient workflow. Nurses played a pivotal role in identifying patients at risk, assessing their financial needs, and referring them for appropriate assistancE.

Results

675 nursing referral orders were placed for patient screening positive, with 86% of patients completing the application process receiving qualified aid totaling more than $1.2 million dollars.

Discussion

The nurse’s role as a collaborative leader was instrumental in fostering productive relationships among team members and ensuring the task force remained mission focused. A diverse group of representatives from various disciplines formed the task force, dedicated to establishing accountability and ensuring the intervention’s sustainability. Key members of this group were responsible for communicating with executive leadership and monitoring the intervention’s progress. Education, designed by nurses was comprehensive, encompassing multiple professional domains to promote continuity and collaboration.

Oncology Nursing Forum. 2025 Mar 1;52(2):10–11.

014. Tar Wars Over Time

Andria Caton 1

Significance & Background

According to Georgia cancer statistics, Barrow County has significantly higher rates of lung cancer incidence and mortality compared to state and national numbers. A 2016 and 2019 Community Needs Assessment reported Barrow County residents consistently have smoking rates higher than surrounding Georgia counties. Lastly, the American Lung Association reports rates of e-cigarette and non-combustible tobacco use in Georgia high school students that are higher than national rates.

Purpose

The project purpose and objective was to implement an annual evidence-based tobacco use prevention program for 4th and 5th grade students in Barrow County Georgia.

Interventions

TAR Wars, a free, evidence-based educational campaign, developed by the American Academy of Family Physicians, was delivered in nine Barrow County elementary schools annually from 2018 to 2024 in collaboration with oncology nurses, school nurses, teachers, community leaders, and school board staff. Pre-program and post program surveys were administered each year and knowledge gains were assessed by the school system and oncology nurses. Results were reported and reviewed by the collaboration. TAR Wars was adjusted to meet the needs of Barrow County students and teachers when indicated. Students participated in poster contests annually to highlight tobacco, vaping, and non-combustible tobacco issues. The community participated by selecting the poster winners through social media voting. Poster contest winners were publicly recognized in school board meetings and awarded a small cash prize by the local hospital system.

ResulTS

Over a six-year period, TAR Wars has been delivered to over 2,000 4th and 5th graders each year. 100% of the nine Barrow County elementary schools participated each year. In 2018 and 2019, pre- and post-program surveys were administered on paper, but for years 2020–2024, surveys were administered electronically. Overall knowledge gains were reported annually with the highest gains demonstrated for e-cigarette, vaping, and tobacco advertising questions. In 2020, TAR Wars continued but shifted from in person to online delivery. For years 2021 to 2024, school staff selected the best method of presentation to meet the needs of student.

Discussion

Over time, knowledge gained through the implementation of TAR Wars in Barrow County will likely result in decreased combustible and non-combustible tobacco use, e-cigarette and vaping use. Likewise, programs like TAR Wars and community collaborations will decrease the rates of preventable cancers and other tobacco-related illnesses for Barrow County.

Oncology Nursing Forum. 2025 Mar 1;52(2):11.

015. “Tea-Time”: A Peer Led Intervention to Improve Nursing Comfort When Educating Patients on Oncology Related Topics

Rylie Chambers 1, Karen Anderson 2

Significance & Background

The expansion of oncology outpatient care has heightened the need for proficient infusion nurses capable of providing education to patients with diverse cancer diagnoses receiving complex antineoplastic therapies. As the nursing workforce evolves, there is a noticeable increase in new-to-specialty and newly graduated nurses entering ambulatory oncology infusion settings. Nurses have traditionally learned to teach patients by observing their peers who have often had many years of experience teaching patients. Nurses new to oncology may lack comfort related to patient teaching. Research demonstrates peer education can be an effective way to improve nursing knowledge and self-reported comfort can be improved by educational interventions.

Purpose

The goal of this unit-based project was to improve staff comfort with their ability to teach patients through peer-led education sessions.

Interventions

An oncology infusion nurse initiated bi-monthly educational sessions in the spring of 2024 called “Tea-Time” to educate peers. Sessions were held at 5pm for 30 minutes and tea and snacks were provided. Topics included cancer diagnoses, infusion procedures, and treatments, and related toxicities based on staff and clinical nurse specialist input. Educational handouts were developed from evidence-based sources and departmental procedures to guide the sessions. Learning was facilitated through group discussions, questions and answers, sharing of case examples, and equipment demonstrations. Pre and post assessments were performed to measure staff comfort with teaching patients using a Likert scale.

Results

On average seven nurses participated in each session. Sessions were held during existing hours in the department when infusion volumes begin to decrease so that changes to patient or staff schedule were not required. To date, eight educational sessions have been completed. Aggregate data from pre-test assessments revealed that 40% of nurses reported feeling uncomfortable teaching the topics to patients. After the intervention, 85% of nurses felt comfortable teaching their patients the topics presented.

Discussion

Educational sessions leveraging peers as instructors_led to enhanced comfort of oncology nurses with providing patient education. The improvement in self-reported comfort underscores the value of peer-led education. Expansion and continuation of the peer-led educational sessions is anticipated based on positive results and staff feedback.

Oncology Nursing Forum. 2025 Mar 1;52(2):11–12.

016. Escape From Revalidation: A Unique Aapproach to Annual Chemotherapy Competency

Anna Choquette 1, Susan Bruce 2

Significance & Background

During COVID, the inpatient oncology unit needed a way to revalidate chemotherapy administration practice/knowledge without close staff proximity or increased patient contact. Chemotherapy was given at irregular intervals, limiting revalidation during real-time in clinical practice. In order to mitigate this, the team developed a virtual escape room to revalidate current oncology knowledge and evaluate gaps in chemotherapy administration which has been expanded across additional inpatient and ambulatory oncology settings.

Purpose

To describe a virtual method of revalidating chemotherapy competency.

Interventions

Using an online platform, a virtual escape room was created where participants had to answer questions related to an unfolding oncology case study involving chemotherapy safety, dosage calculations, administration and ongoing care. Branching logic was used to determine which scenario best fits the participant’s role and practice setting. Participants had to provide the correct responses based on each question. Once an answer was chosen, the participant used the answer number (A = 1, B = 2, etc) to input a code to “escape” to the next room; hints were given if a code was incorrectly entered. Upon completion of the escape room, reports were sent to each participant along with feedback for each answer which included links to policies and supporting articles.

Results

Feedback for the escape room has been overwhelmingly positive. Nurses report it is easy to use and understand yet challenges critical thinking with each question. Using a companion worksheet, answer numbers can be tracked to help “escape” each section. In addition, scores have consistently been over 90% as this method forces a participant to eventually come to the correct conclusion in order to “escape”. The online platform summarized answers and created reports allowing leadership to track competency and revalidation each year.

Discussion

Revalidating competency for chemotherapy administration requires both critical thinking and physical demonstration of the skill. Using the escape room, nurses have the autonomy to complete a portion at their own pace and then prepare to demonstrate their competency in real time. This decreases time spent with an auditor and increases confidence when performing skills. Current revalidation practices, combine the escape room with an in-person skills demonstration, this has proved an innovative way to revalidate our chemo-competent nurses. The success of this application has led to expansion across all health system oncology areas for upcoming revalidation processes.

Oncology Nursing Forum. 2025 Mar 1;52(2):12.

017. Informing a Virtual Oncology Navigation Model to Offer Nationwide Assistance to People Facing Cancer

Deborah Christensen 1, Helen Meldrum 2

Significance & Background

Despite significant advances in precision oncology, breakthroughs are underutilized due to system fragmentation, lack of standardization, and patient access barriers, especially in rural areas.

Purpose

The founders of Cancer Help Desk (CHD), a 501(c)(3) non-profit organization, recognized the need for a virtual navigation model to expand patient access to precision oncology care regardless of their location within the U.S.

Interventions

CHD created a survey to gather insights into how patients and caregivers viewed their cancer care. After obtaining IRB approval, students from Bentley University distributed the survey via email to over 1,000 support groups across 50 states, ultimately receiving 139 responses. The survey requested demographic information and answers to 10 scaled and 6 open-ended questions.

Results

Survey respondents were primarily white, well-educated, non-rural, and located in the Midwest. Responses revealed challenges in accessing reliable information, coordinating care, and finding credible resources to make informed decisions. Some respondents reported involvement with clinical trials; however, there was little indication that biomarker testing was understood or performed. Bentley students also provided CHD with key insights and recommendations for marketing strategies.

Discussion

CHD established a virtual navigation model comprising oncology nurses and PhD scientists. From July 2023 to August 2024, CHD assisted 190 patients or caregivers. An oncology nurse navigator evaluated each caller’s needs, with 56% of the inquiries related to clinical questions alone. Personalized cancer resource guides containing information on biomarkers, clinical trials, and diagnosis, plus resources for mental health support, coping, financial assistance, specialists, and specialty programs, were provided to 88% of contacts. Furthermore, 53% of patients received a case review with options for clinical trials, and 10% received a scientific case review encompassing biomarker and clinical trial analysis by a PhD scientist.

The CHD virtual navigation model effectively addresses patients’ clinical questions, provides personalized resources, and supports precision oncology care. Marketing these services to improve access for rural patients can expand equitable care nationwide.

Oncology Nursing Forum. 2025 Mar 1;52(2):12–13.

018. Empowering Excellence: Oncology Outpatient Nursing Orientation

Caitlin Clarke 1

Significance & Background

The ability to provide excellent patient care begins with each nurse receiving a solid foundation and well-rounded orientation experience focused on support, structure, and clear expectations. In 2023 we identified inconsistencies in our unit’s orientation process. The redesign, development, and implementation of a comprehensive orientation program ensures each new hire nurse is prepared to provide expert and outstanding patient care after orientation completion.

Purpose

Redesign and implement a standardized and comprehensive orientation experience to our outpatient infusion nurses. Create a standardized onboarding day to ensure each new hire receives the same information upon hire. Utilize Orientation Status Reports (OSRs) to track progress throughout orientation. Provide continued support to new hires after orientation completion via 1:1 check-ins completed by unit senior clinical nurses (SCNs).

Interventions

We used a presurvey to gain feedback on how current staff members perceived their orientation experience. Based on survey findings, a three-step plan was developed:

  • ■ “Welcome Day” was created for the new hire’s first day in our infusion area. The day is spent reviewing policies, procedures, and share time with various disciplines.

  • ■ Utilize OSRs to determine readiness to practice.

  • ■ 30, 60, and 90 Day check-ins are completed by SCNs after orientation is completed to ensure continued support and identify needs or areas of interest.

Results

In the pre-surveys the majority of nurses felt orientation was not organized, about half reported that their clinical progression was not monitored, and the majority could not remember or did not have post-orientation check-ins. There have been 2 new hires go through the new orientation program. Their feedback showed that our interventions positively impacted their experience. Both new hires reported that they felt as though their orientation was organized, their clinical progression was monitored, and they were provided check-ins.

Discussion

The revamped and targeted orientation program will empower new hires by giving them the tools they need to succeed on our unit. The feedback on our robust redesigned orientation has been positive. As new hires continue to be onboarded using the new program we will continue to adjust and improve the process. In doing so, we will empower our new hires and foster a supportive and healthy work environment.

Oncology Nursing Forum. 2025 Mar 1;52(2):13.

019. Transition to Practice Mentorship for Ambulatory Nurse Educators

Latesha Cook-Webb 1

Significance & Background

Mentorship is crucial in supporting nurses’ growth as they transition into new roles. It has been associated with increased job satisfaction, reduced turnover, improved competency development, and motivation for career planning (Bradley, Bugos, & Hernandez, 2024). An environmental scan found three critical barriers for unit nurse educators (UNEs) transitioning from clinic nurse to unit nurse educator:

  • ■ UNEs need to take ownership of their transition by understanding their competency requirements.

  • ■ Nursing leadership must support the competency requirements.

  • ■ A feasible plan is required to complete the requirements while fulfilling clinic nurse duties.

Purpose

This abstract aims to illustrate how a Nursing Professional Development Specialist (NPDS) piloted a mentorship for unit nurse educators (UNEs) at an NCI Designated ambulatory cancer center.

Interventions

The NPDS took the initiative to create a learning needs assessment (LNA) as the first step. This was to determine the UNEs’ understanding of their role and how to function in it. The LNA evaluated their ability, awareness, and confidence to perform the competencies required by the organization. It’s worth noting that three of the twelve UNEs, who had been in their role for more than two years, chose not to participate in the mentorship, and one transferred to a different role before the mentorship began. Once the mentorship commenced, each UNE was provided with a binder containing important policies, a copy of Bloom’s Taxonomy, and other tools to support their success. The NPDS also held one-on-one meetings every six weeks with each UNE to review their progress and discuss any situations they may have encountered.

Results

After collecting pre-assessment data, the NPDS reviewed the results with key stakeholders and provided a comprehensive action plan based on Benner’s Novice to Expert Model. Progress was evident within six months, as two UNEs were promoted to education coordinators and another completing the mentorship within a year. A post-survey revealed that all participants felt the mentorship helped them reach their learning goals and improved their competency and knowledge.

Discussion

Transitioning to a new role can be challenging for any nurse, regardless of their level of expertise. The post-survey results clearly demonstrate the crucial role that mentorship plays during this transition and its significant impact on professional development.

Oncology Nursing Forum. 2025 Mar 1;52(2):13–14.

020. Hypersensitivity Reaction Simulation: Improving the Rescue Response Through Increased Self-Confidence and Nurse Empowerment

Megan Corbett 1, Crystal Derosier 2, Brittany Puccia 3

Significance & Background

The high risk and high volume of hypersensitivity reactions (HSR) in oncology, combined with the complexity of managing HSRs requires transforming how nurses are educated to respond to clinical emergencies. Nurses must react quickly and effectively, with precise patient assessments, interventions, and rescue medication administration. Simulation is critical to nurse education, allowing for safe practice of skills to enhance knowledge, increase self-confidence, and empower nursing practice.

Purpose

To enhance knowledge, self-confidence, and the HSR rescue response through simulation at an adult ambulatory comprehensive cancer center.

Interventions

Multiple, simulated HSR scenarios were developed for infusion nurses by clinical specialists. Identified roles included patient, observer, facilitator, and primary, charge, medication, and documentation nurse. Supplies including a CPR mannequin, AED trainer, and mock emergency cart with expired drugs and equipment were created. Cue cards for the patient role, including vital signs were made. Simulations were advertised, held in the infusion room, and all infusion nurses were invited to attend. Clinic schedules were blocked. No pre-work was required. Prior to beginning, expectations and roles were reviewed. Obstacles (trash cans, chairs, etc.) were left in place. Patient handoff was provided. Participants were asked to perform as they would in a true HSR. A 60 min debriefing allowed for discussion, Q+A, and feedback about concerns, performance, and review of lessons learned. Positive reinforcement, encouragement, and critique was provided as needed.

Results

Post simulation, infusion nurses (n = 50) completed an anonymous, voluntary evaluation to assess enhanced learning, opportunities for clinical care through practice enhancements, and self-confidence level. Evaluations were overwhelmingly positive. 88% of nurses strongly agreed (n=44) and 12% of nurses agreed (n=6) that simulation assists in providing improved clinical care and helped identify opportunities for practice enhancements. 76% of nurses (n=38) reported increased confidence levels. Additional free text comments were positive and appreciative, requesting future interdisciplinary simulations and debriefings. Simulation has spread across the organization, and new, interdisciplinary offerings are being developed.

Discussion

Simulated HSRs are a fun and meaningful way to improve the patient’s rescue response and increase staff knowledge and self-confidence. Simulation promotes team building and critical thinking skills. Implications for practice include incorporating future simulated interdisciplinary HSRs, with dedicated time for debriefing, to enhance self-confidence, empowerment, teamwork, and communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):14–15.

021. The Value of Oncology Nurse Verification in Chemotherapy Order Accuracy

Doralyn Costello 1, Makena Gardner 2, Erin Elizabeth Munk 3, Stacy Shaeffer 4, Alex Roder 5, Lauren Wells 6

Significance & Background

Oncology nurses administer high-risk medications, which have high potential for toxicities and complications. Currently there is varying practice in how chemotherapy orders are verified. Even within the same organization, there can be different processes. Some institutions rely solely on pharmacists to verify chemotherapy orders. The current practice on this inpatient Hematology-Oncology unit is to have nurses independently verify the chemotherapy orders, after pharmacy has completed their verification. Both nurses and pharmacy compare the orders to established chemotherapy protocolS.

Purpose

Our purpose was to determine the value of having chemotherapy-certified oncology nurses perform verification of the chemotherapy orders, in addition to the pharmacy check. By setting a standard practice in how chemotherapy is verified, best practice recommendations can be established.

Interventions

The team created an intake form to identify discrepancies between chemotherapy orders and protocols. Common issues included: proper consent, correct baseline labs/diagnostics ordered and addressed, dose adjustments, appropriate hydration and pre-medication, and medication discrepancies from protocol. The form also tracked whether the discrepancies were explained by the provider and whether pharmacy caught the error prior to nursing.

Results

Discrepancies between the protocol and orders occurred 79% of the time (n=62). Variances from protocol included: dose reduction (14%), premedication differences (18%), hydration differences (16%), medications removed from orders (15%), and medications added to orders (13%). These discrepancies were explained through documentation by the provider only 51% of the time. In addition to medication differences, the following issues were identified: consent not signed (5%), orders not signed (17%), recommended labs not ordered (13%), pregnancy test not ordered (6%), labs outside of parameters (18%), echo not ordered (6%), and echo requiring clarification (4%). Despite the initial pharmacy verification, nurses found an issue that was not seen by pharmacy 35% of the time.

Discussion

This data reveals the value of having a multidisciplinary review of chemotherapy orders. Oncology nurses use their expertise to add depth and perspective to the patient’s treatment. Nurses spend the most time with the patient, putting them in the best position to identify patient-specific conditions that may impact their plan of care. Nurses administer the treatments and provide the last safety check. Oncology nurses have the crucial responsibility and privilege of safeguarding vulnerable oncology patients by ensuring the accuracy and safety of chemotherapy orders.

Oncology Nursing Forum. 2025 Mar 1;52(2):15.

022. A Virtual Reality Simulation (VRS) Intervention to Decrease Rapid Response Calls

Norma Coyne 1

Significance & Background

The Institute of Healthcare Improvement recommends the use of rapid response (RR) teams to reduce preventable deaths, however activation of the RR team is dependent on early nurse recognition of clinical deterioration. The rescue of declining patients is considered a nurse-sensitive outcome measure and past research has indicated signs and symptoms of decline are evident up to 48 hours before the RR team is called. Recognizing and acting upon early signs of patient decline requires knowledge and skills to intervene as well as working relationships with effective communication. The increasing acuity of patients in hospitals has increased demands on nurses to expertly identify deteriorating clients. A comprehensive cancer center has seen a decrease in code blues outside the intensive care unit after establishing continuous coverage by a RR nurse and RR team at the campus less than eight years ago. The number of RR calls has not decreased despite the round the clock RR nurse coverage.

Purpose

The purpose of this quality improvement project was to determine if a virtual reality simulation (VRS) intervention would affect the number of RR calls and nurse confidence in early recognition and intervention in deteriorating patients.

Interventions

A VRS scenario was developed to increase staff nurse recognition and early intervention of deteriorating patients to decrease the need to call a RR code. 40 staff nurses from three inpatient hematology units participated in the intervention. Surveys were collected before and after participants interacted with the VRS intervention and at the end of 12-weeks. Data was also collected on the number of RR calls and code blues before and after the project.

Results

Participating nurse recognition and intervention of a deteriorating patient increased by 11% and confidence in knowledge and skills increased by 17% after participating in the VRS intervention. The number of RR call decreased by 66% after the intervention on participating units.

Discussion

VRS may have a positive impact on nurse confidence and knowledge in early recognition of deteriorating patients. Nurses at the project site found the VRS innovation beneficial and are supportive of future expansion of the project. Additional research needs to be done to confirm if VRS innovation affects RR calls.

Oncology Nursing Forum. 2025 Mar 1;52(2):15–16.

023. Implementation of a Taxane Titration Protocol to Decrease Paclitaxel Hypersensitivity Reactions

Kerri Dalton 1, Sally Barbour 2, Aviva Emmons 3, Sara Nezirevic 4

Significance & Background

Taxanes, such as paclitaxel, are commonly used to treat a variety of malignancies, but carry a high potential for hypersensitivity reactions (HSRs). Despite premedication with H1 & H2 antagonists and glucocorticoids prior to administration, HSR rates during first infusions exceeded 20% at this NCI-designated cancer institute. Recently published evidence suggests utilizing a 3-step titration (3ST) protocol can reduce HSR rates.

Purpose

The purpose of this evidence-based practice project was to pilot the 3ST protocol described by Lynch and colleagues (2023) in the breast and gyn populations at this institution.

Interventions

Prior to initiation, baseline HSR rates were determined for all paclitaxel administrations and for the pilot group. Stakeholders were engaged to review HSR rates and proposed titration protocol. An interprofessional core team including advanced practice nursing and pharmacy was developed to lead this project. An order-set for the electronic health record (EHR) was developed and disease group pharmacists were engaged to place these orders. Infusion nurses were then trained to this new protocol, eligible patients, location of orders, the steps to perform the 3-step titration protocol. The initial hyper-prime step cleared the IV line of normal saline to ensure paclitaxel was titrated. The 3-steps of titration orders were 1% of the dose for 15 minutes, 10% of dose for 15 minutes, and then 100% of dose for the remainder of the infusion. Real time data were collected to evaluate for HSRs in the pilot group and were reported back to stakeholders quarterly.

Results

Initial three-month data indicated only 11 patients were treated using 3ST, however, the HSR rates decreased by 56% in these patients. Extension of the pilot was recommended. 135 Paclitaxel titrations were completed between 10/23-08/24, resulting in a sustained 53% decrease in HSR rates. Additional feedback from infusion nurses was positive, indicating ease of performing the titrations, and leadership reported minimal impact from chair-time extension with titrations.

Discussion

This 3ST pilot demonstrated feasibility and consistency with published protocols in reducing HSRs during first time paclitaxel administrations. Volume of hyper-priming may have contributed to initial HSRs seen and influenced lessons learned during this pilot. While HSR rates continue to be monitored, next steps include expansion across all paclitaxel first-dose administrations with integration of orders in the EHR as standard practice across the health system.

Oncology Nursing Forum. 2025 Mar 1;52(2):16.

024. A Dose of Insight: Understanding the Reasons Behind Missed Growth Factor Injections

Holly DeFeo 1, Roberta Sterling 2, Christopher Iannuzzi 3

Significance & Background

The risk of an oncology patient developing febrile neutropenia is impacted by multiple factors including their disease, individual risk factors, and chemotherapy regimen they receive. Patients that develop febrile neutropenia and have not received prophylactic granulocyte colony-stimulating factor (G-CSF) have a significantly increased risk from complications related to the infection and poor clinical outcomes (NCCN Guidelines, 2024). Our healthcare delivery system is comprised of 7 acute care hospitals and 13 infusion centers. There was a significant increase, over a 6-month period, in G-CSF injections that were missed or administered at incorrect times. Fifty percent of these patients were admitted with neutropenic fever and/or required a delay in treatment.

Purpose

To decrease the incidence of missed or incorrectly timed growth factor injections, by 75%, within 6 months of establishing a system-wide quality improvement project.

Interventions

A system-wide workgroup comprised of oncology providers, nurses, managers, pharmacists, informatics, educators, and schedulers was convened. Root causes that contributed to the events were identified and included variations in the appointment scheduling process, expired order plans not being discontinued, communication barriers, and knowledge gaps. Interventions included enhancing language in chemotherapy orders, creating a process to remove expired order sets, standardizing electronic communication for scheduling appointments, and educating staff on the use of G-CSF.

Results

Preliminary results in the first 4-months of the project, has resulted in a 90% decrease in incidents of missed or inappropriately timed G-CSF injections. Seventy-five chemotherapy order sets that require G-CSF as part of the guidelines have been updated with a scheduling reminder order. A plan has been implemented to discontinue over 13,000 expired order sets from the electronic health record. Chemotherapy training has been enhanced to include expanded G-CSF information. An electronic scheduling communication tool has been revised and its use is being standardized throughout all medical oncology areas.

Discussion

Including front-line staff in identifying root causes and countermeasures when improvement opportunities arise is imperative. Standardized communication tools, education, order management in the electronic health record, and a standard process for scheduling treatment days are helpful in preventing missed or inappropriately timed G-CSF injections.

Oncology Nursing Forum. 2025 Mar 1;52(2):16–17.

025. Development of a Predictive Acuity Model for Oncology Infusion Staffing: Integrating Data Science and Nursing Science

Alden Egan 1, Daniela Gehrke 2, Bo He 3, Jody Garey 4, Judi Payne-De Bock 5, Ping Ye 6

Significance & Background

Appropriate staffing is essential for safe and effective patient care in oncology infusion rooms. Despite the Oncology Nursing Society (ONS) advocating for acuity-based staffing, no standardized, evidence-based model exists. Current methods are manual, time-consuming, inconsistent, and often completed post-care, limiting their practical applicability and reliability for predicting staffing needs. Developing a valid, reliable model to automatically predict patient acuity could revolutionize oncology infusion rooms by providing a standardized, evidence-based approach to safe and effective staffing.

Purpose

Develop an evidenced-based machine learning model (MLM) to accurately and automatically predict infusion room patient acuity and staffing needs using EHR data.

Interventions

Acuity Scale Development

A six-level acuity scale was designed, with levels escalating based on estimated nursing time required for care coordination, delivery and documentation per patient, ranging from 15 minutes to 120 minutes.

Feature Identification

Identified 22 unique features potentially impacting acuity based on literature reviews and expert opinions.

Data Collection

Over three months, infusion nurses from five community oncology practices and nine infusion rooms recorded acuity using the six-level scale. Corresponding EHR data was extracted for 22 features of interest.

Exploratory Analysis and Modeling

Using gradient boosting decision tree, conducted statistical analysis of the relationship between acuity levels and EHR features. A MLM was trained on data to predict future acuity for scheduled infusion room patients.

Results

Collected data from 14,610 visits and 5,139 unique patients. Fourteen of the 22 features were identified for modeling. Significant features included diagnosis, appointment duration, number of antineoplastic medications, delivery route, hypersensitivity risk, emetic risk, cycle one day one, patient language, performance status, mobility, depression, and venous access difficulty. The MLM demonstrated an R-squared value of 0.60. During validation, acuity was predicted accurately 63% and within one level 95% of the time.

Discussion

The implementation of a machine learning model (MLM) for predicting patient acuity is feasible and effective, offering a practical approach to acuity-based staffing. By accurately forecasting nursing time and care requirements, this innovative method enhances staffing decisions, promoting safe and effective patient care. Companion abstracts explore the development of an infusion room staffing dashboard featuring this MLM, as well as the perceptions of nursing staff on factors influencing staffing appropriateness. Future research will evaluate the impact of this model on various direct and indirect measures of efficiency, safety and infusion room staffing appropriateness.

Oncology Nursing Forum. 2025 Mar 1;52(2):17–18.

026. Development of a Comprehensive Oncology Infusion Staffing Dashboard: Leveraging Technology for Meaningful Insights

Alden Egan 1, Jake Gaston 2, Bo He 3, Judi Payne-De Bock 4, Jody Garey 5, Daniela Gehrke 6

Significance & Background

Proper staffing and equitable assignments are crucial for safe, effective care in oncology infusion rooms. Collecting and compiling data on patient volume and complexity is time-consuming and challenging, hindering meaningful insights and communication. Infusion room professionals spend an estimated 10 minutes per patient preparing staffing information that could be extracted directly from EHRs and enhanced by technology. A dashboard with machine learning model (MLM) enabled acuity prediction could streamline this process reducing nursing workload, enhancing quality insights and stakeholder communication leading to safer and more effective care delivery.

Purpose

This project aims to develop a dashboard that automatically aggregates critical staffing data from EHRs, leverages MLM-enabled patient acuity predictions, and incorporates a user experience centered around real-world infusion room workflows to facilitate meaningful staffing decisions.

Interventions

Formed task force consisting of nurse leaders, direct care nurses, data scientists and visualization developers. The development process included:

  • ■ Initial design based on user requirements

  • ■ Development of a predictive MLM for patient acuity (discussed in companion abstract)

  • ■ Multiple trial and testing phases

  • ■ Pilot with iterative optimization cycles

Results

Dashboard

The resulting dashboard seamlessly integrates into daily workflows, efficiently aggregating data. Key features include: 8-Day Outlook: Visual representations of daily patient volume, acuity mix, predicted nursing care time, and adjustable FTE requirements; Appointment Lists: Comprehensive patient details, including treatment and patient specific considerations relevant for infusion room assignment; Trends Analysis: Insights from future and historical data trends; Pilot Site Experience: The dashboard was deployed across twelve infusion rooms in August 2024. Preliminary data indicates it reduces time spent on staffing and assignment decisions, enhancing staff allocation for improved safety and efficiency. A formal evaluation of the pilot site is scheduled for November 2024.

Discussion

It is feasible to create a dashboard that automatically and prospectively aggregates EHR data, for staffing insights and acuity predictions aligning with infusion room needs. Early deployment shows promising results in reducing time and simplifying processes for staffing decisions, aiding in allocating staff for safe and effective care. Further data to be collected in November 2024. Preliminary expansion plans include seven additional community oncology practices and nearly 150 infusion rooms, with ongoing feedback and optimization to refine the dashboard and predictive acuity model, discussed further in companion abstract “Development of a Predictive Acuity Model for Oncology Infusion Staffing.”

Oncology Nursing Forum. 2025 Mar 1;52(2):18.

027. Sexual Health Screening in an Ambulatory Cancer Center: Identification of Patient Needs, Perceptions, and Intentions to Seek Support

Marloe Esch 1, Natalie McAndrew 2, Natalie McAndrew 3, Jayme Cotter 4, Jutta Deininger 5

Significance & Background

Best practice guidelines endorse regular screening and assessment of sexual health in all survivors, yet sexual health is consistently identified as an unmet survivorship need. Sexual and intimacy problems after cancer contribute to psychological and relationship distress and negatively impact survivorship well-being and quality of life. At one Midwest academic medical center, no standardized sexual health screening process existed to identify oncology patients experiencing sexual concerns. Lack of routine screening contributes to under-identifying patient needs and underutilizing available specialty services.

Purpose

This evidence-based quality improvement project aimed to determine the clinical utility and patients’ perceived value of sexual health screening in an ambulatory oncology setting by piloting a self-report sexual health screening process.

Interventions

Patients seen in six cancer clinics were invited to participate in a survey about sexual health screening. The survey included the Sexual Problems Checklist Screener and the InSYNC Questionnaire. Additionally, the survey provided instructions for self-referral to specialty services and evidence-based sexual health information. We also collected limited patient characteristics, care-seeking behavior intentions, and information about the perceived value of the screening process. We included open-ended questions to allow patients to share additional thoughts about sexual health screening.

Results

We had 289 survey attempts, and participants had 12 different primary cancers. Only 18.0% of respondents reported that their sexual health had been previously assessed as part of their cancer care. The Sexual Problems Checklist Screener identified the greatest prevalence of positive screens (n=159, 55.0%) and was the most preferred tool. Respondents reported increased understanding of sexual problems after cancer (43.9%) and increased confidence to manage sexual concerns (27.7%) after completing the survey. Patients perceived sexual health screening as valuable and identified increased care-seeking behavior intentions, including accessing additional resources, bringing up a concern to their provider, and asking about available specialty services.

Discussion

We found a high prevalence of sexual concerns and that a limited portion of the sample had been asked about their sexual health. Adopting a self-report sexual health screening process in the oncology ambulatory setting may improve the identification of individuals who can benefit from sexual health specialty services and may facilitate patients’ care-seeking behaviors. Nurses can use these screening tools in practice to normalize sexuality, initiate face-to-face conversations with patients, and as a needs assessment to guide individualized care planning.

Oncology Nursing Forum. 2025 Mar 1;52(2):19.

028. Fueling Passion, Igniting Excellence: The Journey of an Oncology Nurse Fellowship

Nicole Ferreira 1, Judy Johnson 2

Significance & Background

New-to-specialty registered nurses (NTS-RNs) represented 48.5% of hires in the ambulatory oncology setting at an academic medical center from January 2021 to September 2023. Elevated turnover rates were observed with 25% of newly hired NTS-RNs leaving the cancer center after 6.2 months of employment. This data did not align with the organization’s retention and staff satisfaction goals. Post-orientation evaluations indicated learning the hematology/oncology specialty was a challenge, suggesting a need for enhanced education opportunities.

Purpose

The purpose of this quality improvement initiative was to decrease first-year turnover, increase retention, and increase the confidence, competence, and professionalism of NTS-RNs in the hematology/oncology specialty.

Interventions

With support from leadership, the Nursing Education Specialist (NES) performed a needs assessment and literature review to develop an oncology fellowship program. Newly hired NTS-RNs were assigned to a cohort, fostering mentorship, peer support, and enculturation into the organization. The program featured four sessions spaced throughout the year to prevent information overload while building upon prior knowledge and clinical experience (see Figure 1). Each session began with a debrief and check-in facilitated by the NES to cultivate a community of practice. Participants engaged in a dynamic case study activity called Nursing Grand Rounds. Each nurse selected a newly diagnosed patient to follow through chart review and presented clinical updates during the second, third, and fourth fellowship sessions. This approach promoted critical thinking and a reflective practice throughout the patient’s continuum of care.

Results

Since launching in November 2023, the fellowship onboarded four cohorts with 28 total participants and achieved a retention rate of 96.5%. The Oncology Nurse Confidence Survey, administered every three months, revealed increased confidence across all five domains of the oncology nurse generalist competencies (see Figure 2). Given this success, NTS-RNs from inpatient areas were added to the program. The blended inpatient and outpatient experience fostered robust discussions, with nurses providing suggestions to address common issues encountered across various departments.

Discussion

Preliminary findings indicate the Oncology Nurse Fellowship enhances knowledge and confidence in oncology nursing competencies for NTS-RNs. Based on this initial data, the cancer center intends to offer additional cohorts aligned with hiring trends. Program graduates will be followed over the course of two years to measure indicators of professional development, including oncology certification, clinical ladder advancement, and participation in evidence-based practice or quality improvement initiatives.

Oncology Nursing Forum. 2025 Mar 1;52(2):19–20.

029. Improving the Patient Experience and Access to Radiation Treatment for Breast Cancer Through Nurse Driven Process Efficiencies

Sarah Ferrin 1, Amber Nguyen 2

Significance & Background

CT simulation (CT sim) is a critical first step in preparing breast cancer patients for radiation therapy (RT), as it allows precise mapping of the treatment area to ensure accurate radiation delivery. RT typically occurs at the end of the patient’s care plan; therefore, any delay affects treatment. Scheduling CT sim and follow up on the same day led to frequent cancellations and delays, anxiety, and decreased patient and staff satisfactioN.

Purpose

This project’s purpose was to improve template efficiency and patient access to care through nurse-driven communication, thereby decreasing CT sim cancelations. Setting up RT for breast cancer is dependent on excellent care coordination. In this clinic, an average of 27 (31%) of CT sims were cancelled monthly, resulting in delays for starting RT and causing anxiety and frustration.

Interventions

A multidisciplinary committee including hospital leadership, scheduling, nursing, providers, radiation therapists, Epic personnel, and a senior process engineer was formed. The committee collaborated to generate a project timeline and formulate ideas to streamline scheduling and reduce cancellations. One key intervention was to empower Advanced Practice Providers (APPs) to facilitate telehealth appointments, enabling oncology nurse-driven evaluation of patient readiness prior to CT sim. These changes were designed to improve patient experience, increase communication, minimize cancellations, and ensure an efficient process.

Results

Thorough data collection and review took place prior to initiating the project to assess the extent and impact of CT simulation cancellations, confirming the need for intervention. Data continues to be collected and is reported to hospital leadership. In the month following project implementation, cancellation rates dropped significantly to 13 (11%) of CT sims. It simultaneously maximized treatment table template utilization and significantly improved access to care. These changes have led to increased patient and staff satisfaction by ensuring better preparation and minimizing delays in the treatment timeline.

Discussion

The introduction of APP telehealth visits has significantly improved patient preparedness and has positively impacted oncology nursing roles, allowing nurse driven efficiencies in communication and education to lead the patient through an optimized treatment timeline. It incidentally improved enrollment in clinical trials, improved staff and table utilization, and ultimately has enhanced both patient and staff satisfaction. This project will roll out through all of Radiation Oncology in our organization and is translatable to facilities of all sizes who are providing RT services.

Oncology Nursing Forum. 2025 Mar 1;52(2):20.

030. Implementing a Virtual Nursing Pilot on Inpatient Cancer Units

Sarit Fleishman 1, Nichole Baltzer 2, Suzanne Cowperthwaite 3, Marie Swisher 4, Laura Hearson 5, Rebecca Stecher 6

Significance & Background

As healthcare becomes more complex, frontline nurses may find themselves prioritizing some tasks above others, leading to missed nursing care. The role of a virtual nurse (VN) is to help manage gaps in care by facilitating patient teaching, admission and discharge documentation, dual medication sign offs, procedural checklists, and nurse care plans.

Purpose

A VN pilot project was initiated in January 2024 on an inpatient oncology unit at a National Cancer Institute- Designated Comprehensive Cancer Center. The purpose of the project is to reduce the burden of bedside nurses, improve nurse and patient satisfaction, reduce errors, and improve care.

Interventions

A Plan – Do – Study – Act approach was taken for this pilot project. VNs and leaders completed training to learn about the VN role and the technology. Staff were educated on associating and disassociating patients to iPads and additional software for chemotherapy dual sign offs. The telehealth platform, currently in use at our facility, was utilized for the pilot. Educators created an electronic resource dashboard for staff. Following implementation, feedback was solicited from staff and patients. Patient education video usage, patient satisfaction scores, and discharge instruction error data were collected. Weekly meetings are ongoing with unit leadership and VNs to continuously evaluate and improve VN processes.

Results

Between January and May 2024, there have been 88 VN shifts. The VNs provided education for 175 admissions and 212 discharges. The VNs corrected or sought clarification for 59 medication orders, 29 patient instructions, and 20 follow-up appointments during discharge summary instruction review. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey demonstrated an increase in nursing communication top box scores, from 79 to 91%, and discharge information, from 85 to 94%, when comparing four months pre- and post-implementation. Patient education video use increased from 13 views for the entirety of 2023 to 176 views four months post-implementation. Patients appreciated VNs “undivided attention” when completing education.

Discussion

The VN role increased patient satisfaction and reduced healthcare errors. The VN can improve nursing workflow and allows us to enter a new reality of optimized resource utilization for better patient care. Next steps include expanding the VN role to the Bone Marrow Transplant unit and improving technology and workflow for medication sign offs.

Oncology Nursing Forum. 2025 Mar 1;52(2):20–21.

031. Decreasing Common Commensal Occurrences

Claire Flores 1

Significance & Background

On the inpatient oncology units, blood cultures are typically drawn from both a central line (CL) and a peripheral (stick) source. From the paired blood cultures that were collected from June to November 2023, there was a 1.54% common commensal occurrence rate. Common commensal occurrences can result in unnecessary antibiotic treatment, prolonged hospital stay, and increased cost to patients. Correctly identifying common commensals promotes antibiotic stewardship, leading to the appropriate initiation and usage of antibiotics.

Purpose

The goal of this evidence-based practice project was to standardize the peripheral blood culture collection process within the Cancer Hospital and decrease common commensal occurrences. Practice changes included extremity cleaning with chlorohexidine gluconate (CHG) immediately before peripheral blood culture collection paired with the use of a blood diversion device.

Interventions

Before incorporating new strategies for peripheral blood culture collection, education materials were reviewed with bedside leaders, phlebotomy staff, and leadership in the format of group huddles and one-on-one teaching sessions. Education materials and door signs with step-by-step instructions were posted outside each patient’s door. Beginning January 2024, peripheral blood culture collection required the performance of a CHG wipe-down immediately prior to peripheral blood culture collection with the utilization of a blood diversion device by the phlebotomist. Data collection included the following time periods: pre-intervention June 2023 through November 2023, intervention/education December 2023, and post-intervention January 2024 through June 2024. All blood culture collections were reviewed to determine if the event was a CLABSI (central line associated blood stream infection), MBI (mucosal barrier injury), or a common commensal occurrence.

Results

Review of the post-intervention blood cultures pairs showed a decrease in common commensal contamination to 0.86%, meaning there was a 50% decrease in hospitalized oncology patients with central line access testing “positive” for common commensal organisms. This is significant in that the practice changes directly decreased antibiotic administration. The units continue to use CHG cleansing and use of the blood diversion device before drawing peripheral blood cultures.

Discussion

The interventions will be established as the new standard of practice (SOP) within the Cancer Hospital. Additional reviews will be performed at different intervals to confirm consistency of decreasing common commensal occurrences. The evaluation only included paired CL and peripheral blood cultures, and a future analysis is planned to evaluate all cultures.

Oncology Nursing Forum. 2025 Mar 1;52(2):21–22.

032. The Impact of Targeted Community Cancer Education on Cancer Screening Rate

Fabienne Gaillard Ulysse 1

Significance & Background

Globally Cancer is the second leading cause of death. Cancer incidence and mortality are predicted to increase to 30.2 million cases and 16.3 million deaths by 2040. Delay between symptoms onset and treatment leads to poorer cancer survival. Cancer Screening increases the chance of early detection and treatment, therefore, remains a powerful tool that can help find disease at an early stage. The goal of cancer screening is to reduce cancer morbidity and mortality. Oncology nurses are well positioned and equipped to partner with communities to addressing the issue. In identified disease specific high-risk communities, poor awareness, lack of knowledge with negative perception towards cancer correlates to a low screening rate. This places the community at a disadvantage to early diagnosis and reduction of cancer morbidity and mortality when the evidence shows screening reduces the incidence of high-grade cancers.

Purpose

The aim is to implement innovative community targeted Education activities educating populations on cancer awareness, cancer screening, early detection, modifying health behaviors and risk-reducing interventions to increase cancer screening rate.

Interventions

We Identified areas in Brooklyn, Queens and Long Island with high population of African American male and female. We performed an educational need assessment and cancer screening rate. We partnered with community leaders to host health fair and prostate and breast cancer screening via onsite urologic evaluation and onsite mammography. Another strategy used is providing monthly three to five minutes health Nuggets on prostate cancer and breast cancer which are broadcasted on local radio stations or presented in person at local churches or local gatherings. These include emphasizing on Cancer awareness, screening and early detections, risks reducing interventions and modifying health behaviors.

Results

From 2021 to date we have screened over 8000 patients for both prostate and breast cancer. We have broadcasted over 100 health nuggets presentations to different targeted communities reaching over 15000 listeners in Brooklyn, Queens and Long Island areas.

Discussion

The initiative continues. We are actively collecting data for additional impact evaluation and results will be used to determine area of concentrations. A partnership with the NYC department of health is important to facilitate dissemination of language specific literature pamphlets to the different communities based on risk determination for disease type.

Oncology Nursing Forum. 2025 Mar 1;52(2):22.

033. Transforming Immunotherapy Education: Tailored E-Learning for Improved Patient Success

Joanne Gonzalez 1, Whitney Archer 2, Sam Dalin 3

Significance & BackgrounD

In recent years, cancer therapy has been transformed by the growing availability of immunotherapy treatments. Immunotherapy, which can be used in conjunction with or independently of chemotherapy, has a distinct side effect profile. These side effects require unique management approaches compared to traditional chemotherapeutic agents. As oncology care has advanced, nurses in the hematology oncology clinic identified a gap in education and management of care for patients receiving immunotherapy. This was evidenced by patient comments following the standard chemotherapy education class and incoming patient phone calls and portal messages related to immunotherapy management.

Purpose

The oncology ambulatory nurses determined these educational gaps negatively impacted patient safety and satisfaction. In response, this quality improvement project was initiated with the goal of increasing the percentage of patients receiving tailored immunotherapy education from 0% to 50% by mid-2024.

Interventions

A multidisciplinary team, including ambulatory clinic nurses, an oncology nurse navigator, a nursing education specialist, a quality nurse specialist, and nursing leadership, collaborated to develop an immunotherapy e-learning module. Following its creation, the module underwent approval by the Patient Education department and the Oncology Nursing Subcommittee. The objective was to distribute this module to patients through the patient portal, supplementing the standardized chemotherapy education class with tailored immunotherapy information.

Results

After implementing the e-learning module, 17% of patients starting a new treatment received immunotherapy specific-education, which increased to 30% after standardizing a process for communication to patients. To further improve the process, a tracking system for module completion was developed and implemented. By the end of the project, the rate of patients (n=147) who received tailored immunotherapy-specific education had increased from 0% to 100%. A chi-squared test validated statistical significance of the change in percentages (x2(5)=31.26,p<0.001).

Discussion

This nurse-led, innovative approach to immunotherapy education enhanced the patient experience by delivering essential information in a way that accommodated diverse learning styles. Patients were able to review the module at their own pace and revisit the information as often as needed. A well-informed patient is better equipped to recognize and report concerns early, enabling timely interventions and potentially enhancing treatment tolerance. By making education adaptable and comprehensible, oncology nurses can better meet patients’ needs, which may improve overall treatment outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):22–23.

034. Fueling the Oncology Nurse Scientist Pipeline Through an Academic Medical Center Based Postdoctoral Research Fellowship in Oncology Nursing

Eileen Hacker 1, Joyce Dains 2, Anecita Fadol 3, Eunju Choi 4, Karen Alsbrook 5, Gisele Tlusty 6

Significance & Background

The sustainability and future of oncology nursing science depends on our ability to educate, train, and mentor the next generation of nurse scientists. This need is becoming urgent with declining enrollment in Nursing PhD programs. An oncology nursing postdoctoral research fellowship provides an opportunity to extend knowledge, expand areas of expertise, and build skills necessary to launch an independent research career to improve cancer care. Postdoctoral training provides protected time to focus on career development and research.

Purpose

This report outlines the progress and impact achieved over the three years of the University of Texas MD Anderson Cancer Center’s Argyros Postdoctoral Research Fellowship in Oncology Nursing.

Interventions

Oncology nursing postdoctoral research fellows are selected through a competitive process following a national call for applications. Fellows are paired with a mentoring team consisting of a nurse scientist and other senior scientists from health-related fields aligned with the fellows’ research interest. Fellows engage in an oncology nursing specific postdoctoral training program and the institution’s broader postdoctoral research training. Fellows also participate in disease-specific and theme-focused programs, such as data science, to further enhance career development and professional network expansion.

Results

The Argyros Postdoctoral Research Fellowship in Oncology Nursing was successfully launched and is now in its third year. The program includes seminars, grand rounds, research training, and discipline- and cancer-specific mentorship. One fellow per year has been recruited as planned. A third fellow started in September 2024. Two of the three postdoctoral fellows successfully competed for highly competitive funding, including one funded NIH Pathway to Independence Award (K99/R00). Another K99/R00 award is currently under review. Fellows disseminated their research via publications and presentations; thus, meeting predefined metrics for success.

Discussion

This philanthropic-funded postdoctoral research training program is critical to fueling the oncology nurse scientist pipeline and highly unique given its execution in an academic medical center and housing in a Department of Nursing. The program’s multidisciplinary environment focused on cancer patient care, research, education, and prevention is a significant strength for building the postdoctoral oncology nursing research fellowship. A challenge lies in building and sustaining a robust, nursing-focused, research-intensive environment that encourages scientific discourse and supports rigorous studies when the faculty and fellow pool is diminishing. Philanthropic-funded postdoctoral research fellowships may be an essential strategy for keeping the pipeline of oncology nurse scientists flowing.

Oncology Nursing Forum. 2025 Mar 1;52(2):23.

035. Empowering Nurse Management of Hypersensitivity Reactions in the Ambulatory Setting

Trisha Harmon 1, Katie Ortner-Henry 2, Phuong Huynh 3, Amy S Boswell 4, Anna McClenny 5

Significance & Background

At a large NCI-designated ambulatory cancer center, hypersensitivity reactions (HSRs), have become more prevalent with new and innovative antineoplastic agents. The majority of HSRs in the ambulatory setting are lower in severity, grade 2–3 (CTCAE v5.0), and interventions are predictable. A gap was identified within oncology nurse management of prolonged or higher severity HSRs, as further intervention could not be initiated by nursing until a medical provider was present.

Purpose

To provide education and training for the implementation of a new nurse-led hypersensitivity reaction protocol.

Interventions

A team of expert infusion nurse educators identified priorities for education which included content discussing the pathophysiology of HSRs and the rationale for associated interventions. The educational content included topics such as physiologic responses to mast cell histamine release, including hives, pruritus, fever, back pain, hypotension, angioedema, and anaphylaxis. To support the anticipated concerns of nurse-led interventions in a high-risk setting, education included an emphasis on predictable and well-established interventions, ensuring continued provider response, and equating the practice to using “as needed” medications for symptom management. This content was integrated into clinical in-services, video recordings, job aids, and intentional educator rounding with frontline staff to answer questions.

Results

A nurse-led HSR protocol provides the ability to implement timely interventions. However, early in the practice change, nursing comfort and confidence were identified as barriers to implementing timely interventions. Despite comprehensive education that addressed nursing apprehension, nurses were waiting until the medical provider was present to initiate the protocol. An unintended outcome of the practice change was role confusion between the responding medical provider and nurse.

Discussion

Dedicated time for pathophysiology review was well received by nursing and facilitated learner engagement and acceptance of the practice change. Defining clear clinical roles and responsibilities was initially overlooked and discovered to be a critical education component. Further rounding with frontline staff helped solidify role expectations when managing HSRs. Nurses reported that adoption of this protocol empowered them to better care for their patients. A broad and intentional approach to education and training can increase nursing confidence, enhance collaboration, and ultimately improve patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):23–24.

036. Understanding Firefighter Occupational Cancer Risk, Prevention, and Screening

Lynn Harrison 1, Lynn Harrison 2

Significance & Background

In 2023, The International Agency for Research on Cancer evaluated Occupational Exposure as a Firefighter as carcinogenic to humans (Group 1). NIOSH research shows firefighters are at 9% greater risk of developing cancer and 14% greater risk of dying from cancer. It also shows firefighters get cancer at an earlier age and often develop more than one type of cancer. Current firefighter NFPA standards do not include cancer screenings. We identified a lack of knowledge about firefighter occupational cancer among local firefighters and physicians. Oncology nurses can provide education and advocate for aggressive cancer screenings for this unique population, resulting in better outcomes and a lower burden of cancer in our community.

Purpose

The purpose of this project is to promote appropriate cancer screenings and best practices for occupational cancer prevention in the fire service.

Interventions

A free “Cancer Class” is provided by oncology nurses at Fire Chief’s Association meetings, fire houses, military fire departments, and fire academies in the hospital’s catchment area. Cancer Class includes basic information on how cancer develops and progresses; current firefighter cancer research findings; how early detection leads to better outcomes and saves lives; unique firefighter cancer screening recommendations; self-screening instructions; and best practices to reduce exposure to occupational carcinogens. An anonymous, post-class, optional questionnaire gathers information about current cancer prevention practices, perceived barriers to implementation of best practices, insurance coverage, and access to cancer screening. Education is also provided via newsletters and email to nurses, physicians and physician leadership about appropriate firefighter medical evaluations, cancer screenings, PFAS testing, and interventions for elevated PFAS levels.

Results

This is an ongoing project. We found the majority of firefighters in our communities are volunteer. Many are uninsured, and most do not have access to appropriate cancer screening. Feedback suggests some best practices are easily implemented, while others are more challenging to enforce, like smoking and vaping. Awareness, funding, and firefighter culture were cited as barriers to implementation of best practices.

Discussion

This is an innovative approach to address the increased incidence of occupational cancer in firefighters in our community. The project calls upon oncology nurses to link firefighters and healthcare as a means to open communication, provide education and promote appropriate cancer screening for firefighters. Oncology nurses are now advocating for a mobile lung cancer screening CT for firefighters.

Oncology Nursing Forum. 2025 Mar 1;52(2):24–25.

037. Improving Timeliness to Care for Head & Neck Cancer Patients

Laura Hayes 1, Madison Skotcher 2, Regina Dixon 3, Jill Reuille 4

Significance & Background

Timeliness to care is essential, as delays can lead to disease progression and poorer outcomes. Facilitating prompt treatment enhances overall patient experiences. Discussion s with care team members and patients revealed that many struggled to find appropriate and timely dental care, highlighting this as a key barrier.

Purpose

Head and neck cancer patients often face delays in accessing timely care, which is critical for effective management. Newly diagnosed patients needing radiation therapy must undergo pre-radiotherapy dental evaluations, yet many lack access to dental care. This project aimed to reduce these delays through nurse-led interventions and collaboration with a local dental school, which was integrated into our surgical oncology clinic at the oncology center.

Interventions

This six-month quality improvement project established a standardized referral pathway. Key interventions included:

  • ■ Early Dental Evaluation: Scheduling assessments at diagnosis to address dental issues swiftly.

  • ■ Nurse-Led Navigation: A dedicated navigator guided patients through the diagnostic and treatment processes.

  • ■ Multidisciplinary Case Reviews: Weekly meetings with specialists prioritized scheduling and minimized delays.

  • ■ Oral Medicine Clinic: Launched weekly at the cancer center, allowing patients without dental access to receive evaluations and recommendations on-site.

Metrics were collected on the time from diagnosis to treatment initiation, measuring business days from the pathology result to the first treatment.

Results

Post-intervention, the average time from diagnosis to treatment initiation decreased by 20%, from 45 days to 36 days (p<0.01). The oral medicine clinic, initiated in June 2023, showed improvements: Q1 averaged 29 days, Q2 28.6 days, Q3 41.75 days, and Q4 28 days from biopsy to treatment start. Patient satisfaction also improved, with 85% reporting enhanced communication and care timeliness.

Discussion

This project highlights that a structured, nurse-driven approach, alongside the integration of the dental school into our surgical oncology clinic, significantly reduces delays in head and neck cancer treatment. While outcomes improved, ongoing evaluation and access to resources like surgical facilities for dental procedures remain areas for future enhancement.

Oncology Nursing Forum. 2025 Mar 1;52(2):25.

038. Guardians of Gravity: Orthostatic Vitals Defending Hematopoietic Transplant Patients Against Falls

Vanessa Hernandez 1, Jose Llanas 2

Significance & Background

The Morse fall screening tool does not identify patients at risk for syncopal falls. During the fiscal year 2023, the inpatient oncology unit had 19 falls from patients who had a negative morse screen post-completion of chemotherapy. Internal review demonstrated that 43% were due to syncope and 15% were due to dizziness. Of the 19 falls, 7 of them were hematopoietic stem cell transplant (HSCT) patients.

Purpose

Nurses will perform orthostatic vital signs for the HSCT patients’ twice a day for the first 4 days of status-post transplant compared to regular vital signs as an assessment tool to identify patients at risk for syncope fall events between April 2024 and August 2024.

Interventions

The evidence-based practice project was based on H. Lee Moffitt Cancer Center, who led a project to decreased falls by completing orthostatic vital signs. The nursing staff presented their data and received approval through a MD/RN collaborative committee. Nursing staff were educated through in-services prior to implementation. The oncology attending ordered orthostatic vitals twice a day for HSCT patients on the day of admission. Nurses implemented fall precautions and notified the oncologist with each positive orthostatic vital sign.

Results

There were 34 HSCT (23 Autologous and 11 Allogenic HSCT) patients during our project period. Of those patients, 38% had at least one positive orthostatic vital sign reading. Allogenic patients had a higher rate of positive orthostasis at 54.5%. The medical team treated 92% of patients with orthostasis with intravenous fluids. During the project period, there was 1 assisted fall in the HSCT population due to positive orthostatic vitals. All patients with positive orthostatic vitals had a documented low-risk screening for falls based on the Morse Scale proving the tool does not capture patients at risk for syncopal falls.

Discussion

The HSCT population have a high risk for mortality from bleeding due to their thrombocytopenia. Completing orthostatic vitals is a nurse driven assessment that is non-invasive and budget friendly. Identifying patients with orthostasis allows for a collaborative approach to decrease falls by nursing staff initiating fall prevention measures and physicians ordering supportive treatment. This project demonstrated that completing orthostatic vitals as an assessment screen can assist in identifying patients at risk for syncopal episodes and allowed for early treatment to prevent falls.

Oncology Nursing Forum. 2025 Mar 1;52(2):25–26.

039. Use of a Surgical Oncology Nursing Manual for Oncology Nurses

Lindsay Herndon 1, Danette Birkhimer 2, Karen Meade 3, Lynne Brophy 4, Allison De Villiers 5

Significance & Background

New and experienced nurses coming into oncology have a challenge of learning all new disease processes and procedures. From chemotherapy to surgery, nurses have a steep learning curve coming into the field, especially for temporary staff such as travel nurses. At a large academic medical center, nurses reported having a lack of knowledge and resources related to oncologic surgical procedures. Evidence suggested that access to education, especially ‘bite sized’ education, improved nursing satisfaction and retention of knowledge.

Purpose

This project’s goal was to create an easily accessible, succinct surgical oncology manual for nurses, providers, and ancillary staff. This manual would be placed on the hospital’s intranet and available 24/7 to staff. Each surgical procedure would be covered in brief sections, approximately one page long, ensuring they were brief and easy to access.

Interventions

A team of clinical nurse specialists, nurse educators, and bedside nurses worked together to create the content for the surgical manual. A previous surgical manual existed for abdominal surgeries, but not for the breadth of procedures performed at the academic medical center. The information in the manual was reviewed by nurses and providers for accuracy and relevancy. Once confirmed, the final version was uploaded to the hospital intranet with advertisement to staff via flyers and announcements.

Results

Once the surgical manual was published, we monitored the page visits to the file hosted on our intranet. From Jan 2023 to April 2023, the manual received 248 page views, with 152 unique users, meaning many users had repeat visits. This was the most utilized page on our hospital’s nursing education site.

Discussion

The field of oncology nursing is ever-changing with new procedures, medications and surgeries. Oncology nurses are uniquely challenged with the amount of information needed to provide competent, holistic care. A succinct, easy to access surgical manual gives nurses the tools they need to care for their patients and provide optimal clinical outcomes. Our surgical manual gained quick popularity amongst the nursing staff and provided this knowledge to augment their professional development. Other hospitals could benefit from providing a surgical manual to their staff. The work on this project also led to the development of a Medical Oncology manual.

Oncology Nursing Forum. 2025 Mar 1;52(2):26.

040. Improving Central Line Associated Blood Stream Infections Using K-Cards

Megan Hoffman 1

Significance & Background

Central line associated bloodstream infections (CLABSI) are a significant problem in healthcare. Risk factors associated with CLABSI include chronic illness, immunosuppression, malnutrition, age, and prolonged hospital stay. Oncology patients are at increased risk due to these factors, and typically have higher rates of central line placement to deliver treatment for their cancer diagnosis. Literature suggests that increasing compliance with a standard care bundle can decrease the CLABSI rate.

Purpose

The purpose of this Doctor of Nursing Practice project was to implement an evidence-based process to decrease CLABSI rate on an acute care oncology unit by 10% in three months after implementation.

Interventions

A literature review was conducted to identify a strategy to increase compliance with the standard care bundle. Kamishibai Cards (K-Cards) were identified as a cost-effective method that had not yet been implemented in the pilot unit. K-Cards are a tool to guide conversation using color coded sides as a visual display of compliance. After creation of a K-Card focused on CLABSI prevention, the tool was incorporated into monthly audits performed by quality and safety champions in the unit. During the audit, if compliant, the auditor would praise staff and would result in a green K-Card. If elements were missing, resulting in a red K-Card, the auditor would mentor the nurse in real time and fix the element together. Results of K-Cards were shared without staff names, to remove punitive action from the result and shift focus to the learning process.

Results

Data analysis was performed monthly to track the implementation progress during the project period of December 2023-February 2024. The CLABSI rate only included those that were classified as non-mucosal barrier injury. Post implementation, there were 0 CLABSIs reported on the pilot unit during the three-month project period. Compliance with the K-Card during the audit was also measured and during the project period, there was a 58% rate of green K-card results, meaning all elements of the bundle were present on audit.

Discussion

Utilizing K-Cards during auditing can increase compliance with standard care bundles, which can decrease CLABSI rates. The K-Card is a sustainable and cost-effective strategy to incorporate into audits to increase communication between auditors and nursing, increasing compliance, and ultimately patient care outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):26–27.

041. Best Practice for Blincyto Administration

Victoria Holmes 1

Significance & Background

Treatment of oncology patients is rapidly advancing. Oncology nurses strive to stay current while being inundated with new medications and treatment approaches. Bispecific antibodies are a new class of antineoplastic medications with specific guidelines new for outpatient oncology nurses.

Purpose

Increase nursing awareness and confidence with Blincyto administration guidelines and procedure by 50% and have 80% of nurses complete education sessions.

Interventions

Education was delivered during four safety huddles to engage 100% of staff. Cards with Blincyto reminders were created to attach to the nurse’s badge. An informational leaflet was compiled for the patient’s pump bag to alert healthcare providers (ER staff) on the specifics to follow when handling a Blincyto administration. Due to complexities regarding accidental bolus if lines are flushed, administration process maps were created to increase administration safety. All tools were distributed during the education sessions. A “Best Practice for Blincyto Administration” slide deck was developed for the sessions. Participants completed an anonymous pre- and post-survey collected day of education.

Results

Pre- and post-survey data were compared and indicated both goals were achieved and exceeded. Nurse confidence in Blincyto administration increased above 50% following the nurse education sessions and distribution of the administration tools. Participation rate of 100% by infusion nurses, Clinical Manager, and Clinical Specialist was achieved. Immediate practice implications were seen on one of the education days. A patient arrived for a Blincyto pump exchange but was held due to toxicity concerns. Due to the nurse’s increased knowledge of Blincyto administration guidelines, patient safety was ensured, and drug waste was prevented. This scenario highlighted the importance of nursing education provided and its impact on patient care.

Discussion

Nurses reported increased understanding and confidence, though some indicated a need for improved patient education. Some nurses were previously unaware of the black box warning and necessary assessments but now feel equipped to properly manage these aspects. All Blincyto education materials have been added to new teammate orientation binders and will be reviewed with Clinical Specialists and preceptors.

Oncology Nursing Forum. 2025 Mar 1;52(2):27.

042. Implementation and Impact of Smart Infusion Pumps in an Outpatient Oncology Setting

Tiffany Hopper 1

Significance & Background

Smart infusion pumps with integrated drug libraries have significantly improved medication safety. Our outpatient oncology practice introduced these pumps across nine clinical sites to enhance safety by utilizing drug library guardrails, targeted alerts, and in-pump information as the previous pumps lacked features such as real-time data, guardrails, and built-in medication information. After selecting the new pumps, a nurse-led multidisciplinary committee developed a comprehensive drug library containing 143 medications. A literature review identified strategies for measuring safety impact by capturing near-miss events. This initiative is designed to reduce medication errors, provide nurses with critical information, and ultimately improve patient safety.

Purpose

This project analyzes the effectiveness of smart pumps in preventing medication errors within an outpatient oncology setting.

Interventions

Smart pump data was tracked using a structured query language (SQL) database, with a focus on drug library compliance and near miss events. In August 2024, a survey of nurses was conducted to gather feedback on the smart pump’s effects on safety and usability.

Results

Survey results showed that 61.3% of nurses who had used the previous pumps agreed that smart pumps enhanced safety; 47.8% felt the overall environment was safer. Among nurses who were onboarded after the rollout, 72.5% reported feeling safer due to drug library guardrails, and 75% found alert pop-ups helpful. Between January 1 to August 30, 2024, there were 13,870 out-of-guidance alerts, with 35% (n=4807) indicating a near miss. The mean percent difference between programming alert triggers and guidance limits was calculated for duration (75%), concentration (126%), rate (48%), and dose (99%).

Discussion

Smart infusion pumps have had a positive impact on safety and usability, especially through drug library guardrails that helped prevent significant errors. However, lower utilization of certain resources in the drug library highlights the need for additional training and awareness. Future phases will focus on integrating the pumps with the EHR and implementing barcoding to further enhance safety and enable real-time infusion monitoring. Ongoing collaboration with clinical staff and regular drug library reviews will drive continuous improvement. Additionally, further evaluation of the frequency of overrides is planned to inform future library adjustments.

Oncology Nursing Forum. 2025 Mar 1;52(2):27–28.

043. Are Vitals Overrated? Administration and Monitoring Practices for ATG and Other Drugs at Higher Risk for Infusion Reaction

Vivian Huang 1

Significance & Background

Infusion-related reactions (IRRs) to drugs such as antithymocyte globulin (ATG) are a common challenge in oncology. The adult hematology service at a large academic medical center previously employed a complex ATG administration protocol requiring extensive nursing time for titration calculations and frequent vital sign (VS) monitoring. This process contributed to increased nursing workload, potential for staff injury, and decreased patient satisfaction.

Purpose

By reassessing ATG infusion administration and monitoring and simplifying the procedure from a 2-pronged 3-step titration with 5-step VS monitoring, we aimed to alleviate nursing work burden of rate calculation and titration and VS assessment by at least 50% in 1 year without increasing IRR incidents or severity above baseline.

Interventions

To optimize patient care and nursing efficiency, we implemented a simplified ATG infusion protocol involving flat-rate administration and reduced VS monitoring. This change was based on evidence suggesting that symptom-based monitoring is more effective in detecting IRRs than frequent VS checks.

Results

Since titration and monitoring practice change in September 2022, the hematology service has seen no increase in ATG infusion reaction risk or severity, with 28 patients administered 111 ATG doses for transplant. The change has led to decrease in nursing time spent on titration calculation as well as vital sign monitoring, saving ~60 nursing hours and $5328. Our results demonstrate a significant reduction in nursing workload, improved staff satisfaction, and no increase in IRR incidence. Additionally, we observed a decrease in repetitive motion injuries among nursing staff.

Discussion

While VS are a mainstay of nursing care, alterations in VS are unlikely to be the first signs of an infusion-related reaction and thus provide little clinical benefit while negatively impacting nursing workflow. Frequent VS are often found to be carryovers from strict clinical trial requirements and unlikely to detect IRRs. Patient education of and nursing monitoring for symptoms of an IRR are critical. As novel immunotherapies are introduced, and when evidence emerges regarding older therapies, the Clinical Nurse Specialist has a critical role in reviewing best practices for administration and monitoring across care settings and populations to balance patient safety with nursing work burden and resources.

Oncology Nursing Forum. 2025 Mar 1;52(2):28.

044. Marvelous Central Line Associated Bloodstream Infection (CLABSI) Prevention Heroes-One Unit’s Incredible Fight

Shannon Hunger 1, Jenna Lisk 2, Allison Weis 3

Significance & Background

A 24-bed stem cell transplant and cellular therapies unit previously implemented a 2-Person Central Line Dressing Change Team to combat CLABSI incidence, with highly effective results. 5 years later it was re-evaluated and recognized that the approach inadvertently led to dressing change incompetence and generalized depletion of central line stewardship. Reflection and analysis clearly indicated it was time for modification.

Purpose

The goal was to re-introduce and re-educate details that would improve central line stewardship and accountability of each staff member, including return demonstration 2-person dressing change. In doing so, it would provide all staff members the competence of skills and improved confidence in their individual contribution to CLABSI prevention.

Interventions

Unit-based hands-on competencies were provided with a fun theme each year in 2023 (MARVEL) and 2024 (The INCREDIBLES) to excite and engage staff while educating on the significance of CLABSI prevention. Following The Iowa Model©, with several feedback loops, reflecting analysis, evaluation and modification, all unit nursing staff were invited to complete a pre-survey, 6-month and 1-year follow up. Specifically, the surveys addressed questions on knowledge, behaviors, and attitudes towards CLABSI prevention.

Results

Staff nurse prevention knowledge improved from 12% to 77%. When performing a 2-person dressing change, confidence enlivened from 29% to 77%. Other improvements included staff strongly agreeing that their knowledge improved, self-report of feeling more knowledgeable of their individual role in prevention, improved confidence in central line stewardship, and improved ability to perform a 2-person dressing change and accurate documentation. CLABSI prevention bundle behaviors improved 75%-100%. Improvements were ultimately demonstrated by an overall unit reduction of CLABSIs by 65%.

Discussion

It is the conclusion that after each staff member was re-educated in creative, fun, and engaging ways, nursing central line stewardship improved as well as confidence and competence in executing CLABSI prevention measures. It is statistically evident that this reinfusion of knowledge supports the importance of leadership focus, education, and continuous monitoring of outcomes to lead positive evidence-based practice and thereby significantly impacting the patient experience and outcome.

Oncology Nursing Forum. 2025 Mar 1;52(2):28–29.

045. Standardize, Teach-Back, Repeat

Debora Hutton 1, Erika Gonazlez 2

Significance & Background

Chemotherapy treatment requires extensive patient education, which can overwhelm patients. To empower patients to take an active role in their treatment, oncology nurses must allow them to learn at their own pace. Oncology nurses are uniquely positioned to provide ongoing patient education during their scheduled infusion treatments.

Purpose

Knowledge retention varies from patient to patient and patient education varies from nurse to nurse. To minimize gaps in what is taught, we standardized our patient education by developing deliberate scripted materials focusing on key concepts of treatments and management of common side effects. The goal of this improvement project was to increase patient education retention by 30% to 40% within three months. Our theory was that this could be accomplished by using nurse conducted, standardized, repeated, patient education using the teach-back method.

Interventions

Patients on a chemotherapy regimen with a treatment cycle requiring a clinic visit every 2 weeks were selected to pilot. Through staff collaboration, a list of standardized questions related to common, and drug specific patient education was created. Using this tool, we conducted our face-to-face, teach-back patient education sessions. Each session consisted of the same patient education. To evaluate the impact on knowledge retention, each session was scored by dividing the number of correct answers by the total number of questions and this was expressed as percent correct. First session scores were noted as baseline scores, second and third session scores were then compared with the baseline scores.

Results

After three months of conducting patient education sessions, we observed that patient scores increased as predicted. The mean score of Session 1 was 45%, rising to 66% in Session 2, and reaching 81% in Session 3. The result was a 36% increase in knowledge retention between Sessions 1 and 3. Standardized, repeated, patient education using the teach-back method successfully increased patient knowledge retention.

Discussion

We are currently working on sustaining this quality improvement project in our Infusion Center by introducing different chemotherapy regimens and questions tailored to meet the specific needs of patients on those therapies. Repeated, patient teach-back sessions:

  • ■ Represent an innovative approach aimed at improving patient education retention.

  • ■ Foster meaningful and satisfying communication between patients and nurses.

  • ■ Contribute to a valuable, positive healthcare experience.

  • ■ Enhance the quality of service provided to patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):29–30.

046. Improving the Recognition of Vesicants Across Practice Settings to Reduce Extravasation Risk

Catherine Jansen 1, Nadia Aslam 2

Significance & Background

With the rapid influx of new medications, even the experienced chemotherapy nurse may have difficulty recalling the vesicant potential of all drugs administered. There have been cases when the vesicant properties of a chemotherapy drug were unknown upon initial approval by the Food and Drug Administration (FDA) but later identified in post marketing surveillance. Additionally, some drugs have been classified as “weak vesicants” or irritants with vesicant properties. The ability of nurses to promptly identify medications with vesicant properties or irritants with vesicant potential is crucial for selecting appropriate venous access, determining assessment frequency, ensuring patient safety and improving patient outcomes.

Purpose

to develop a high leverage error-reduction strategy for extravasation prevention and management.

Interventions

A regional multidisciplinary group reviewed our current process, and potential informational gaps for nurses to reduce the risk of serious harm secondary to extravasation. It was determined that awareness of vesicant or irritant medications with vesicant potential at the time of administration would be key for the subsequent appropriate monitoring and immediate management in the event of infiltration. After evaluating various proposed strategies, the team chose to focus on programming tools in the electronic health record (EHR) used during medication administration, as well as monitoring within our EHR.

Results

An existing organization alert on the Medical Administration Record (MAR) for hazardous drugs notifying staff of the need for personal protective equipment (PPE) while administering hazardous drugs was identified as a model. The workgroup recommended creating a similar advisory for vesicants, as well as irritants with vesicant potential. Content experts identified all the medications to be included and defined the language for the MAR alert. This MAR alert was then implemented in the inpatient and outpatient settings, for both adult and pediatric populations.

Discussion

The simplicity of the MAR alert has been well received by staff, especially when dealing with unfamiliar drugs. While extravasations are an uncommon occurrence, nurses need to be aware of vesicant properties of chemotherapy agents during administration to institute preventative measures and to act quickly if extravasations are suspected.

Oncology Nursing Forum. 2025 Mar 1;52(2):30.

047. Enhancing Outpatient Care: Strategies to Reduce Emergency Room Visits and Hospital Admissions Postchemotherapy

Joy Joseph 1, Elizabeth De Cosmo 2

Significance & Background

Challenges from outpatient chemotherapy complications significantly affect patient outcomes, overall health, and healthcare costs. The Centers for Medicare (CMS) measure OP-35 assesses Medicare quality by tracking emergency room visits and hospital admissions within 30 days after chemotherapy. A large quaternary care system, including eight facilities across several counties, had an admission rate of 13.5% exceeding the CMS benchmark of 10.4% and aimed to identify barriers while developing series of initiatives.

Purpose

The purpose of this project was to apply strategies to lower hospital admissions and emergency room visits after outpatient chemotherapy. This is in accordance with CMS quality measures that impact the CMS hospital star rating.

Interventions

To implement this quality improvement, several interventions were executed.

  • ■ Enhanced patient education by providing additional information on common side effects to monitor after chemotherapy and when to seek medical attention.

  • ■ Established an oncology nurse hotline for patients to obtain immediate advice and support.

  • ■ Conducted intentional follow-up calls to high-risk populations 3–5 days after each chemotherapy infusion to assess side effect symptoms and reinforce education.

  • ■ Improved care coordination by engaging the multidisciplinary care team address all patient needs, both social and medical.

  • ■ Created a triage pathway utilizing midlevel providers to reduce ED visits and decrease the burden on provider schedules.

  • ■ Created same-day infusion appointments for outpatient symptom management.

  • ■ Partnered with a healthcare service for home-based urgent care when patients could not return to the infusion area.

  • ■ Developed a reporting structure to regularly monitor metrics such as ED visit rates and hospital admission rates, and escalation rates to assess the effectiveness of interventions. Feedback loops were established to continually refine and improve care processes based on data and feedback from patients and staff.

Results

Since July 2023, our interventions have reduced admissions following outpatient chemotherapy to an internal rate of 8.4 which is below current CMS benchmarks. We have also connected over 2000 high-risk patients with nurses through follow-up calls, giving them access to outpatient care.

Discussion

These strategies implemented helped create a more supportive and efficient care environment for oncology patients, reducing the need for emergency and inpatient care. Nonetheless, implementing these initiatives across a large organization encountered obstacles such as staffing issues, reporting challenges, and technology constraints that required resolution. The deliberate feedback mechanisms and commitment from organizational leaders were key to the project’s success.

Oncology Nursing Forum. 2025 Mar 1;52(2):30–31.

048. Isolation Champion Workgroup-The Importance of Infection Control and Nursing Collaboration

Jalen Junek 1, Kim Nguyen 2, Arfel De Jesus 3, Jane Powell 4

Significance & Background

Transmission-based precautions (TBPs) are an effective means for preventing infection transmission for patients, but when used unnecessarily they add unwarranted costs to the institution and can result in negative outcomes for the patient and their families. Upon review, it was discovered our comprehensive cancer center had an ineffective process for assessing and removing patients from TBPs when appropriate, resulting in TBPs remaining in place longer than necessary. Averaging more than 1.6 million outpatient visits annually, our ambulatory centers presented a unique opportunity to develop an effective TBP discontinuation process.

Purpose

The aim is to enhance staff knowledge of TBPs and improve removal rates, thereby increasing patient safety, improving staff efficiency, and reducing unnecessary costs to the institution. The project ensures each area has the education and resources needed to identify patients requiring TBPs and the criteria for removal.

Interventions

The Isolation Champion Workgroup (ICW) was created out of collaboration with the Ambulatory Quality Professional Action Coordinating Team (PACT) and Infection Control (IC). This workgroup is comprised of nurses from various ambulatory centers, chaired by ambulatory nurses, and co-chaired by IC. They meet quarterly for presentations on infectious disease topics, TBPs, and other relevant issues, discussing questions, challenges, and successes in their areas. The champions share the information learned with their local units, review daily patient lists and notify care teams about patient TBP status, and ensure patient removal from TBPs when appropriate.

Results

The workgroup currently has over 80 isolation champions from more than 30 outpatient centers. From 2020 to 2023, our Stem Cell Transplant Center alone removed 293 patients from TBPs. These champions serve as subject matter experts in TBPs on their units and have strengthened collaboration between Nursing and IC. Additionally, this partnership has identified educational gaps and inconsistent processes at the unit level that IC had not previously recognized, creating more opportunities to address those needs.

Discussion

Oncology patients face a higher risk of healthcare-associated infections and typically have longer hospital stays than other patients. Therefore, it is imperative to develop a strong partnership between IC and Nursing using strategies such as the ICW. These efforts equip staff with the necessary education and resources to prevent infection transmission through proper precautions, while improving the efficiency and cost of care by implementing an effective process for appropriate TBP removal.

Oncology Nursing Forum. 2025 Mar 1;52(2):31–32.

049. Careing for Our Community

Marisa Kalkstein 1, Meghan Mcloone 2, Catherine Krumsiek 3, Ann Francese 4, Kerry King 5, Jacqueline Patterson 6

Significance & Background

Cancer treatment often results in substantial physical and psychological distress, with up to 52% of patients reporting clinical levels of distress, negatively impacting treatment adherence, quality of life, and even survival. At a tertiary cancer center’s inpatient oncology unit, patients frequently experience prolonged hospitalizations due to complex treatments and complications. These extended stays heighten emotional and physical challenges, emphasizing the need for holistic care. To address this gap, theCARE Cart was developed by oncology nurses to provide creative and relaxing interventions aimed at alleviating distress, enhancing the patient experience, and promoting better health outcomes.

Purpose

On a hematology oncology unit at an NCI-designated Comprehensive Cancer Center, the CARE Cart project was designed to improve the mental and emotional well-being of oncology patients during their hospitalization by offering a variety of creative and relaxation-based interventions. The project’s goals are to: (1) promote self-expression and mental stimulation, (2) offer relaxation tools to support emotional resilience during treatment, and (3) evaluate the impact of these interventions on patient satisfaction and emotional well-being.

Interventions

The CARE Cart is stocked with items grouped into four key areas: Compassion, Companionship, Creativity; Amenities and Art; Recreation and Relaxation; and Education and Exploration. Items include art supplies, stress-relief tools (such as stress balls), headscarves, playing cards, and virtual reality (VR) goggles for meditation and distraction during procedures. The CARE Cart is accessible to all patients on the hematological oncology unit and is managed by nursing staff who round weekly to offer items for patients to choose, with primary nurses providing access on a daily basis.

Results

Following implementation, a five-question post-intervention survey was conducted with 41 patients who used the CARE Cart. Results were overwhelmingly positive: 100% of patients reported that the CARE Cart helped reduce their stress and anxiety, improved their quality of life, and made them feel more relaxed and comfortable during their hospital stay. These findings highlight the significant role the CARE Cart plays in enhancing the patient experience.

Discussion

The CARE Cart offers a practical, patient-centered approach to improving the emotional well-being of oncology patients during hospitalization. Its success underscores the importance of addressing psychological distress alongside physical care in oncology nursing. The CARE Cart model has the potential for broader application across oncology units, providing a scalable, effective intervention to support holistic patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):32.

050. Use of Chlorhexidine Gluconate Pad Dressing for Continuous Vesicant Chemotherapy Administration

Emoke Karonis 1, Ikuko (Koko) Komo 2, Elizabeth Joy 3, Megan Leary 4, Caroline Preisser 5, Sara Haefner 6

Significance & Background

The oncology population experiences hematologic side effects of their disease and treatment, creating challenges for the care of the central venous catheter (CVC), low platelets, chemotherapy, and the threat of infection all impact nursing management. CVCs may leak small amounts of interstitial fluid and blood from an otherwise uncompromised CVC, complicating site assessment during chemotherapy administration. Fluid at the CVC insertion site may increase the risk of CLABSI (Marschall et al., 2014). The use of chlorhexidine gluconate (CHG) impregnated dressings is known to decrease central line associated bloodstream infections (CLABSI). Practice at our institution was to change CHG impregnated dressings to plain transparent ones when administering continuous infusion vesicant chemotherapy to minimize visual obstruction of site assessment. The use of hemostatic powder at CVC insertion sites to control bleeding was recently implemented at our hospital, causing closer scrutiny of our current practice.

Purpose

The purpose of our study was to explore the incidence of extravasation with CHG gel pad impregnated dressings on CVCs and compare incidence with the Cancer Centers Consortium Nursing-Sensitive Indicators’ benchmark of 0.07% (Jackson-Rose, et al., 2017).

Interventions

Incident reports for extravasation/infiltration of a CVC were collected for all types of CVCs from 2011 to June 2024 with 31 reviewable events. A literature search for CHG and leaking yielded no results. Outside institutions were queried and received 11 responses. All institutions used CHG dressings regardless of infusion type. Four practice organizations were reviewed for recommendations with none mentioning extravasation as a contraindication.

Results

Twenty-one reports were Peripherally Inserted CVCs (PICCS); 10 were a combination of tunneled/non-tunneled CVCs. Subcutaneous ports were excluded. The most common observation was leaking and/or oozing of serosanguinous fluid at the insertion site. Soreness, pain, or pressure were reported. Clinical evaluation showed the most common diagnosis was peri catheter or deep vein thrombosis. Chart review at three-month follow-up showed no extravasation injuries.

Discussion

Based on this evidence, the policy change of maintaining CHG dressings has led to increased nurse satisfaction as it reduced their workload and boosted their confidence in managing leaking CVCs. Patients benefited from fewer dressing changes, which decreased pain and minimized the risk of skin tears. The practice also led to a cost reduction of $5.41 for each dressing change avoided.

Oncology Nursing Forum. 2025 Mar 1;52(2):32–33.

051. Innovating Nurse Educator Recruitment: Enhancing Interviews with Educational Demonstrations

Sarah Kimbrough 1, Katy Leptich 2, Phuong Huynh 3, Briana Sanger 4

Significance & Background

At a large NCI-designated cancer center, professional practice coordinators are nurses who function as nurse educators and practice specialists. The Professional Practice Coordinator role is integral to nurse onboarding, training, professional development, and practice implementation and improvement. Professional Practice Coordinator applicants frequently come with nursing experience but lack role specific experience in education. Often applicant’s experience with education is through precepting and patient education. Traditionally, interviews have utilized experience-based questions focus on skills such as clinical knowledge, organization, time management, leadership, presentation (oral and written), mentoring, and coaching to assess an applicant’s skillset, interest, and fit for the position. A gap was identified in effectively assess education and presentation skills.

Purpose

To enhance the recruitment and interview process for nursing education positions by directly evaluating applicants’ skillset and illustrating the role’s key responsibilities.

Interventions

We introduced a 5–10 minute education demonstration as a part of the interview process. Applicants received a prompt to “teach the interviewer anything in 5–10 minutes: with examples including how to fold origami, how to interpret CBC results, or review the history of pizza. Applicants are encouraged to use multimedia tools during their presentations, and we developed a standard rubric to assess the education sessions on a scale of 1–5.

Results

Interviewers found this approach allowed them to better evaluate applicants’ grasp of the education process and presentation skills. Applicants reported that creating an educational session increased their enthusiasm for the position and improved their understanding of a key responsibility of the role. Most applicants chose non-clinical topics, which allowed and invited creativity, innovation, and personal interest.

Discussion

Recruiting for specialty nursing education positions can be challenging. Standard interview processes typically involve 1–3 interactions focused on skillset questions and may not fully capture an applicant’s potential. Innovative approaches can improve assessment and recruitment; especially as competition for specialty roles intensifies. Oncology care is rapidly evolving, mandating highly skilled educators. Ensuring a strong fit for the organization and the applicant is crucial for success in new roles. Educators lay the foundation and drive innovation in nursing practice, making effective recruitment essential for advancing the oncology nursing field.

Oncology Nursing Forum. 2025 Mar 1;52(2):33.

052. Empowering Oncology Nurses: A Strategic Approach to Certification Success Through Comprehensive Support and Education

Renjitha Kolambel 1

Significance & Background

Promoting OCN certification is a vital step in advancing the knowledge and skills of our oncology nursing staff. By fostering a deeper understanding of all oncology specialties, we enhance the care and support provided to our patients. This commitment ensures that our nurses are equipped to meet the highest standards of care, aligning with our institution’s vision that no one fights cancer alone. Ultimately, this initiative strengthens our ability to offer exceptional care to our community, supporting patients at every stage of their journeY.

Purpose

This initiative aims to encourage oncology nurses to pursue OCN certification by providing easy access to review courses and resources. This effort aims to increase the number of certified oncology nurses within our specialty, thereby enhancing the quality of care we deliver to our patients.

Interventions

We implemented several key interventions to support and encourage OCN certification. We scheduled 2–3 OCN review courses annually, with at least one session held on a Saturday to accommodate clinic and radiation oncology nurses. Additionally, we introduced Freetake opportunities to make the OCN exam more affordable for our staff. All preparation materials were provided free to those attending the OCN review sessions, ensuring that nurses have the resources they need to obtain their certification.

Results

Since opening the virtual OCN review sessions to all oncology staff, including external nurses, in 2020, over 500 nurses have participated in these reviews. This initiative proved especially valuable during the COVID-19 pandemic, as it provided critical support to numerous institutions, with nurses from more than 20 states participating. These efforts have been instrumental in maintaining our institution’s OCN certification rate at approximately 50% despite challenges such as staff turnover and the ongoing expansion of oncology services.

Discussion

The expansion of virtual OCN review sessions to include all oncology staff, both internal and external, has had a profound impact on our institution. This initiative has reinforced our commitment to providing exceptional oncology care and ensuring that our staff remains highly skilled and certified in their specialty.

Oncology Nursing Forum. 2025 Mar 1;52(2):33–34.

053. Benefits of a Remote Nurse Refill Team

Kristopher Kramer 1, Heather Levy 2

Significance & Background

To support in clinic nurses to focus primarily on patient facing needs and to alleviate the large volume of incoming prescription refill requests, a team of LPNs was established to assist with managing, reviewing, and processing prescription refill requests.

Purpose

A workflow was created to allow the processing of refills to be completed within two business days decreasing turnaround times and providing easier access to patients The workflow and Remote Nurse Refill Team enable the in-clinic staff to focus primarily on direct patient care in the clinic by reviewing, clarifying, and handling prescription refill requests that are received from several different sources throughout the organization.

Interventions

After the establishment of Care Coordination, previously known as Care Management, the Nurse Refill Team, compromised of seven LPN refill nurses, was formed to assist with refills for patients. Initially all requests were received in fax batches and were entered, reviewed, and processed by 1 assigned nurse. This method has since expanded due to an exponential increase of incoming requests to the supportive services team entering the requested data, along with requests being placed by clinic staff, live patient calls, and triage teams.

Results

The results show a dramatic increase in the number of refills managed by the remote refill team from 2022-August 2024 as the remote refill team went from being active in 46 clinics to 63 clinics. Additionally, there was an upsurge in processing refills from an average of 2317 requests per month in 2022 to an average of 4905 requests per month through August of 2024.

Discussion

With the formation and implementation of a more streamlined process the remote Nurse Refill Team has been able to increase the number of clinics being assisted and the number of refills being processed. Development of the Nurse Refill Team alleviates the burden on patient-facing clinicians, provides additional nurse support for the patient, and assists with reducing treatment plan delays.

Oncology Nursing Forum. 2025 Mar 1;52(2):34.

054. Implementation of Synchronous and Asynchronous CAR-T Education for Emergency Room and Intensive Care Unit Nurses in Non-Oncology Units

Kylie Kuck 1

Significance & Background

Chimeric antigen receptor T cell (CAR-T) therapy is a novel and promising cancer treatment for hematologic malignancies. This treatment is highly regulated by the Food and Drug Administration and The Foundation for the Accreditation of Cellular Therapy (FACT) because of the known toxicities associated with treatment. In 2022, FACT published guidelines requiring formal education for both oncology and non-oncology nurses who care for these patients, including emergency room and intensive care unit nurses.

Purpose

This quality improvement project provided education to emergency room and intensive care unit care nurses who are caring for CAR-T cell therapy patients using synchronous and asynchronous education sessions, with an aim of improving nurses’ knowledge of common toxicities and confidence in caring for CAR-T patients.

Interventions

Education sessions were 30–60 minutes long and focused on early identification and documentation of Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS), grading of toxicities, subsequent triage, and appropriate interventions according to clinical guidelines by the American Society for Transplantation and Cellular Therapy.

Results

In total, 141 staff from the medical intensive care unit and emergency room completed the education and post-survey, with most (74.4%) attending synchronous sessions. Five questions were asked in both the pre and post survey to assess participants’ increase in knowledge and skills. For each question that measured knowledge and skill in caring for CAR-T patients, there was a clear improvement in management of CRS and ICANS between the pre and post survey. There was not a substantial difference between learner outcomes when synchronous and asynchronous learning was compared. See attached document for results. Overall, learners reported less negative confidence scores and although both methods of education were effective, synchronous education was associated with a higher positive self-report of confidence when compared to asynchronous education. Continuing education opportunities were identified from the post data survey.

Discussion

Both synchronous and asynchronous education are an effective means of providing education. However, when given the option, more learners chose to participate in synchronous education. Participants reported wanting to have the ability to ask questions during the training which influenced their decision to participate in synchronous education. Both methods should be offered to learners in the future and embedded into unit orientation.

Oncology Nursing Forum. 2025 Mar 1;52(2):34–35.

055. Take a Break: A Nurse-Led Initiative for Well-Being

Jacob Lawrence 1, Kim Orr 2, Emily Rush 3, Amy Rettig 4

Significance & Background

Purpose ful work breaks are integral to promoting improved mental and physical well-being, performance, and overall workplace safety. Inadequate breaks contribute to the incidence of burnout and workplace fatigue. The Unit Collaboration Council (UCC) is a nurse-led professional governance council with council chairs from every unit. They share best practices and foster a culture that empowers nurses to provide high quality, safe, patient centered care across the continuum. One of their responsibilities is to promote professional development, equity, health, wellness and resiliency.

Purpose

To provide an evidence-based approach to improving oncology nurse well-being.

Interventions

UCC provided the structure and mechanism to facilitate Take-A-Break (TAB) activities at the unit-level in outpatient, inpatient, and perioperative units with the aim to positively impact mood and well-being. This unique intervention was led by direct-care nurses with support from leadership to remove barriers if they arose. Nurses facilitate brief, 10 minute or less, wellness activities. Examples include coloring, origami, and rock painting. UCC nurses exercise control over things such as time, cost, space, and equipment, ensuring access to necessary resources. UCC created a goal that every unit council will host at least one quarterly TAB and report attendance and program evaluation after each program. An oncology mental health APRN, who is also a member of the UCC, facilitated data collection. A TAB instruction packet was supplied to council chairs for the first activity: pinwheels. The packet included supplies for ten pinwheels, a TAB instruction sheet, a sign-in sheet, and an evaluation survey.

Results

Results demonstrated 612 participants engaged in TAB over the year implementation period, including repeat attendees. Most participants were Registered Nurses, patient care associates, and managers, with colleagues from pharmacy, social work, and environmental services also taking part. Of those who responded to a program evaluation, 98% enjoyed the activity, found the room comfortable, and felt their mood improved, with 95% stating they would participate again.

Discussion

The success of improving mood through a peer-led initiative was rewarding and inspiring to the unit council chairs. The survey results demonstrate TAB program efficacy and units continue to successfully replicate TAB across the organization.

Oncology Nursing Forum. 2025 Mar 1;52(2):35.

056. A Five-Year Nurse-Led Initiative to Increase Advance Directives Among Oncology Patients Over 65

Danielle Lovell 1

Significance & Background

Advance directives (ADs) are important to the oncology care plan as it ensures the patient’s preferences for medical care are documented in the event they become unable to make their own decisions. Unfortunately, due to barriers such as appointment time constraints, lack of knowledge by the staff and patients, and the anxiety over AD conversations prevents the discussion about the importance of having an AD from occurring.

Purpose

In 2019 the percentage of oncology patients over age 65 who had an AD and/or POLST in the electronic medical record (EMR) was 14%. As oncology nurses we recognized the need to improve communication and education to the patients and staff on the importance of having an advance care plan (ACP) completed in the EMR. By bridging the gaps in knowledge and awareness through AD initiatives would allow for the patients, family, and staff to be better prepared in the event a patient was unable to make decisions reducing unnecessary suffering, stress, and uncertainty.

Interventions

An Advance Directive Committee was created to develop initiatives to improve education and participation in ACP. Some of the patient initiatives created to increase participation and AD completions were providing education and access to AD forms, assistance with form completion, raffle contests to encourage involvement, and follow up phone calls to patients who showed an interest. Staff initiatives included AD education sessions by palliative care, contests to encourage patient discussions, and provider meetings to increase provider participation.

Results

Over the five years, the number of completed ACP fluctuated and hit a high of 38% completion rate in 2020, but declined to 31% in 2023. Starting in 2022, the percentage of patients who were educated and received AD information, but declined completing the form was also tracked as it provided useful data on the number of AD discussions being completed with patients.

Discussion

Discussing the importance of an ACP to cancer patients is not always comfortable, but necessary. The lack of time, knowledge, and comfortability among the staff and providers to have the conversation on ACP is a huge barrier to improve AD completion in the EMR. Having better provider participation would have been instrumental in patient participation and increasing AD rates. Overall, the initiatives developed did increase the completion of ADs in the EMR throughout the five years.

Oncology Nursing Forum. 2025 Mar 1;52(2):36.

057. Tryptase and IL-6: Role of Biomarkers During Hypersensitivity Reactions

Donna-Marie Lynch 1

Significance & Background

Drug hypersensitivity reactions (HSRs) impact patient cancer treatments and outcomes. These reactions can be defined by their clinical presentation (phenotypes), pathophysiology (endotype), and biomarkers. For patients undergoing rapid desensitization (RDD), biomarkers such as skin testing, serum tryptase, and serum lnterleukin (IL)-6 levels can be used to guide protocol selection (both initial and subsequent if continued reactions) and clinical outcomes.

Purpose

To develop a RDD treatment algorithm based on the initial and breakthrough HSR phenotypes and associated biomarkers in patients referred to the Brigham and Women’s Hospital Drug Desensitization Center.

Methods

This study was a retrospective IRB-approved descriptive analysis of adult patients from January 2022 through August 2023. Data collected included symptom presentation, desensitization protocols/outcomes and the following associated biomarkers: skin test, tryptase, and IL-6 levels at the initial reaction and during breakthrough desensitization reactions (BTRs).

Interventions

Patients were classified into 3 groups based on endophenotype (Type 1, Cytokine Release Reactions (CRR), and Mixed). Positive skin testing and/or elevated tryptase levels with only symptoms of Type 1 HSR were provided multiple bag desensitization protocols. Patients with an elevated IL-6 that only experienced CRR symptoms were provided a 1 bag protocol. Patients that experienced mixed reactions symptoms of both CRR and Type 1 and/or positive biomarkers received multiple bag protocols.

Results

A total of 1,633 desensitization protocols were provided to 326 patients. Biomarkers obtained included skin testing (242 patients), initial reaction tryptase levels (185 patients), BTR tryptase levels (154 patients), initial reaction IL-6 levels (35 patients), and BTR IL-6 levels (142 patients). Based on biomarkers specific desensitization protocols were administered, 4 bag / 16 step (30), 3 bag / 12 step (835), 2 bag / 8 step (327), 1 bag /4–6 step (356) and 1 bag challenges (85). There were 87% protocols (1423) were completed without reactions and 13% with mild to moderate reactions, without deaths. Of the 228/1633 (14%) desensitization protocols completed in patients with an initial CRR phenotype, 208 (91.2%) were successfully completed without reactions.

Discussion

Defining the pathogenic mechanism of HSRs helps select specific desensitization protocols (number of bags, steps, and premedication), which increases safety upon re-exposure. The application of biomarkers, although useful in understanding HSR phenotype and endotypes, may have an even greater impact when used to predict response or modify treatment in the setting of desensitization to targeted therpies.

Oncology Nursing Forum. 2025 Mar 1;52(2):36–37.

058. Empowering Inpatient and Ambulatory Oncology Nurses: Through Interprofessional Goals of Care Communication Training

Victoria McClosky 1, Asha Demla 2, Gary Martinez 3, Christi Bowe 4, Enefe Queen 5

Significance & Background

There are many dimensions when providing care to individuals with cancer. Nurses frequently receive sensitive patient information but may lack confidence in communicating with patients about topics involving their treatment goals and preferences. To bridge this gap, our institution developed an interprofessional Goals of Care (GOC) communication training. This is a relationship-driven ongoing conversation with individuals and their caregivers addressing their goals, values, and preferences. This incorporates the psychosocial, physical, and spiritual needs of individuals. Our institution in collaboration with the Alliance of Dedicated Cancer Centers introduced the Goal Concordant Care (GCC) initiative to promote timely GOC conversations. This initiative was aimed at providers only. However, our institution acknowledges the gap in confidence and knowledge, and the critical role of nursing in GCC, which led us to initiate the nursing GOC communication education program.

Purpose

Provide GOC communication training for inpatient and ambulatory oncology nurses at a designed National Cancer Institute. The training aims to enhance nurses’ communication skills, confidence in responding to patients’ emotions, and the ability to integrate patients’ GOCs and address psychosocial dimensions.

Interventions

Implementing a comprehensive interprofessional GOC communication training program tailored for the oncology population. This program combined educational modules with an in-person engagement session, which included interactive activities such as GOC case studies, discussions, and games.

Results

We surveyed nurses’ training experiences using a 5-point Likert-scale, from October 2023 to July 2024. Out of 2,833 participants, 1,814 responded (1,172 inpatient; 642 ambulatory); Both groups showed improvement in connected conversations (inpatient 35.2%; ambulatory 42%), responding to patients’ emotions, (inpatient 34.1%; ambulatory 37.6%), and over 95% found GOC communication training relevant.

Discussion & Innovation

Nurses are essential members of the GCC team, and they recognize the value of receiving GOC training. The interprofessional GOC training includes in-person engagement sessions that utilize oncology case studies provided by interprofessional team members focusing on common GOC scenarios in the oncology setting to strengthen, enhance, and utilize interprofessional team members and the communication tools effectively tools. Nurses play a crucial role in supporting GOC conversations but often lack the knowledge, training, or confidence to engage in such conversations. By enhancing their confidence and knowledge, GOC training enables nurses to play a crucial role in supporting patient-centered care and identifying goals, values, and preferences early.

Oncology Nursing Forum. 2025 Mar 1;52(2):37.

059. Oncology Nursing Education: Innovation and Insights from an Oncology Symposium

Colleen McCracken 1, Sarah Davis 2, Allison Baus 3, Tabetha Frank 4

Significance & Background

Treatments for oncology patients are ever-changing, and oncology nurses need up-to-date evidence-based information to provide optimal care. A local Oncology Nursing Society chapter recognized this gap through environmental scanning and needs assessments. To narrow this gap, we created the annual Oncology Nursing Symposium focused on oncology treatment and care to serve oncology nurses in the Southeastern Wisconsin region.

Purpose

Our goal with the Oncology Nursing Symposium was to empower oncology nurses to stay current on the latest advancements and emerging topics in oncology and deepen their expertise.

Interventions

A team of oncology clinical educators and staff nurses developed a four-hour symposium with representation from various specialties (pharmacy, critical care, radiation oncology, and immunology). Presenters included an oncology board certified pharmacist, a medical oncology hematology and internal medicine board certified physician, a nationally certified nurse practitioner, and a rapid response nurse with 30 years of critical care experience. Topics included a primer in immunology, proton therapy, immunotherapy medications, and cytokine release syndrome management. Registration information was shared with health systems throughout Wisconsin. Contact hours were awarded to eligible nurse attendees. The symposium was free for all who wished to attend.

Results

This inaugural symposium had 61 attendees from 11 different health systems throughout Wisconsin. Of these, 47 attendees received contact hours after completing an evaluation summary after the program. Importantly, 94% of participants reported an increase in knowledge, and 92% were able to give examples of how this information could be used in their practice.

Discussion

We developed a symposium to increase nurses’ knowledge about oncology care. The formal evaluation and informal feedback about this symposium highlight the need for this type of ongoing education for oncology nurses. This symposium is filling an educational gap for oncology nurses in Southeastern Wisconsin. We plan to continue this symposium annually and recruit more national speakers.

Oncology Nursing Forum. 2025 Mar 1;52(2):37–38.

060. Mentorship Relationships for the First Independent Year Can Help With Nursing Retention

Danielle Moody 1, Kendall McCreary 2

Significance & Background

Data shows that new graduates experience “reality shock” within the first few months on their own and in environments like the ICU which can deter nurses from the bedside leading to poor staff retention. We designed a mentorship program called “The Buddy System” to create an environment that supports new graduates. With the focus to increase new graduate retention at the one- and two-year mark.

Purpose

To generate a supportive environment and relationship with the new graduates on the unit. Each new graduate selects a mentor of their choosing, to be an experienced resource for their first independent year. This provides a personal approach to assist the mentee with questions, concerns, issues with assignments, conflicts with staff, and more. The hope is that this relationship will help create a supportive environment that aids in staff retention.

Interventions

Each new graduate chooses a more senior nurse as their mentor from a list of mentor volunteers. If the mentor is not on the list, the coordinators reach out to that nurse to determine interest in mentoring. The mentor and mentee are given tips, guidelines, and expectations before starting the relationship. They have weekly check ins, and quarterly meet ups to discuss their progress in the program. The coordinators check in with them every couple of months to address any concerns they may have. Surveys are sent at the beginning, middle, and end of the program to assess learning needs, comfort levels, and progress being made.

Results

The first group in this program had 100% retention at the end of their first year and 75% retention after two years. The two that left moved on to further their education. The second group had 83% retention after the first year. One person left to further their education and one left to go to a different field of nursing.

Discussion

This program is still in its early years, but the data has shown it to be effective. The nurses that left did so for reasons unrelated to the unit. Our initiative has shown that having a mentor your first year helps with comfort and unit cohesion. This leads to staff retention at the one- and two-year mark.

Oncology Nursing Forum. 2025 Mar 1;52(2):38.

061. Evaluating the Efficacy of Nitrous Oxide as Sedation for Outpatient Bone Marrow Biopsies

Baylie Mullinax 1, Kelly Godby 2, Kimo Bachiashvili 3

Significance & Background

A bone marrow biopsy (BMBx) is an invasive procedure that can cause significant pain and distress to patients. Outpatient sedation options are often limited during BMBx due to factors such as age, comorbidities, drug shortages, and necessary monitoring. The PRO-NOX™ Nitrous Oxide Delivery System delivers a fixed 50% N2O/50% O2 mixture for sedation during procedures.

Purpose

To assess the effectiveness of nitrous oxide (N2O) using PRO-NOX™ for sedation during outpatient BMBx compared to minimal IV or oral sedation.

Interventions

Before their BMBx, adult patients were offered three types of sedation: oral Lorazepam, IV Lorazepam or Morphine, or N2O. After the BMBx, patients were randomly selected to complete a survey that assessed their choice of sedation, pain and comfort level, and preference for future sedation. The survey also evaluated how patients perceived their current biopsy experience compared to previous biopsies.

Results

On a scale of 1–10, with 10 being the worst, patients who received N2O reported lower average pain scores (4.7) compared to those who received IV or oral sedation (6.4). 84% of N2O patients felt comfortable during the BMBx, compared to 64% and 66% in the IV and oral groups. 68% of N2O patients found this BMBx experience better than previous ones, compared to 50% of IV patients. Of 68 patients with prior BMBx, 33 chose N2O for this biopsy and reported an average pain score of 3.95, with 76% finding the experience better than before. No adverse effects were reported during the survey period.

Discussion

The results indicate that N2O is an acceptable sedation method for BMBx. Patients who received N2O were satisfied with their pain and comfort during their BMBx, and it is their preferred sedation method for future biopsies. N2O is a potential sedation option for individuals who do not have a driver as evidenced by nine out of twelve patients who received N2O reported feeling comfortable during their biopsy. The effects of N2O diminish within fifteen minutes, making it a safe option for patients while also reducing recovery time and the need for additional monitoring. Nurses can safely administer nitrous oxide with appropriate training. This study warrants further prospective studies to investigate safety and feasibility.

Oncology Nursing Forum. 2025 Mar 1;52(2):38–39.

062. Exploring Access Barriers in Car T-Cell Therapy: Insights from the NIMHD Research Framework

Kimberly Munoz 1, Kimberly Ito 2

Significance & Background

CAR T-cell therapy is one of the most innovative treatments at the forefront of cancer care, leveraging patients’ own immune cells to target and destroy cancer cells. While this treatment has been promising, research highlights persistent barriers to access of care. Such barriers may disproportionately affect vulnerable populations, leading to health disparities.

Purpose

This analysis aims to review the existing body of literature to identify barriers to CAR T-cell therapy access. These barriers will be mapped onto the National Institute on Minority Health and Health Disparities Research Framework (NIMHD) to assess the level and domain of influence for each identified barrier. This mapping will provide a more comprehensive understanding of the various factors contributing to disparities in access.

Interventions

An extensive literature review was conducted using databases such as PubMed, Google Scholar, and CINAHL, with search terms “CAR T CELL” and “ACCESS.” All relevant articles were reviewed, and additional articles were identified through reviewing the references. Each article was assessed for relevance. Barriers to CAR T-cell therapy access were identified and mapped onto the NIMHD framework. This process helped identify where the barriers occurred within the levels of influence (individual, interpersonal, community, societal) and domains of influence (biological, behavioral, physical/built environment, sociocultural environment, health care system). A narrative approach was employed to synthesize the findings.

Results

Initial searches yielded 22 relevant articles. The majority (n= 20) of these studies identified barriers at the individual level of influence, including factors such as age, gender, race, socioeconomic status, travel distance to treatment centers, and cost/insurance issues. Interpersonal barriers included caregiver availability post-treatment, household income, and the need for timely referrals to specialty cancer centers. Barriers at the community and societal levels were less frequently explored and included manufacturing wait times and living in neighborhoods with household mean incomes less than $40,000.

Discussion

The research focused the greatest on access barriers at the individual and interpersonal levels, with only few reporting on community and societal barriers. This gap indicates a need for further investigation to fully understand the scope of barriers to CAR T-cell therapy. As oncology treatments evolve and more innovative therapies are introduced, examining access inequities will be critical to ensuring that all patients benefit from advancements in cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):39.

063. Reducing Infusion, No Shows and Cancellations

Jan Norkis 1, Fumei Cerecino Mayer 2, Karen Candidi 3, Mary Pat Lynch 4

Significance & Background

In January 2024, our infusion center had an average monthly no show and same day cancellation rate of 23.7%. Rates for these patterns of not attending scheduled appointments has increased steadily over the last 3 years. Infusion centers with similar profiles average rates of 10–12%. Higher rates of no-shows and same day cancellations decrease patient access to infusion services, limits efforts to appropriately staff nursing for patient care, and increases work for the scheduling team.

Purpose

To decrease our center’s no show and same day cancellation rates with development and implementation of new scheduling guidelines accompanied by patient and care partner education.

Interventions

We began a project to decrease the no show and same day cancellation rate. Our initial goal was to decrease the average monthly rate to 17% by the end of 2024. The center nursing and scheduling leadership teams met regularly to discuss our existing process, identify process pitfalls, and analyze how pitfalls contribute to high rates of no shows and same day cancellations. We changed the scheduling process to ensure appointments are made no more than 3 weeks or 1 cycle in advance. Modifications were also made to scheduling patients for blood product transfusions where we now scheduling transfusions no more than 2 weeks in advance. We reserved the hours from 9 am to 2 pm for infusion appointments that are linked to a provider visit to support integrated care, avoiding the possibility of patients needing to make two separate trips for these appointments. The new scheduling parameters were conveyed to patient and care partners in our patient portal and in appointment scheduling.

Results

By August 2024, our no show and same day cancellation rate was 15.7%. With this initial success, we modified our goal to 10%. Established patients express some concern as they were comfortable with the old practice of scheduling appointments months in advance.

Discussion

Feedback on the new scheduling parameters is positive. Some concerns from longtime patients prompted us to engage the Patient and Family Advisory Committee. Our work with this committee aims to better capture the wishes of our patients and their care partners. We will continue to monitor appointment data and partner with the Patient and Family Advisory Committee to refine procedures as necessary.

Oncology Nursing Forum. 2025 Mar 1;52(2):39–40.

064. Addressing Gaps in Tobacco Use Assessment and Treatment in Cancer Care: Evidence-Based Experiential Training and Professional Development for Oncology Nurses

Maureen O’Brien 1, Noshin Haque 2, Chris Kotsen 3, Elizabeth Schofield 4, Gleneara Bates-Pappas 5, Jamie S Ostroff 6

Significance & Background

Given that persistent tobacco use is associated with adverse clinical outcomes regardless of site, stage or prognosis, assessment of tobacco use and treatment of tobacco dependence (TUAT) is essential for high quality cancer care. Although oncology nurses are uniquely positioned to facilitate evidence-based and culturally sensitive conversations about the risks of smoking and the benefits of quitting, prior surveys have found that only 30% of nurses assist their patients with making a quit attempt and lack of adequate training is reported as a leading barrier.

Purpose

To address the evidence-to-practice gap in tobacco treatment education for multidisciplinary oncology clinicians, including oncology nursing, a highly interactive TUAT skills-based workshop and collaborative learning initiative (Tobacco Treatment Training-Oncology [TTT-O]) was developed. This presentation will describe the use of novel experiential learning strategies with simulated patients (SPs) in tobacco treatment training tailored to oncology nurses and nurse practitioners and share participants’ feedback.

Interventions

Supported by an NCI Cancer Education Grant, the TTT-O program is a 2-day workshop offered in-person or virtually, followed by 6 monthly videoconferences led by training faculty with relevant TUAT delivery expertise in cancer. The curriculum content was guided by the PHS Guidelines for Treating Tobacco Use and Dependence and the NCCN Guidelines for Smoking Cessation. The training format features didactic presentations and simulated role play exercises with standardized patients (i.e., trained actors) portraying cancer-specific, clinical vignettes focusing on empathic assessment of tobacco use and treatment, personalized quitting advice, behavioral and motivational interventions, promoting shared decision-making and use of cessation pharmacotherapy.

Results

To date, course evaluation data has been collected from 19 cohorts of TTT-O participants (n=375) who completed the workshop and course evaluations. Didactic presentations and interactive simulated patient roleplays were seen as highly favorable as evidenced by mean ratings for all satisfaction items exceeding 4.8 (range 1–5). Participants emphasized the value of the clinical roleplay exercises. Overall, participants reported significant (p<.001) pre- post-training gains in self-efficacy in their skills to assess and treat tobacco dependence.

Discussion

These findings strongly support the feasibility, satisfaction, and effectiveness of the TTT-O in fostering TUAT in cancer care. Didactic presentations reinforced by experiential role plays with simulated patients are seen as a promising professional development strategy for oncology nurses and nurse practitioners to improve TUAT skill acquisition and self-efficacy in assisting patient quit attempts.

Oncology Nursing Forum. 2025 Mar 1;52(2):40–41.

065. Benefits from Initiating a Pharmacy/Infusion Nurse Workgroup in an Outpatient Infusion Area

Lindsey O’Brien 1, Lillian Clark 2, Anne Bledsoe 3, Alexandra Mehlhaff 4, David Trenary 5, Aketia Seymour 6

Significance & Background

The compounding pharmacy and infusion nurses’ workflows are intertwined, and a good working relationship is imperative for safe and efficient patient care. Interruptions such as phone calls can lead to delays and errors. Tension between the two departments can result in poor communication and lack of coordinated efforts on improvement work. It also contributes to poor workplace morale overall when two professions feel in opposition to one another.

Purpose

The purpose of this project was to strengthen the interprofessional relationship between nursing and pharmacy in the infusion area. The objectives of this group were to improve understanding of each department’s workflow, identify and prioritize the pain points in shared workflows, and create a space for respectful and productive communication.

Interventions

Leadership created a workgroup made up of frontline infusion nurses and pharmacists in the compounding pharmacy. The group discussed common issues, created a safe space for expressing opinions, and worked on improvements for identified pain points. This group also utilized the Plan-Do-Check-Act (PDCA) cycle to implement and evaluate their own interventions.

Results

This group initiated several process changes. These include having an electronic chat between the pharmacists and nurses that are working that day, having nursing and pharmacy spend shadow time with one another during orientation, and creation of resources for nursing based on some of the frequently asked questions pharmacy receives. These initiatives have improved understanding of each other’s role, reduced phone calls and interruptions, and enhanced nursing autonomy.

Discussion

Having frontline professionals from the infusion area meet has improved relationships between nursing and pharmacy and led to many successful projects to help both professions better understand the other and improve workflows. With frontline professionals rather than leadership spearheading this group there has been a culture shift in the way these two departments work with one another. Respectful and timely communication has improved efficiency in workflows in the infusion space.

Oncology Nursing Forum. 2025 Mar 1;52(2):41.

066. Preventing Delays in Initiation of Radiation Therapy Following Breast Conserving Surgery - A Process Improvement

Catherine Oplinger 1, Margaret Wight 2

Significance & Background

In July 2023, the Commission on Cancer released new guidelines regarding length of time from definitive surgical intervention to the start of radiation for patients undergoing breast conserving surgery. This updated quality measure prompted an improvement process in order to meet the requirement. (1) Discussion revealed that our tracking methods were not adequate due to data and cases being reviewed too late to impact the start of treatment prior to the 60-day window.

Purpose

Development of a process for proactive referral of patients who are undergoing breast conserving surgery without having had systemic treatment to allow for timely start of care within the 60-day window for initiation of radiation treatment.

Interventions

The improved process involves referral to Radiation Oncology prior to surgical intervention with an appropriate date for consultation. This includes identifying appropriate patients, pre-operative outreach from nurse navigator to patients advising that they would be referred to radiation for consultation three to five weeks after their upcoming surgical date, advising the radiation team of appropriate consult timing, assuring that the appointment is kept, and confirming start of radiation is within 60 days of surgery. Tracking is managed with a spreadsheet which is updated regularly, and color coded for ease of use. Because the 60-day window applies to start of treatment regardless of the location of care, coordination with outside health systems due to location or patient preference may also be needed.

Results

Data demonstrates improvement with performance rate of 78% in 2022, 81% in 2023, and 87% thus far in 2024 meeting the 60-day goal. Data from 2024 (2/1/2024 to 8/15/2024), with the improved referral/tracking system indicates that those who fell outside of the time goal were due to unavoidable, specific reasons.

Discussion

As a Surgical Nurse Navigator within the breast center, I saw an opportunity to impact care for our patients and improve statistics regarding start of radiation for patients who had undergone breast conserving surgery without prior systemic therapy. This process change resulted in improvement in timeliness to treatment for patients and increased coordination of scheduling for the radiation team. Remaining within the appropriate time parameters for treatment provides benefit not only to the care continuum for patients but streamlines data collection for various accreditation processes for the cancer center.

Oncology Nursing Forum. 2025 Mar 1;52(2):41–42.

067. The Sage Team: Supporting Frontline Staff in the Resuscitation of End-of-Life Patients

Justin O’Leary 1

Significance & Background

Frontline staff report discomfort in caring for patients who are end of life with no further treatment options yet remain full code. An interdisciplinary survey of frontline staff at a large comprehensive cancer center identified 92% of staff had reported caring for this thought-to-be rare population with 72% reporting caring for this patient population at least monthly or more frequently. Staff reported knowledge gaps in disease processes, discomfort in performing resuscitation skills, ethical dilemmas, and a need for psychological support when caring for these patients.

Purpose

A 24/7 interdisciplinary response team, the Staff Assistance Guiding End of life resuscitation (SAGE) Team, was created to provide to support frontline staff prior to cardiopulmonary arrest that was anticipated to occur within hours to the next shift for these specific patients to minimize staff distress.

Interventions

The SAGE Team is composed of a rapid response advance practice provider, rapid response nurse, respiratory therapy supervisor, social worker, and spiritual care provider. Together, utilizing their specialties, they identify needed resources for staff, provide education necessary to perform patient care, recommend team composition and roles ahead of time, address perceived ethical dilemmas, and provide psychosocial support to frontline staff. The team operates as a non-urgent request that is not patient facing and therefore does not replace other patient-directed emergency teams.

Results

The SAGE Team has been activated 60 times within 11 months, a 200% increase compared to the expected yearly volume at the program’s onset. Although utilized as a resource mainly by nurses, the SAGE Team has been activated by members of the interdisciplinary team as well. Staff activations crossed all specialties and ultimately 11 patients required resuscitation. The SAGE team was activated earlier than expected 58% of the time. Surveys administered to individuals who activated the SAGE Team post-event revealed a 31% increase in staff comfort caring for this patient population.

Discussion

Supporting frontline staff prior to cardiopulmonary arrest in end-of-life patients can increase comfort in providing direct patient care. This specific patient population is often medically complicated and aligning cardiopulmonary resuscitation with their goals of care is nuanced. The SAGE Team is a holistic approach to support and decrease distress in staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):42.

068. Error Reduction in Home Infusion: A Quality Improvement Study of Closed System Transfer Device Usability

Erin Peone 1, Suzie Allen 2

Significance & Background

The use of Closed System Transfer Devices (CSTD) for hazardous drug (HD) administration is an industry standard and required by USP <800>. After adopting use of a CSTD in 2019, nurse leaders at a NCI-designated Comprehensive Cancer center recognized a significant increase in accidental disconnections in home infusions of HDs. These disconnections caused HD exposure, lost medication, and patient distress. While home administration of HDs lasting longer than 24 hours is not uncommon, most CSTD on the market are only labeled for less than 24 hours of use.

Purpose

With the rising demand for outpatient treatments, ensuring the safe administration of hazardous drugs in the home setting is critical. The aim of this QI project was to systematically evaluate the usability of CSTD for home infusion based on error rates and staff preference for three devices. The goal was to find a CSTD that could be used for home infusion without causing increased errors.

Interventions

Three different devices were trialed, one at a time, and error rates evaluated monthly via incident reports within the Chemotherapy Quality and Safety council.

Results

Error rates were calculated using the number of reported errors vs dispenses. End user and patient feedback were also collected and considered. The baseline error rate for home infusions from 6 months prior to first intervention was 0.21%. The first intervention added a securement device to the BD PhaSeal N35-C35 product, yielding an unacceptable error rate of 1.07%. The trial was discontinued and the error rate dropped back down to 0.27%. The 2nd intervention, the N40-C35 locking injector yielded 1.79% error rate. The project team switched to a totally different device Texium-Smart Site system. The error rate with this device was 0.18% and thus was accepted.

Discussion

While CSTD provide important protections from HD exposure, most are not indicated for use longer than 24 hours. This presents a challenge for institutions giving HDs via home infusion pump. Through the systematic evaluation of products and careful attention to end-user feedback, this system was able to identify a product that maintained protections of the CSTD without increasing the error rate. Institutions need to be aware of the limitations of these devices and apply similar methodologies to evaluate their use in unique cases such as home infusion.

Oncology Nursing Forum. 2025 Mar 1;52(2):42–43.

069. Implementation Adherence of Virtual Reality to Reduce Anxiety During Chemotherapy Infusion

Kim Peterson 1, Cortney Alianiello 2, Suzanna Fitzpatrick 3

Significance & Background

A cancer diagnosis can be an overwhelming, life-altering event as patients are faced with multiple medical appointments, fear of the unknown, potential functional deficits, and side effects from cancer or accompanying treatments. Anxiety is the most common mental health disorder among cancer patients and is found in 20.58% of patients receiving treatment at a suburban ambulatory infusion center. At a large suburban cancer infusion center, healthcare staff report the need for a nurse-driven treatment available for patients’ experiencing anxiety during infusions. Virtual Reality (VR) is an effective nonpharmacologic intervention that can reduce anxiety in patients receiving chemotherapy. This immersive experience significantly reduces unpleasant sensations that contribute to anxiety, offering a novel and effective approach to improving the emotional well-being of patients undergoing chemotherapy.

Purpose

This quality improvement project aims to reduce anxiety among patients with cancer receiving treatment in an outpatient infusion center by implementing and measuring adherence to the offering and use of VR, an evidence-based, research-supported practice change.

Interventions

In the Fall of 2024, staff were educated on the new VR intervention, implemented over 15 weeks. Nurses assessed patient anxiety using the Common Terminology Criteria for Adverse Events (CTCAE) assessment tool on arrival and before infusion. Patients with anxiety grades >0 are offered VR during infusion with instruction provided by nurses. A standardized nursing note was developed to document the offering of VR, use of VR, total time used, and anxiety reassessment.

Results

100% staff educated about anxiety prevalence, documentation requirements, and use of VR headsets prior to project implementation. Adherence to documentation, percentage of patients with CTCAE anxiety grades >0, VR usage, and CTCAE anxiety reassessment will be tracked daily. Chart audit data are recorded in Research Electronic Data Capture (REDCap) and run charts will be completed. Initial results after week 4 include weekly CTCAE anxiety grade documentation adherence increased from baseline 96.77% (60/62) to 100% (57/57). After implementation, patients with CTCAE >0 was 24.56% (42/171), and 45.24% (19/42) were offered VR. Education completed in week 5 to increase adherence with offering VR and meet 100% goal.

Discussion

Anxiety is common in patients receiving cancer treatment infusions, and VR implementation is an evidence-based intervention driven by nurses that can improve anxiety during cancer treatment and should be considered as an effective tool to improve mental health during infusion treatment.

Oncology Nursing Forum. 2025 Mar 1;52(2):43–44.

070. Launch of a New Multidisciplinary Genetic Cancer Prevention Clinic (GCPC): Eighteen-Month Experience

Kathryn Pratt 1, Megan Templo 2, Delaney Gaston 3, Sara Pirzadeh-Miller 4, Sayoni Lahiri 5

Significance & Background

In January 2023, our National Cancer Institute-designated comprehensive cancer center launched a weekly multidisciplinary clinic, the Genetic Cancer Prevention Clinic (GCPC), for individuals at an increased risk for hereditary cancer due to a known pathogenic variant (PV). As part of the multidisciplinary team, the genetic nurse navigator (GNN) provides education about hereditary cancers and assists with coordination of high-risk surveillance and/or prophylactic procedures, as well as support for cascade testing of family members.

Purpose

The GCPC mission is to reduce cancer incidence through coordination and implementation of longitudinal cancer risk reduction efforts, promotion of cascade testing, and research. Data was collected through retrospective chart review. This study was determined to be non-regulated research through the Institutional Review Board.

Interventions

Patients are seen annually by a genetic counselor, advanced practice provider or physician, and GNN. Before the appointment, the GNN reviews the chart and calls the patient to confirm genetic test results, update personal/ family history, and adherence to recommended risk-management interventions. Each case, along with pertinent updates and plans, is discussed in a multidisciplinary conference prior to clinic. National Comprehensive Cancer Network guidelines and recommended screenings are shared with the patient at the time of their visit and each of the patient’s relevant providers through the visit note.

Results

Between January 2023 and June 2024, there were 277 unique patient encounters (new and/ or established patients) in GCPC. Patients had PVs in 38 different genes, most commonly (56% of PVs) in the ATM, BRCA1, BRCA2, CHEK2, and PALB2 genes. Sixty-six percent of patients were previvors; 98% reported family history of cancer; 82% were female; 63% were age 50 or younger; and 99% were English-speaking. Patients residing in 40 counties were served across 4 states. Forty patients underwent updated genetic testing as a result of their GCPC visit; 10% had a newly identified PV. There were 369 referrals placed, and 1,854 pieces of educational materials provided.

Discussion

Patient volumes have continued to grow in our second year. In addition to a steady flow of new patients, we are now seeing established patients, and we have expanded our gastrointestinal GCPC clinic. Most current data will be included if invited to share in a poster. The GNN has played an integral role within the multidisciplinary team in the development and ongoing adjustments to GCPC.

Oncology Nursing Forum. 2025 Mar 1;52(2):44.

071. Standardizing Onboarding Practices for New Clinical Staff RNS in Inpatient and Outpatient Oncology Areas: Capturing Tasks Completed, Facilitating Teaching, and Improving Communication Between the Preceptee, Preceptor(S), and Unit Leadership

Julia Prokic 1, Jesse Kelsey 2, Jamie Ferrell 3, Dena Hofmeister 4, Karen Anderson 5

Significance & Background

Many institutions use paper forms for general onboarding tasks and skills checklists to ensure consistent teaching of skills. However, these generalized forms do not facilitate information sharing between preceptee, preceptors, and unit leadership on a shift-to-shift basis, nor do they cover all tasks. This was also true at our academic institution. While each inpatient and outpatient oncology area used the general onboarding documents, some created more detailed versions. This lack of standardization led to areas working in silos.

Purpose

The aim of this project was to standardize onboarding practices for new clinical staff RNs in both inpatient and outpatient oncology areas using online documents. These documents would cover all necessary tasks, facilitate teaching, and improve communication between the preceptee, preceptor(s), and unit leadership.

Interventions

Nursing educators reviewed and assessed the current onboarding methods. Two online forms were created. The first, the RN Orientation Summary, includes a comprehensive list of tasks to be covered, with hyperlinks to relevant policies, clinical skills, and skill checklists for tasks, where applicable. Only tasks that the new RN can independently perform are to be signed-off. The second form, the Preceptor and Leadership Feedback form, records feedback from preceptors and unit leadership on the new employee’s progress per shift and weekly. It also provides feedback on skills that were attempted but not signed-off. Two virtual meetings were conducted for current preceptors to review the new forms and provide feedback. Formal training was delivered through staff meetings, online videos, and in-person nurse educator rounding.

Results

Participation rates for the new clinical staff onboarding forms reached 100%. Data indicated that preceptees valued the transparency of the tasks and the feedback on their progress. Initially, preceptors found the forms difficult to access, but after resolving these issues, they found them easy to use. Preceptors also noted that not having to fill out each individual skill checklist saved time. Unit leadership appreciated the organization of the information.

Discussion

The successful implementation of the online onboarding forms for new clinical staff RN brought harmonization to inpatient and outpatient oncology areas. Stakeholders appreciated the standardization of the process. This standardization ensures that all clinical staff are well-prepared and competent with required education and skills, Stakeholders are now looking forward to implementing these forms for other job roles.

Oncology Nursing Forum. 2025 Mar 1;52(2):44–45.

072. Safety First! Expanding Guidelines of Safe Handling of Antineoplastic Agents in the Interventional Radiology Setting

Jacqueline Redeemer 1, Lisa Thomas 2

Significance & Background

The administration of HEPZATO (high-dose melphalan) presents unique challenges in the interventional radiology department, particularly regarding safe handling and potential exposure to hazardous materials. Liver cancer patients receiving this treatment require meticulous protocols to minimize risk for both patients and healthcare providers. With interventional radiology staff often lacking chemotherapy certification, ensuring adherence to safe handling practices is critical.

Purpose

To enhance safety protocols for administering HEPZATO in the interventional radiology setting. We sought to address gaps in knowledge and practice among non-chemotherapy certified professionals, focusing on safe handling techniques and minimizing exposure to hazardous materials during and after the administration process.

Interventions

We implemented an in-service training program for interventional radiology, perfusion staff, ICU registered nurses, and oncology RNs involved in operative infusion and post op patient observation. This program included, safe handling of bodily waste and linens, and emergency procedures in the event of exposure. We implemented guidelines based on the 2024 ONS/ASCO Antineoplastic Safety Standard and recommendations specific to HEPZATO. Additionally, we fostered collaboration with the perfusion team and pharmacy to ensure safe and timely administration within the designated treatment window.

Results

The initiative resulted in improved communication and collaboration among interventional radiology, pharmacy and nursing staff, leading to successful HEPZATO administration within the established timeframes. Training sessions increased staff confidence in handling hazardous materials, and adherence to safety protocols was documented through direct observation and feedback. Staff reported enhanced understanding of safe disposal practices for waste and linens, with zero reported incidents of contact exposure.

Discussion

Our findings demonstrate that targeted education and collaboration can significantly improve the safety of HEPZATO administration in an interventional radiology setting. While the program was effective, ongoing evaluation and adaptation of training materials will be essential to address evolving challenges. Future initiatives should consider integrating simulation-based training to further enhance staff preparedness and response to potential exposure scenarios.

Oncology Nursing Forum. 2025 Mar 1;52(2):45.

073. Introducing New Patient Binders to the Outpatient Lymphoma Population

Melissa Reinhold 1

Significance & Background

When a newly diagnosed cancer patient and their caregiver meet their oncology team, they often find themselves overwhelmed by the amount of new information being presented. Likewise, providers often find themselves inundated by the number of wide-ranging questions and concerns the patient has. There is rarely enough time to address all their needs in a 60-minute initial consult, or in the 30-minute visits that follow. Additionally, a great deal of the information that is discussed during these appointments is not written down, is then poorly retained by the patient and/or caregiver, and ultimately necessitates re-education during future visits.

Purpose

The intention of the New Patient Binder is to compile all of the relevant, written education for a newly diagnosed lymphoma patient’s individual disease, treatment, and supportive care into one centralized, well-organized binder. It is meant to be a personalized, patient-friendly, tangible resource that evolves with the patient’s cancer journey. It also serves to offload some of the educational burden from the MD, APP, and/or PharmD to the oncology nurse navigator (ONN).

Interventions

The New Patient Binder was delivered by the ONN to each newly diagnosed lymphoma patient prior to their first treatment during a face-to-face nursing education encounter. Prior to the implementation of these binders, a dedicated nursing education session did not exist. Inside the binder was a compilation of Duke Cancer Institute-approved teaching sheets that served to address a wide variety of topics from support resources, campus maps, local accommodations, and important contact numbers to regimen-specific side effects, tailored treatment calendars, and patient-friendly disease guides.

Results

Over the course of 18 months, the ONN provided approximately 3–4 binders to patients each month for a total of more than 50 binders. The patients’ caregivers, in particular, consistently expressed satisfaction with this tool, particularly with the treatment calendars and side effect guides. Provider feedback was also overwhelmingly positive and included praise for enhanced coordination of care for their patients, reduced workload, improved patient adherence, and increased utilization of available resources (e.g., grants and funding, social work and nutrition consults).

Discussion

After this nurse navigator successfully rolled out the new patient binders to the outpatient lymphoma population, she started training newly hired navigators in this process with the hopes of increasing utilization to the other disease groups at the oncology center.

Oncology Nursing Forum. 2025 Mar 1;52(2):45–46.

074. A Specialty-Focused Skills fair for Oncology Nurses

Karen Rios 1

Significance & Background

Our oncology unit has undergone significant transformation, expanding from a 12-bed unit to an advanced 30-bed unit to accommodate the growing complexity of cancer care. Consequently, the nursing staff has more than doubled in the past 10 months, with the majority of these 24 nurses being recent graduates. As the influx of new nurses occurred, existing staff nurses noticed inconsistencies in our oncology nursing practice.

Purpose

The nurse-driven skills fair provided a specialty-focused refresher course for all staff nurses. The goal was to ensure patient safety and quality of care by reinforcing evidence-based practices through hands-on continuing education and highlighting relevant institutional policies.

Interventions

Charge nurses, nurse educators, and oncology nursing leadership collaborated to brainstorm foundational topics pertinent to our oncology nursing practice. These included central line maintenance, sepsis protocol, safe handling of chemotherapy with spills, and chemotherapy calculations. A two-hour skills fair was scheduled over four days, with staff able to sign up online for the sessions. A team of charge nurses was assigned to lead stations on each topic. Their responsibilities included creating educational materials using hospital policies, ONS guidelines, and Dynamic Health, as well as a 5-question quiz on each topic. Attendees were given passports to get stamped at each station they visited during the skills fair.

Results

100% of unit nurses participated in the skills fair. After the skills fair, an online survey was distributed. The results revealed a 225% increase in staff knowledge, with the percentage of nurses rating themselves as “Good” or “Expert” rising from 25% before the sessions to 87.5% afterwards. Staff provided positive feedback, with comments such as “Honestly surprised at how good it was” and “Overall, I enjoyed the skills class, I learned some things I was not aware.”

Discussion

The staff nurses in our growing oncology unit can apply their enhanced skills to reduce central line-associated bloodstream infections (CLABSI), recognize and initiate sepsis protocols to decrease mortality rates, accurately calculate chemotherapy dosages, handle chemotherapy safely, and respond appropriately to chemotherapy spills. By hosting a specialty-focused skills fair, we can further develop our nurses’ knowledge and comfort-level, ultimately improving patient outcomes for our oncology population.

Oncology Nursing Forum. 2025 Mar 1;52(2):46.

075. Nursing Productivity Reimagined: The Impact of a New Off Unit Chemotherapy Cost Center

Olivia Rocco 1, Andrea Wagner 2, Judith Miranda Rankin 3

Significance & Background

According to the article “Time to Disrupt How We Calculate Nursing Productivity,” Morin defines productivity as “a hospital takes the total of all the nursing hours for a 24-hour period of time... and divides it by the total number of patient bed charges dropped at midnight...” In a large academic medical center, the lymphoma, multiple myeloma unit’s productivity has been an average of 91%, under the benchmark of 98–102%, from January 1st through March 30th, 2024. This unit is designated to administer off unit chemotherapies throughout the hospital for those units without chemotherapy trained nurses. When analyzing strategies to improve productivity, it became apparent that time spent off the unit administering chemotherapy needed to be captured separately.

Purpose

Create a new off unit chemotherapy cost center to improve productivity on a 15 bed lymphoma, multiple myeloma unit.

Interventions

In April 2024, nursing and finance leadership met to create the off unit chemotherapy cost center. A system was developed to record time spent on off unit chemotherapy, allowing accurate time allocation to the new cost center. Nurses utilized a tracker to document total time spent on off unit chemotherapy with patient, unit, and drug information. Total time spent on chemotherapy incorporated coordination, administration and documentation. The nurse manager reviewed the tracker daily, extracting the nurse’s total time spent on off unit chemotherapy and charging it to the new cost center.

Results

From April 2024 to present, a total of 133 off unit chemotherapies have been administered on 26 units totaling 154 hours. This time has been transferred to the new cost center. As a result, the lymphoma, multiple myeloma unit’s productivity increased from an average of 91% to 99% now meeting benchmark. Limitations to this study include the limited time the new cost center has been live and additional productivity interventions that were initiated.

Discussion

The oncology nurse manager plays a pivotal role in managing unit productivity as it remains an important indicator. By transferring time spent on off unit chemotherapy to a new cost center, unit productivity was able to be increased. Nurse management continues to use the new cost center and explore other ideas to help maintain productivity.

Oncology Nursing Forum. 2025 Mar 1;52(2):46–47.

076. Implementation of Social Determinants of Health Screening to Reduce Barriers to Care and Emotional Distress in Outpatient Chemotherapy Infusion Patients

Johanna Rochat 1, Lorena Delgado 2

Significance & Background

Social determinants of health (SDoH) can play an important role in an oncology patient’s ability to receive their treatment on schedule, which provides for optimal patient outcomes. SDoH barriers such as lack of transportation, finances, nutrition, and high cost of medications can all impact oncology patients’ treatments, outcomes, and distress levels throughout their cancer care journey.

Purpose

Prior to implementation of a SDoH assessment protocol, staff in an ambulatory infusion center recognized that patients were canceling treatments last minute due to transportation or work-related barriers leading to delays in care. Patients were also reporting significant emotional distress due to SDoH obstacles. Implementation of a SDoH screening tool was incorporated to assess patients for SDoH barriers prior to initiating chemotherapy treatment and connect them with resources before starting infusion treatment to prevent delays in care and reduce emotional distress.

Interventions

To enhance patient support and address SDoH in oncology care, a systematic approach was implemented to assess and meet the needs of patients prior to and throughout their treatment journey. Initially, nurses collaborated with social work professionals to familiarize themselves with available resources within the cancer service line and to educate peers at affiliated sites about the significance of conducting comprehensive needs assessments at the initial chemotherapy teach visit. Using the NCCN Distress Thermometer tool, patients were screened during their initial visit for issues related to transportation, housing security, food access, and financial stability. The information collected was communicated to a multidisciplinary team, including social workers, providers, and clinic nurses, to facilitate resource allocation and support. Patients were reassessed every two months during treatment and at the first follow-up appointment post-treatment.

Results

Preliminary results indicate a significant reduction in distress across all assessed areas. 117/161 (approximately 73%) of patients assessed reported an emotional distress level >1. Out of those 117 patients, 44 were reassessed at least once and 31/44 (approximately 70%) of those reassessed reported lower emotional distress scores. The collected data also guided targeted interventions, revealing transportation and nutritional insecurity as major concerns.

Discussion

In response, a grant was secured, and a partnership with a non-profit organization was established to address these critical needs. This initiative demonstrates the value of early and ongoing SDOH assessments in improving patient well-being and informs future strategies for comprehensive oncology care.

Oncology Nursing Forum. 2025 Mar 1;52(2):47–48.

077. Improving Care Delivery for Infusion Patients with a Designated Infusion Advance Practice Provider

Miwa Saito 1

Significance & Background

An ambulatory infusion center within a large metropolitan area provides chemotherapy/immunotherapy treatment and supportive care to an average of 200 patients daily. The infusion center serves over 17 disease groups within a comprehensive outpatient cancer center. Advanced Practice Providers (APP) and Registered Nurses (RN) who practice in office practice clinics receive calls from infusion nurses for treatment-related concerns. This impacts clinic’s workflow and workload while managing patients within the office practice clinic, causing delays in care for patients. With the ambulatory cancer center’s current staffing model, it is challenging to justify additional clinic staff using patient volume alone. Therefore, additional resources to support infusion-related workload are needed to ensure timely care is delivered to patients receiving cancer treatments and to reduce interruptions in the office practice clinic workflow, enhancing the overall patient care experience.

Purpose

To promote timely care for patients who receive cancer infusion treatments while reducing the interruptions to office practice clinics workflows and decreasing the APP and RNs workload.

Interventions

A full-time Infusion-designated APP was hired to pilot coverage for solid tumor office practices and address infusion-related concerns such as unmet treatment parameters, abnormal patient conditions, and emergencies for solid tumor disease groups. A pre-implementation redcap survey was developed to assess the baseline needs of office practice staff. A post-implementation redcap survey was conducted to evaluate the outcome and effectiveness of the infusion designated APP.

Results

The post-implementation Redcap survey demonstrated a 26% decrease in staff who identified they received 15–20 calls per day and a 9% decrease in staff who identified they received more than 25 calls per day, which increased productivity and satisfaction in solid tumor office practice APPs. In addition, 71% of clinic staff identified that a designated infusion APP reduced their overall workload. The survey demonstrated that 82% of clinic staff felt that an infusion-designated APP improved the efficiency of addressing infusion-related issues.

Discussion

Having an infusion designated APP to provide prompt care for infusion patients receiving cancer treatments promotes safety and timely care delivery. The pilot initiative demonstrates that utilization of a designated APP for infusion throughout office practice clinics in a large outpatient cancer center can improve staff satisfaction and efficiency in patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):48.

078. Optimizing High-Risk Adult Oncology Care: The Heart Team Protocol for Reducing ED Visits and Hospital Admissions

Yun-Jeong Seo 1, Pinaki Dutta 2, Toby Bressler 3

Significance & Background

1.5 million Americans visit emergency departments (EDs) due to complications from cancer treatment, such as pain, fever, respiratory distress, and radiation dermatitis. Patients undergoing multimodal cancer therapy (chemoRT) are especially vulnerable. In 2022, the Centers for Medicare and Medicaid Services (CMS) began monitoring hospitalizations and ED visits (EDVs) among outpatient chemoRT patients, aiming to reduce these events. Addressing this issue is vital to improve patient outcomes and reduce healthcare costs.

Purpose

This quality improvement project assessed the impact of the High ED/Admission Risk Therapy (HEART) team protocol on reducing EDV rates among chemoRT patients. The aim was to enhance nurse-driven symptom management by training nursing staff to detect treatment-related symptoms early and implement timely interventions, thereby preventing unnecessary EDVs.

Interventions

An evidence-based assessment tool and the HEART team algorithm were created, focusing on interdisciplinary collaboration and patient-centered care. Radiation Oncology nurses underwent two training sessions, on identifying risk factors in chemoRT patients. Training included point-of-care feedback and weekly huddles to reinforce skills in managing cancer treatment-related symptoms. Pre- and post-training surveys measured improvements in nurses’ knowledge and confidence. Nurses applied the HEARTS checklist weekly to identify high-risk patients, who were managed following the HEART protocol and referred to an NP-led clinic for further evaluation. This clinic involved collaboration among nurses, physicians, and supportive oncology staff for comprehensive patient management.

Results

A Paired-Samples t-test indicated a significant increase in nurses’ knowledge and confidence post-training, with mean scores increased from 14.00 to 21.23 (t (4) = −19.24, p < .001), 95% CI [−8.24, −6.16]. This improvement was crucial for managing the complex needs of chemoRT patients. The HEART team protocol reduced EDV rates by 17.74%, from 39.02% pre-HEART to 21.28% post-HEART, demonstrating its effectiveness in significantly reducing ED visits in this vulnerable patient population.

Discussion

Implementing the HEART team protocol significantly enhanced nursing staff’s ability to detect high-risk patients and manage treatment related complications and identify critical symptoms, leading to fewer EDV. These findings suggest that broader implementation of the HEART team protocol aligns with CMS recommendations, providing a valuable framework for reducing ED visits and hospital admissions among high-risk oncology patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):48–49.

079. Establishing a Nurse-Led Vascular Access Team for Ultrasound-Guided Peripheral IV Placement in Oncology Patients: Improving Success Rates and Patient Satisfaction

Aketia Seymour 1, Ronnie Hollins 2, Darcy Foley 3, Dominique Christenson 4, Deborah Hall 5, Nicola Pistone 6

Significance & Background

Intravenous infusion is often the primary means in which oncology patients receive their antineoplastic therapy. The convenience of peripheral intravenous (PIV) catheters often make them a favored choice for therapy. Due to many factors, including the caustic nature of chemotherapy and other supportive care, the need to rotate sites, and length of treatment, it can be challenging to locate and maintain adequate peripheral access for treatment. Utilizing ultrasound to assist with locating suitable veins, in addition to having a team of nurses specially trained to use the ultrasound on-site, has proven successful in reducing the number of attempts to place an IV, minimizing complications associated with multiple unsuccessful PIV placement attempts, and decreasing treatment delays due to lack of intravenous access.

Purpose

The goal of this project was to establish a self-sustaining, nurse-led vascular access team to assist staff in an ambulatory cancer center with placing PIVs in patients who have been identified as having difficulty in obtaining PIV access.

Interventions

A group of eight cancer center RNs were trained on the use of an ultrasound for PIV placement. The RNs completed didactic training followed by hands-on, on-site training led by a member of the hospital-based vascular access team. Once the RNs were deemed competent on the use of the ultrasound for PIV placement, they were able to independently place PIVs as requested by staff for patients that the traditional method of PIV placement was unsuccessful. Staff throughout the cancer center were notified of the availability of these nurses for PIV placement.

Results

In this first year, this group of nurses has successfully placed over 200 PIVS. Many of these placements reduced the number of attempts on a patient to three or fewer. The current PIV attempt limit is 5 per patient. The use of ultrasound increased the number of successful PIV placements and increased both patient and nursing satisfaction significantly. Frequent requests daily from multiple departments in the cancer center have proven the need and success of this program.

Discussion

The introduction of USG PIV trained RNs on-site has decreased the number of PIV attempts on many patients, reduced the number of treatment delays due to unsuccessful PIV placement, and increased patient and staff satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):49.

080. Development of a Virtual Reality Education Program for Oncology Nurses

Renee Shalvoy 1, Diana McMahon 2, Karen Kuhns 3, Amy Rettig 4, Kellen Maicher 5, Rachel Arpin 6

Significance & Background

Oncology, as an evolving specialty, demands highly skilled nurses who are committed to continuous learning. The current literature provides evidence that Virtual Reality (VR) has the potential to revolutionize clinical education. A Learning Needs Assessment has revealed that nurses are eager for innovative learning opportunities that can be integrated seamlessly into their patient care responsibilities.

Purpose

The project’s purpose is to develop a VR program that will deliver innovative and timely education to nurses on their unit.

Interventions

A team of oncology nursing leaders, educators, and instructional designers convened to assess educational needs, evidence for VR education, staff preferences, and prioritization of learning needs. Voluntary VR sessions were offered to nurses to determine the acceptability of using VR as a learning modality on their unit and to engage them as potential superusers of VR education. Superusers are integral to program success, so that staff have 24/7 unit-based support to receive education. The nursing education department chose the inaugural VR education topics of Chemotherapy Spill Process and Emergency Cart Inventory based on learners’ knowledge deficit, impact on quality of care, and applicability to a broad base of nurses.

Results

The development of the VR education programs is in process. 35 nurses have been in headsets, and 32 have completed superuser training. Monthly superuser training will continue until every unit has a VR resource available. 99% of the nurses who have had the opportunity to experience VR headsets enjoyed the new experience. Building this expertise among staff who will help facilitate future VR activities is essential to the program’s success.

Discussion

As the two educational VR programs are being developed, the organization’s unwavering commitment to excellence in oncology nursing is evident. The ongoing development of superusers and the comprehensive evaluation process are key components of this commitment. Pre and post-tests will be conducted to assess learning outcomes, time spent on educational experiences, and satisfaction with the mode of education. The development of a VR program requires an interdisciplinary team and an organizational culture that embraces change. This commitment to excellence and innovation will ensure the success of the VR program in oncology nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):49–50.

081. Moving Toward a Sense of Belonging: The Float Pool Experience

Ellan Shelton 1, Deanna Raudys 2, Amy Altomare 3, Jeannine M Brant 4

Significance & Background

Within a large specialty research oncology hospital, a float pool’s professional governance council noticed increasing RN turnover and demands of the float RN role with an aging oncology population. As highly skilled, flexible staff, float nurses provide a uniquely cost-effective solution to staffing shortages in the post-pandemic era with the ability to serve according to staffing fluctuations ultimately lowering overall costs. Unlike travel nurses, float staff are well-oriented to the specific needs of the oncology population and can uphold a high standard of care, contributing to improved outcomes.

Purpose

Previous council projects focused on improving the float pool orientation process, including developing unit specific TIPs sheets and an accessible comprehensive survival guide. In an attempt to formulate ways to address increased turnover, lack of retention and engagement, increasing demands of the role, and overall job satisfaction, this council sought to understand what an ideal float experience would look like.

Interventions

Float RNs completed a survey (HOPE Floats) following each shift to examine perceptions of their daily experiences. Subsequently, qualitative data were gathered to further explore float perceptions and challenges, out of which several themes emerged. The data indicated a lack of sense of belonging which contributed to a lack of job satisfaction, morale, resilience and engagement. Sense of belonging emerged as an underlying need expressed by staff and informed the development of a sense of belonging toolkit to improve the float nurse experience.

Results

Several themes from the qualitative survey informed the ideal float experience and the BELONG Toolkit contents: Need for an approachable resource RN; Appropriate assignments; Check-ins from charge RNs; Scheduled breaks; Staff awareness of hosting a float; Desire to feel part of the team; Satisfaction of making the unit whole for that day; Being thanked; Ending shifts on time. The attached table describes the connections found between the quantitative and qualitative responses.

Discussion

Ultimately in analyzing data from float staff, sense of belonging emerged as a foundation to improving the float experience. In reviewing the literature, no studies have been done relating to float staff and sense of belonging, yet evidence suggests common challenges of high turnover, burnout, and job dissatisfaction exist in float pools nationwide. Moving forward, the unit council will be conducting an intervention trial using the BELONG Toolkit and measuring its effects with the Belonging Barometer.

Oncology Nursing Forum. 2025 Mar 1;52(2):51.

082. Optimizing Pretreatment Protocols in an NCI Designated Comprehensive Cancer Center Network Location: Reducing Delays and Enhancing Patient Compliance

Christa Shine 1, Kimberly Berman 2, Valerie Heron 3, Rhiannon Levengood 4, Nicolas Hoover 5

Significance & Background

Providing infusion services at an NCI Designated Comprehensive Cancer Center network location, without a lab or pharmacy onsite, presents challenges in ensuring patients are well enough for treatment. The offsite pharmacy requires treatment confirmation, via a pretreatment checklist, one day prior to treatment in order to prepare the medications for transport to the network location the day of treatment. It is essential that external lab results are received on time and phone confirmation that patients feel well enough for treatment is completed. Infusion nurses are challenged with educating patients on the importance of compliance, confirming the ok for treatment and submitting the checklist in a timely manner. Efficient interdisciplinary communication between nurses, pharmacy, providers, and patients is crucial to limit disruptions to treatment plans and negative patient outcomes.

Purpose

A six-month checklist submission review showed 42% of days had checklist submissions with outstanding lab results and/or phone confirmations. This can lead to delays in care, decreased patient outcomes and satisfaction, and increased costs through drug waste and additional courier needs. A process to achieve the goal of zero pretreatment checklists submitted with outstanding labs or phone calls was needed.

Interventions

Nurses and providers collaborated to develop standardized pre-treatment education for patients. Emphasis to the patient is placed on the importance of lab and pretreatment phone confirmation requirements. An infusion instruction sheet with lab and confirmation requirements is reviewed with the patient and patient signature is required to confirm understanding. Treatment specific lab wallet cards, with tube colors and names of required labs, is provided to the patient for easy reference while having labs drawn.

Results

Preliminary data shows only 10% of days have had outstanding labs and phone calls at checklist submission since the implementation of interventions. Monitoring of pretreatment checklist completion at time of submission to evaluate intervention effectiveness is ongoing.

Discussion

Incorporating different methods of patient education and clear communication has the potential to significantly enhance patient care by minimizing delays and improving compliance. Future implications include the possibility of using technology, such as mobile applications or reminders, to further streamline communication between patients and healthcare teams, improving outcomes, satisfaction, and reducing waste. Continued refinement of this initiative could serve as a model for similar healthcare settings facing logistical challenges in cancer treatment delivery.

Oncology Nursing Forum. 2025 Mar 1;52(2):51.

083. Redefining the Experience: Virtual Reality and the Future of Chemotherapy Care

Madison Skotcher 1, Laura Hayes 2

Significance & Background

Chemotherapy is a cornerstone in cancer treatment, yet it often poses significant challenges for patients due to its inherent discomfort. To enhance the chemotherapy experience, our cancer center has introduced a Virtual Reality (VR) initiative using the Meta Quest 2 platform. This project aims to provide immersive, engaging environments designed to improve patient comfort and make the treatment journey more pleasant.

Purpose

The goal of this project was to evaluate the feasibility and impact of integrating VR technology into chemotherapy sessions. We sought to determine if VR could effectively enhance the overall experience of patients during treatment by providing engaging and enjoyable distractions.

Interventions

We implemented a VR system during chemotherapy sessions and collected data through a comprehensive questionnaire distributed to participating patients. The questionnaire gathered information on the patient’s prior experience with VR, and specific feedback about the VR system. Key areas of focus included overall satisfaction with the VR experience, the variety of VR content provided, and patient recommendations for future VR use.

Results

Preliminary results show that most patients provided positive feedback about their VR experience during chemotherapy. They reported that the VR content—ranging from tranquil nature scenes to imaginative space exploration—greatly contributed to a more enjoyable and immersive treatment experience. The majority of patients expressed that VR enhanced their overall comfort and engagement during sessions. A patient testimonial highlights the impact of the VR initiative: “Using VR during my chemotherapy was a game-changer. I was completely absorbed in a beautiful virtual forest, which made the time go by faster and made the whole experience much more pleasant. It felt like a nice escape from the reality of treatment.”

Discussion

The integration of VR technology into chemotherapy sessions has demonstrated significant potential for enhancing patient experiences. With positive feedback and reported improvements in overall comfort, it is advisable to consider broader implementation of VR in cancer care. Further research should explore long-term effects and continually adapt VR content to better suit patient preferences. This initiative illustrates how innovative technologies can transform patient care and provides a framework for other institutions to follow in enhancing the treatment experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):51–52.

084. Establishing Paracentesis for Malignant Ascites at an Outpatient Gynecologic Oncology Clinic

Rita Stiles 1, Annie Nesteroff 2, Sarah Szczepanik 3, Katherine Kennedy 4, Christa Nagel 5, Karen Meade 6

Significance & Background

Malignant ascites, a common complication in advanced gynecologic cancers, significantly diminishes patients’ quality of life due to symptoms like abdominal discomfort, bloating, and respiratory distress. Delays in accessing paracentesis, often caused by scheduling constraints in hospital settings, exacerbate patient discomfort and can lead to unnecessary hospitalizations. In 2021–2022, an outpatient gynecologic oncology clinic faced delays in scheduling paracentesis due to capacity constraints in hospital-based settings, resulting in prolonged patient discomfort and unnecessary hospital admissions.

Purpose

This project aimed to establish a safe and efficient outpatient paracentesis service within a gynecologic oncology clinic, addressing both clinical needs and operational challenges associated with providing this procedure in a non-hospital setting.

Interventions

An interdisciplinary team, comprising physicians, advanced practice providers (APPs), nurses, clinic leaders, and scheduling staff, collaborated to develop the service. A literature review informed best practices, and standard operating procedures were created for clinical and operational workflows. APPs received training in paracentesis, and nursing staff were educated on providing support during the procedure. Patient selection criteria were defined, and the procedure was performed using ultrasound guidance and aseptic technique, with post-procedure monitoring and patient education.

Results

Over 12 months, 15 paracentesis procedures were successfully performed without any adverse events. The average procedure time from “time-out” to dressing application was 21 minutes (range 13–36 minutes), and the average volume drained was 3193 mL (range 800–5000 mL). The average patient age was 68 years old (range 48–80 years old). The average time from clinic check-in to dressing application was 87 minutes (range 45–120 minutes).

Discussion

This initiative demonstrates that outpatient paracentesis is a safe and feasible option for gynecologic oncology patients, resulting in improved symptom management, reduced hospital admissions, and enhanced patient satisfaction. Although literature supports administration of albumin after decompression of ≥ 5 liters of ascites fluid, notably this is not necessary in the gynecology oncology population due to the nature of the exudative ascites. Hypotension was not observed in 100% of the patients. This project also highlights the potential for expanding the skill set of oncology APPs and nurses to provide more comprehensive care. The success of this project supports the wider implementation of outpatient paracentesis services in oncology clinics, offering a patient-centered approach to managing malignant ascites.

Oncology Nursing Forum. 2025 Mar 1;52(2):52–53.

085. Redefining Survivorship Care: Using Standards as a Road Map

Tara Sweeney 1

Significance & Background

Caring for the health and well-being of survivors across all stages and phases of treatment is an integral part of cancer care. Standards for delivering quality survivorship care continue to evolve. Survivorship care is multidimensional, spanning from the time a person is diagnosed with cancer through the remainder of their life. Key components include surveillance, health promotion, assessing for cancer or treatment related effects, and care coordination. Many models exist, most focus on caring for survivors who completed curative intent treatment and are transitioning into extended survivorship.

Purpose

In 2019, we had a similar model. Emphasis was on delivery of Survivorship Care Plans (SCPs) to survivors with an early-stage cancer in compliance with Commission on Cancer (CoC) and NAPBC accreditations. Oncology Nurse Navigators (ONNs) delivering SCPs noted gaps in services and created a committee to assess barriers. Simultaneously, the CoC updated their standards to require a survivorship program, coordinator, and evaluation of services. Our goal was to use Standard 4.8 as a road map to expand and strengthen our system-approach to survivorship carE.

Interventions

Our Survivorship Program includes ONNs, social workers, rehabilitation, and multidisciplinary members from across the health system. Our mission is to support survivors from diagnosis, with a primary focus on active, extended, and metastatic stages of survivorship. We meet every other month to discuss goals, identify barriers, and plan for services. Three services per year also break into separate workgroups that meet monthly to further assess survivor experiences and develop initiatives. Workgroups examples include nutrition, integrative therapy, and financial.

Results

In 2023 our mental health workgroup identified that 45% of survivors reported moderate/severe psychosocial distress on initial screening with 50% reporting concerns related to emotional distress. Many gaps were identified including limited access to oncology experienced counselors. The workgroup collaborated with internal/external partners to identify services and advocated for a system Oncology Psychotherapist. We created a seminar series “We See You: A Series on Caring for Your Emotional Well-Being” diving deeper into the emotional journey throughout survivorship, offering strategies and resources for patients/caregivers.

Discussion

As a community health system with limited resources, using survivorship standards as our road map and collaborating across disciplines to discover mutual goals has been fundamental to program development. As we redefine survivorship care, we aim to further develop individualized services for our survivors.

Oncology Nursing Forum. 2025 Mar 1;52(2):53.

086. Enhancing Interprofessional Collaboration to Improve Outcomes in a Head and Neck Cancer Inpatient Unit Through IPC Huddles

Mohammad Taha 1

Significance & Background

Head and neck cancer patients require complex, multidisciplinary care. The lack of structured handoff between healthcare professionals in this new inpatient unit led to communication breakdowns, delayed identification of adverse events, and low team morale. A pre-implementation survey showed that nurses felt uninformed about patient care and disconnected from decision-making. To address these challenges, daily IPC huddles were introduced to improve communication and care delivery.

Purpose

The purpose of this project is to assess the impact of daily interprofessional collaboration (IPC) huddles on improving communication, nursing confidence, and patient safety in a newly established head and neck cancer inpatient unit at an NCI-designated Comprehensive Cancer Center. The goal was to determine whether structured, regular huddles could address communication gaps and improve clinical outcomes in this complex, multidisciplinary specialty.

Interventions

Daily IPC huddles were implemented at 10 a.m., involving nurses, APPs, physicians, pharmacists, physical therapists, and social workers. The 10-minute structured discussions focused on patient condition updates, potential complications, and team concerns. Surveys were conducted before and after the intervention to assess changes in communication, nursing knowledge, and perceptions of patient safety. Post-implementation surveys were distributed six months after introducing the huddles.

Results

Pre-implementation, only 5 nurses felt well-informed about patient conditions, and 1 nurse believed that communication with other professionals was effective. 16 nurses felt their concerns were not addressed. Post-implementation, 100% of nurses (n=20) reported feeling informed, and all noted improved communication. The number of nurses who felt their concerns were addressed increased to 15. There was also a significant increase in the perception of patient safety, with 19 nurses believing that IPC improved patient care (compared to 9 pre-implementation).

Discussion

Daily IPC huddles significantly improved communication, enhanced nursing confidence, and improved perceptions of patient safety in the head and neck cancer unit. These findings suggest that structured interprofessional collaboration can enhance care in high-acuity, multidisciplinary environments. Further study is needed to assess how this model can be applied to other inpatient units and to measure long-term outcomes such as reduced complications.

Oncology Nursing Forum. 2025 Mar 1;52(2):53–54.

087. Nurse Navigation Reduces Time to First Treatment at a Comprehensive Cancer Center

Catherine Terrell 1, Devon Bloxsom 2

Significance & Background

Our cancer service line identified access and delays in treatment as a significant challenge facing our patients newly diagnosed with cancer in rural central Virginia. For example, in breast oncology, only 36% of patients newly diagnosed with cancer were seen by a specialist within 14 days. Addressing this gap is crucial to ensuring optimal care and enhancing patient outcomes in oncology. Nurse navigation has been identified as effective in reducing barriers to care for vulnerable populations, resulting in quicker access to care and improved time to treatment.

Purpose

The purpose of this project was to implement a nurse navigation model to improve patient access to cancer specialists, as measured by time to treatment.

Interventions

We chose the nurse navigation model based on the four core competencies defined by the Oncology Nursing Society: professional role, education, care coordination, and communication; and the knowledge domains of the Academy of Oncology Nurse & Patient Navigators. In December of 2023, we implemented the nurse navigation model for our service line. We tracked patient outcomes, assessed baseline knowledge of diagnoses, provided disease-specific education, reviewed patient records, triaged new referrals, and coordinated multidisciplinary care. We employed deliberate and focused communication among care teams. Key metrics monitored included referral to scheduled appointment within three days, referral to being seen within 14 days, and time to first treatment.

Results

We reviewed 8 months of data post implementation of the nurse navigation model, from December of 2023 to July of 2024, which included 543 patients with cancer. There was a 45% increase from baseline in patients scheduled within three days of referral, and, a 49% increase in patients seen within 14 days. There was a 45% reduction in time to first treatment for patients with breast cancer, from 85.9 days to 47.74 days.

Discussion

The implementation of a nurse navigation model successfully improved access to care for our patients with cancer needing to see a cancer specialist, specifically by reducing time to first treatment. Nurse navigation addressed the specific needs of our patient population in central Virginia, many of whom face long travel distances from rural areas. Future efforts will focus on implementing the model across all disease groups and expanding the model to our off-ground sites.

Oncology Nursing Forum. 2025 Mar 1;52(2):54.

088. Advancing Safety in Central Venous Access Device Blood Waste Management

Linh Truong 1, Maria Theresa Dizon Fabros 2, Tonya Folkes 3, Renee Riddle 4, Merieanna Chu 5, Merry Williams 6

Significance & Background

Before the study, blood waste was discarded using syringes at our comprehensive cancer center. We aimed to update our blood draw practice due to three factors: the high cost of CVAD draw-related repetitive motion injuries (over $630,000) between 2020 and 2022, observed blood-borne and cytotoxic exposures from splashing events linked to incorrect/uncapped handling of the syringe, and lack of an enclosed system. Evidence-based practice revealed that blood waste can be discarded using either a syringe or discard tube, presenting an opportunity to update our method.

Purpose

Implementation of using either syringe or discard tube with a vacutainer was evaluated to assess impact on repetitive motion injuries and blood-borne and cytotoxic exposures.

Interventions

Following a successful one-month pilot, the use of a vacutainer with a discard tube was implemented across all inpatient, outpatient, and clinical sites, with policy updates. Repetitive motion injury, blood-borne and cytotoxic exposure reports were closely monitored for 90 days. Following the 90 days, a Likert survey was sent to registered nurses and licensed vocational nurses performing CVAD blood draws to assess frequency of discard tube use, perceptions of blood-borne exposure and repetitive motion injury risk, workflow efficiency, and safety impact.

Results

Zero blood-borne or cytotoxic exposures were reported. One repetitive motion injury was reported, however, the discard tube use was unclear, providing opportunity for further investigation. After 90 days of implementation, our survey received 235 responses, with 99% being registered nurses, 47% had over 10 years of nursing experience. 65% agreed that the discard tube reduces blood-borne pathogen exposure risk, 47% perceived a reduction in repetitive motion injury risk, and 62% agreed it enhances safety during blood draws. These findings highlight the positive impact of implementing the discard tube in clinical practice.

Discussion

The discard method has improved perceptions of reduced risk of repetitive motion injuries and blood-borne pathogen exposure. Full implementation of the discard method aligns with our organization with evidence-based practices and fosters a culture of safety. Ongoing efforts include monitoring reported injuries, exposures, and cost savings.

Oncology Nursing Forum. 2025 Mar 1;52(2):54–55.

089. Exploration of a Virtual Nursing Model to Support Care Coordination and Patient Education Across Inpatient Oncology Units

Jillian Tuzio 1, Jessica Carro 2, Kristen Maloney 3, Andrew Keser 4, Lauren Plunkett 5, Kristen Hill 6

Significance & Background

Nursing practice in the acute care setting is becoming increasingly complex, with demands for direct care, patient education, and documentation compliance. There is an opportunity to explore the utilization of virtual care to positively impact patient satisfaction, clinical practice, nursing workflow, and care quality.

Purpose

Utilize virtual nursing (VN) platform to evaluate the efficiency of admissions, discharge planning, caregiver engagement, and patient education.

Interventions

The project occurred in the oncology division with 19 fixed in-room cameras, which is 13% of the oncology footprint at a large academic medical center. We designed a “Virtual Nursing (VN) for Care Coordination” intervention whereby experienced Oncology nurses extended virtual support to complete admission intake, discharge planning, and educate patients and families throughout their hospitalization. The team utilized a specialized build in our Electronic Health Record (EHR) to create a nurse-driven VN order and process for virtual scheduling. The VN captured the care provided in a standardized note in the EHR. Over five months, the VN was scheduled four days a week with varying hours.

Results

During the intervention phase, 156 patient encounters occurred. The average encounter lasted 10.5 minutes, and an average of 2.95 patient education topics were addressed. The top education topics were Fall precautions, cancer fatigue, pain management, and neutropenia. The completeness and accuracy of admission documentation improved by over 21%. We completed surveys with the staff and patients involved to evaluate the intervention. The VN nurses reported being satisfied with the role and technology. Bedside nurses (BRNs) enjoyed the tailored education provided to the patients and the efficiency of the admission and discharge. The implementation allowed BRNs to complete other tasks needed for direct patient care. Feedback from 43 patients was reviewed, and the main themes identified were satisfaction with the VNs’ ability to listen to concerns, answer questions, and reported overall satisfaction with the encounter. Patients enjoyed the flexibility of the VN’s schedule, the involvement of family and caregivers, and the VN’s undivided attention.

Discussion

In summary, the VN for Care Coordination positively impacted admission documentation compliance, individualized patient education, and the efficiency of admission and discharge. The intervention also positively impacted patient and staff satisfaction. There is likely an opportunity to expand the program in our service line and health system.

Oncology Nursing Forum. 2025 Mar 1;52(2):55.

090. Infusion Immediate Care: An Innovative Solution to Increase Same Day Infusion Availability and Decrease Emergency Department Utilization

Christina Villa 1, Brenda Crump 2, Melissa Barnes 3

Significance & Background

Oncology patients require same-day infusion services such as blood products, electrolytes, fluids, and steroids, but due to their immunocompromised status, avoiding the emergency department (ED) is crucial. Nurses aim to provide efficient and convenient care to advocate for patient needs, yet capacity constraints at infusion centers make this difficult. This cancer center’s high demand for chemotherapy scheduling means accommodating an additional patients daily is nearly impossible, often forcing patients to seek care at regional infusion centers or the ED for urgent treatment.

Purpose

The creation of the Infusion Immediate Care (IIC) department established dedicated space and staff to support all non-chemotherapy same day add on patients (those without an appointment that have infusion needs), as well as a small number of scheduled overflow patients from the chemotherapy infusion space. Doing so simultaneously decompressed our infusion space to allow for more chemotherapy patients to be treated, accommodated nearly all same day add on patients, and decreased ED utilization.

InterventionS

Experienced nurses and a clinical supervisor were hired and trained in infusion practices. The supervisor participated in huddles across the cancer center to educate staff and address questions about the new department. Clinic nurses were directed to call a dedicated charge nurse number to quickly secure same-day appointments. Infusion care coordinators were empowered to schedule overflow patients, increasing chair availability for chemotherapy in the primary infusion space.

Results

In the 11 months since opening, the department has treated 3,200 patients, administered 1,800 blood products, saved 4,700 hours of chair time, and only 1.4% of patients required emergency department visits or direct hospital admissions. This success has boosted staff satisfaction, as clinic nurses can easily secure same-day appointments for patients, and the new unit’s nurses feel fulfilled by their positive impact. Despite many newly hired nurses lacking prior oncology experience, the absence of chemotherapy administration has allowed them to learn oncology fundamentals without the added complexity of chemotherapy regimens.

Discussion

The opening of the IIC has resulted in nursing satisfaction and increased access to care for patients. The model utilized in this example could be replicated and tailored to the needs of other infusion centers. Innovative approaches and creative solutions are needed in a world where cancer patient populations and their needs are evolving every day.

Oncology Nursing Forum. 2025 Mar 1;52(2):55–56.

091. Hypersensitivity Reaction: Implementing a High-Fidelity Simulation for Infusion Nurses

Phuong Vo 1

Significance & Background

As more oncology therapies with a high risk for hypersensitivity reaction (HSR) are administered in the outpatient setting, infusion nurses should recognize HSR and intervene promptly to address a patient’s critical condition. An NCI-designated cancer center in the urban northeast region of the United States has an HSR management algorithm and mandatory annual online module for nursing staff. However, infusion nurses continued to request additional skills training for HSR management. In an emergency like HSR, nurses may experience a negative emotional effect and decreased clinical judgment that interferes with guidelines compliance. High-fidelity simulation can provide nurses, especially newly hired staff, with an interactive learning experience to gain knowledge and confidence with assisting patients through an HSR.

Purpose

This project aimed to develop an evidence-based high-fidelity simulation about HSR management per current institutional algorithms to increase confidence for newly hired infusion nurses at the cancer center.

Interventions

The Plan-Do-Study-Act model was used to test an educational high-fidelity simulation about HSR management. Infusion nurses hired within the past 6 months to the cancer center main campus were invited to join a simulation depicting a patient undergoing an HSR during a chemotherapy infusion. The simulation was offered twice and 6 infusion nurses participated. Prior to the simulation, nurses were provided with the institutional HSR management algorithm for review and introduced to the high-fidelity manikin. After the scenario, nurses completed a 30-minute debriefing discussion led by the simulation facilitator.

Results

Nurses filled out anonymous pre- and post-activity surveys using Likert-scale and open-ended questions. After the simulation, 50% of participating nurses showed an increase in the rate of confidence in detecting signs and symptoms of an HSR, as well as applying institutional guidelines in HSR management. 67% of all participants showed an increase in confidence level in prioritizing interventions for HSR management in response to the patient’s changing condition. All nurses enjoyed the simulation and agreed it was a valuable use of their time.

Discussion

High-fidelity simulation was an effective educational activity for nurses to practice psychomotor skills related to HSR identification and treatment. The post-scenario debriefing offered nurses a safe space to enhance critical thinking and clinical reasoning. High-fidelity simulation should be incorporated into oncology nursing education to increase nurses’ knowledge and confidence with HSR management, which will optimize patient outcomes in this emergent clinical event.

Oncology Nursing Forum. 2025 Mar 1;52(2):56.

092. Creation of a Nurse Drive Electrolyte Replacement Protocol in Ambulatory Setting

Nicole Whalen 1, Kendra Hahn 2, Sheila Lukito 3, Chermaine Wulff 4

Significance & Background

Electrolyte replacement in the Infusion Center at Valley Medical Center required nurses to contact an ordering provider when lab values were outside parameters. This caused significant delays in patient care.

Purpose

The goals for the process were to address the following dissatisfiers: systemic inefficiencies, communication inefficiencies, increased workload for nurses, patient and staff dissatisfaction. We sought to empower our advanced practice providers and registered nurses to practice at the top of their license.

Interventions

The creation of a nurse-driven electrolyte replacement protocol that was integrated into our electronic health record system (Epic) and integrated in all Oncology treatment plans. This protocol is standardized for all Oncology patients to reduce medical errors and likelihood of oncologic emergencies. The protocol allowed for rapid intervention of nursing staff and improved patient safety while reducing delays in care.

Results and Discussion

The result was a protocol developed in collaboration with our multidisciplinary team including providers, pharmacists, and nursing. The protocol is included in oncology treatment plans allowing nurses to replace depleted electrolytes based on specified parameters. The practice allows nurses to treat patients efficiently without disrupting providers who are also involved in patient care. Improving the electrolyte replacement process in the Infusion Center enhanced efficiency, patient and staff experience and safety. Implementing this protocol resulted in reduced patient wait time and chair times, improved lines of communication between IC RNs and Oncology providers, and patient and staff satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):57.

093. Treatment Plan Parameters: Building a Confident Team

Jennifer Wolfe 1, Amber Vitale 2

Significance & Background

In a large health system within New York City, a community hospital was acquired that had certain oncology practices and workflows that were not in line with the rest of the health system. One of great significance was the lack of regimen/drug specific treatment parameters for chemotherapy. Chemotherapy is a complex treatment modality for patients with cancer and required individualized, precise dosing, and timing. These attributes are based on tumor type, patient’s overall health, and the goal of the prescribed treatment. Standardizing treatment plans is known to reduce errors, risks, and inconsistencies in patient care. More specifically, operationalizing treatment parameters standardizes practice, improves patient outcomes, and ensures that every patient is receiving evidence-based treatment.

Purpose

The objective of this project was to standardize and operationalize chemotherapy treatment plan parameters, enhance consistency in care delivery, and ensure adherence to established clinical guidelines and protocols.

Interventions

Utilizing existing parameters from the health system that follow ONS and NCCN guidelines, we provided a framework for managing chemotherapy administration. We leveraged technology, standard protocols, and team collaboration to ensure standardized and consistent administration and documentation. Initiating the parameters allowed for centralized review process for orders to be cross-checked by the multi-disciplinary team. We also conducted comprehensive training of the staff concerning understanding the treatment parameters, as well as order verification, dose adjustments, and monitoring of patient responses.

Results

We are still working through all of the chemotherapy plans, but have already seen improved consistency and decreased back and forth communication with providers. Another big win is the increased confidence in the nursing staff in managing chemotherapy regimens and understanding chemotherapy specific implications.

Discussion

Operationalizing chemotherapy treatment plans will prove effective in enhancing patient safety and care that is consistent across the health system. The integration faced initial challenges such as physician buy-in as well as staff perception that treatment parameters will increase the workload per patient. These challenges were overcome with education and providing industry best practices.

Oncology Nursing Forum. 2025 Mar 1;52(2):57–58.

094. The Power of Narrating the Essential Elements of Bedside Shift Report on an Inpatient Oncology Unit

Jennifer Wolfe 1, Rita Jakubowski 2, Lastacia Miles 3, Juliana Roddy 4, Jakia Edey 5, Anna Schloms 6

Significance & Background

Effective communication during shift changes is crucial in ensuring continuity of care and reducing errors, especially in oncology units where patients often require complex treatments and close monitoring. Inconsistencies in nurse communication during handoff results in incomplete critical information, inconsistent patient experiences, and missed opportunities. Effective bedside shift report (BSR) is a best practice that improves communication, increases patient engagement and overall safety. In high-acuity settings, a standardized approach to BSR while narrating the essential elements of handoff ensures that critical information is consistently conveyed. Operationalizing narration in BSR fosters teaming and nurse confidence, minimizes errors, and optimizes patient outcomes.

Purpose

The aim of this initiative was to operationalize narration during BSR on inpatient oncology units to standardize content, enhance communication between nurses, and engage patients and families in the plan of care.

Interventions

Essential elements of BSR are narrated, including but not limited to: central lines, current medications, and goals of care. Nursing leadership played a critical role in education, real-time coaching, and ongoing auditing of handoff. Nurses were trained on the narration as well as provided tips on how to individualize patient needs. Nurses were also encouraged to engage patients and families during BSR, inviting questions and feedback. An auditing tool was used to measure success and make revisions this initiative was implemented.

Results

The implementation of narrating handoff during BSR has led to structured, essential communication during shift change and improvement in patient engagement. We are still collecting implementation data concerning staff satisfaction, but there is already a noticeable reduction in communication-related errors and audits show that 100% of nurses are utilizing BSR and the SBAR tool. We are also on track to have approximately 2 less CLABSIs than in 2023. We continue to audit and evaluate the process in order to sustain effectiveness.

Discussion

Bedside shift report has proven to improve the gold standard for exchange of information between nursing staff and contributes to safe and efficient care. Narrating handoff boosts nurse and patient/family confidence and improves quality and coordination of care outcomes. Despite initial concerns about narrating being rigid and time consuming, nurses agreed that the narration provides structure and allows for individualized interactions. Ongoing education and refinements to the narration has helped address concerns and ensure that the approach remains effective and adaptable to needs.

Oncology Nursing Forum. 2025 Mar 1;52(2):58.

095. Reducing Alarms & Residual Volume: Our Campaign for Customized Tubing

Jennifer Wolfe 1, Frances Cartwright 2

Significance & Background

In chemotherapy administration, two common issues are pump alarms and residual chemotherapy volume. Frequent pump alarms disrupt treatment, cause delays, increase workload, and increase patient anxiety. Additionally, residual chemotherapy in standard tubing can lead to under dosing, impacting treatment efficacy and drug waste. In 2023, many of our system sites went live with a new infusion pump and tubing and we heard many complaints about pump alarms and the frustration of both staff and patients. These complaints resulted in observational audits that confirmed the excessive alarming, as well as identified an undesirable residual volume (>2mL) in the tubing. Addressing both issues through improvements in the tubing design will enhance both workflow efficiency and patient outcomes.

Purpose

The primary purpose of this project was to minimize pump alarms and residual volume by customizing tubing in order to improve chemotherapy administration, minimize interruptions, and decrease drug loss and waste.

Interventions

We requested a meeting with the vendor and presented our concerns regarding excessive alarms and residual volume. Over a few months, our discussions prompted a revision to the existing tubing globally to reduce pressure sensitivity by increasing tubing diameter. The global tubing has already replaced the old product and we have reports sent weekly that are reviewed with the vendor. We also designed customized reduced pressure sensitivity tubing that will decrease the residual volume to <1mL. The global tubing has already replaced the old product and we have automated alarm reports sent weekly that are reviewed with the vendor.

Results

The use of the global tubing has already shown a greater than 50% reduction in alarms across our sites. The reduction in alarms has caused fewer interruptions and increased staff and patient satisfaction. The customized tubing is currently in production and will be available to pilot in October 2024, and will be system-wide mid-November 2024. At that time, we will continue to monitor alarms, as well as the amount of residual volume post-administration. Secondary measures will include infusion delays, nursing interventions required, and patient satisfaction.

Discussion

Reducing residual volume ensures patients receive the full prescribed dose, while fewer pump alarms decrease interruptions and alleviate the workload of nursing staff. These benefits will optimize chemotherapy administration. We look forward to exploring long-term clinical outcomes and cost-effectiveness associated with this project.

Oncology Nursing Forum. 2025 Mar 1;52(2):58–59.

096. 48-Hour Touchpoint: Enhancing Oncology Transitional Care Through a Timely Nurse-Led Follow-up Process

Brenda Wysocki 1, Christina Passio 2

Significance & Background

Transitional care is a crucial component for oncology specialty hospitals, where patients often face complex medical regimens, multiple comorbidities, coupled with a substantial risk of post-discharge complications. Transitional care nurse navigation (TCNN) is an integral service line managing patients’ transitions from hospital to the next level of care, provides post-discharge support, and addresses gaps in care specific to oncology patients. Timely post-discharge follow-up, particularly within 48 hours of discharge, significantly reduces readmission rates, improves patient satisfaction, and enhances overall health outcomes. Ensuring consistent follow-up calls are conducted and subsequently documented is essential for continuity of care and managing the intricate needs of oncology patientS.

Purpose

This initiative, person-centered process was established to create a systematic approach that ensured that post-discharge follow-up calls were conducted with patients.

Interventions

A structured workflow was implemented whereby TCNN nurses are responsible for conducting calls to discharged patients within a 48-hour window. A thorough, telephonic assessment is completed and includes a review of systems, pain levels, nutritional status, ambulation capabilities, management of surgical and medical interventions, home-health presence, medication management, and follow-up appointments, all tailored to oncology care. A new template in the electronic medical record (EMR) facilitates the detailed documentation of these discussions ensuring all relevant information is obtained. A report was created to capture patient information pertaining to discharge disposition, the follow-up call status, and interventions or concerns addressed during the calls.

Results

The effectiveness of this intervention was evaluated by monitoring the completion rate of post-discharge calls. A standardized EMR template was used to track the timeliness and completeness of documentation, identify missed calls, and understand the reasons for these gaps. A comparative analysis pre-and post-implementation was conducted to measure the percentage of discharged patients that received phone calls. The fiscal year 2023 data yielded a 55% post-discharge phone call compliance and post-implementation fiscal year 2024 data demonstrated an increase to 89.91% of the patients that received a post-discharge call.

Discussion

The development of a standardized process for post-discharge follow-up calls within 48 hours, combined with creation of a detailed Epic report and template for documenting call content, demonstrated a significant improvement in care transitions and patient outcomes in an oncology specialty hospital. Future analysis may target examining the relationship between the rate of completed follow-up calls, readmission rates, as well as patient satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):59–60.

01. Symbols of Hope in Hispanic Adolescent and Young Adult Cancer Survivors

Robert Bennett 1, Heather Coats 2, Cindy Tofthagen 3, Verna Ferguson 4

Purpose

Describe symbols of hope as depicted in a sample of Hispanic Adolescent and Young Adult (AYA) cancer survivors.

Significance

AYAs living with cancer often experience existential distress which may persist during cancer survivorship. Historically marginalized populations shoulder disproportionate psychosocial burdens from cancer. This study aimed to evaluate the role of hope in a sample of Hispanic AYAs during cancer survivorship.

Methods

We performed a sequential mixed-methods study among Hispanic AYAs aged 18–39 years who had completed cancer treatment two-to-five years ago. AYA cancer community non-profit organizations advertised the study on closed social-media platforms. Participants completed virtual semi-structured interviews which were theoretically underpinned using the Relational Caring Inquiry as a data collection and analysis framework. Participants described their experiences with hope verbally and visually during cancer treatments and cancer survivorship by drawing pictures using the Paint 3D application. Participants narrated the meanings and temporal events in their drawings. Participants wrote narratives with assistance from the principal investigator about their experiences with hope during cancer treatments and cancer survivorship. Thematic analyses were iteratively performed across the data set to identify final themes. A board-certified art therapist experienced with AYAs who have cancer independently performed a post-hoc thematic analysis of participants’ drawings and verbatim descriptions of their meanings.

Findings and Interpretations

Ten Hispanic AYA cancer survivors aged 22–36 years old participated in this pilot study. Seven participants (70%) were female, and three participants (30%) were male. Six participants (60%) experienced non-hematologic malignancies, and four participants (40%) experienced hematologic malignancies. Eight participants (80%) preferred to participate using Spanish, while two (20%) preferred to participate using English. Themes derived from the written narratives included Spirituality, In This Together, and Dark Moments. Themes derived from analyses of participants’ drawings included Reliable Companionship, Religious Beliefs, and Safe Place and Containment. Multiple participants included images of the sun and/or hearts in their drawings as visual symbols of hope.

Discussion

Themes derived from the written narratives and drawings were closely aligned. The value of spirituality and social support to support hope in Hispanic AYA cancer survivors appears to be mirrored with art and transcend language and written words. Further research is needed to explore the potential protective value of social support and spirituality in the Hispanic AYA population.

Oncology Nursing Forum. 2025 Mar 1;52(2):60.

02. Associations of Neighborhood Deprivation with Symptom Burden in Women with Gynecologic Cancers

Deborah Bruner 1, Zahra A Barandouzi 2, Joseph Shelton 3, Namita Khanna 4, Jill Remick 5, Tony Eng 6

Purpose

This study examined the association of neighborhood socioeconomic deprivation (Area Deprivation Index [ADI]) with symptoms in women with gynecologic cancers.

Significance & Background

Women diagnosed with gynecologic cancers bear a significant symptom burden (fatigue, pain, depressive symptoms, cognitive impairment, and sleep disturbance) that reduces their functional status and quality of life. Emerging evidence suggests that neighborhood deprivation, including an area’s average income, educational attainment, and household characteristics, contributes to high symptom burden by increasing cumulative stressors. However, this relationship in women with gynecologic cancer remains largely unknown.

Methods

In this secondary data analysis, data from 127 women who were diagnosed with cervical or endometrial cancer were evaluated pretreatment. The ADI was calculated via the American Community Survey using patient zip codes, higher scores indicate greater disadvantage. Symptom burden was assessed using functional assessment of cancer therapy-general (FACT-G) items to measure fatigue, pain, sleep disturbances, and cognitive impairment, and the Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Average Z score of at least three/five symptoms was computed as the psychoneurological symptom (PNS) total score. A linear regression model was used to evaluate the associations between ADI and symptom burden.

Findings and Interpretations

Mean age of subjects was 58 years, with a BMI of 31.5. 47% were Black, and 52% had endometrial cancer. 68% of participants had an education of college level or above, and 14% lived in the most deprived neighborhoods (ADI≥ 75). Patients from the ADI ≥ 75 (vs. the other ADI<75) were more likely to be diagnosed with cervical cancer, at a younger age, had higher BMI, and were Black. Also, these patients were more likely to experience more severe symptoms, including fatigue, pain, depressive symptoms, sleep disturbance, and PNS. The regression model indicated that patients from the most deprived neighborhoods had worse pain (P=0.011), worse sleep disturbance (P=0.013), and worse PNS (P=0.035) than those who resided in less deprived neighborhoods.

Discussion

Gynecologic cancer patients who lived in the most deprived neighborhoods present with more symptoms even before treatment. Although larger studies are needed to confirm, results highlight the need for targeted interventions to manage symptoms in patients who reside in deprived neighborhoods.

Oncology Nursing Forum. 2025 Mar 1;52(2):60–61.

03. Data-Driven Epigenomic Analyses Reveal Different Signaling Pathways for Subjective and Objective Cognitive Function in Early-Stage Breast Cancer

Yvette Conley 1, Shuwei Liu 2, Daniel Weeks 3, John Shaffer 4, Kirk Erickson 5, Catherine Bender 6

Purpose

To identify biological underpinnings for variation in cognitive function (CF) in women with early-stage breast cancer.

Significance

Evidence is building indicating that cancer impacts CF even before adjuvant therapy is administered. A data-driven exploratory approach has the advantage of not needing to select a priori what measures and factors to investigate in relation to CF and cancer. This is important given how poorly we understand the biological pathways driving the impact of cancer on CF, hindering development of interventions.

Methods

Postmenopausal women with early-stage, hormone receptor-positive breast cancer (n=109) were phenotyped for objective CF (7 domains, each assessed with two or more neuropsychological measures) and subjective CF (using the Patient’s Assessment of Own Functioning Inventory, PAOFI). Differentially methylated regions of the genome were identified from whole blood samples using an epigenome-wide association study (EWAS) approach for each CF phenotype and pathways identified using Ingenuity Pathway Analysis. The CF phenotype data and blood sample was collected at time of enrollment, prior to adjuvant therapy.

Findings and Interpretations

Differentially methylated regions of the genome were identified, and pathway analyses revealed the axonal guidance signaling pathway was the top significant pathway for the objectively measured domain of processing speed and the synaptogenesis signaling pathway was the top significant pathway for the subjectively measured PAOFI total scores. Axonal guidance and synaptogenesis are both important to normal brain function therefore it makes sense that these pathways would surface in a discovery-based manner as being important to CF. However, finding that different pathways may play different roles in objective CF versus subjective CF hints that patient reported CF may be biologically distinct from objectively measured CF.

Discussion

This study provides evidence that objective CF and patient-reported subjective CF, particularly within the context of early-stage breast cancer, may be biologically distinct. This has implications for patient outcomes given that response to interventions to mitigate decline in CF may vary depending upon how CF is measured.

Oncology Nursing Forum. 2025 Mar 1;52(2):61.

04. Women’s Sexuality After Gynecologic Cancer Treatment: A Phenomenological Inquiry

Jessie Desir 1

Purpose

The purpose of this qualitative hermeneutic phenomenological study was to explore the lived experiences of women’s sexuality after gynecologic cancer treatments. The study aimed to give these women a voice to express their unique experiences with this significant aspect of their lives.

Significance

Cancer remains a leading cause of death worldwide. Gynecologic cancers are the most prevalent among women, contributing notably to global and national mortality rates (Yi et al., 2021). With the expected rise in gynecologic cancer diagnoses, particularly for younger women (CDC, 2021), the effects of treatments on women’s sexuality are increasingly important. Women’s sexuality after gynecologic cancer treatment is a phenomenon significant to nursing practice because it aligns with Maslow’s hierarchy of needs, which forms the basis of human survival. Sex is categorized within the physiological needs tier of Maslow’s hierarchy alongside essential functions such as breathing and eating (McLeod, 2020). An unmet need within the aspect of sexuality may hinder the optimal functioning of the human body. Addressing the impact on women’s sexuality is essential and often overlooked in survivorship care.

Methods

This study was guided by an interpretivist paradigm, emphasizing a profound interpretation of women’s experiences with sexuality post-treatment. The research utilized a qualitative hermeneutic phenomenological approach, incorporating purposive and snowball sampling methods. Data collection involved semi-structured, auto-recorded interviews, which were transcribed and verified for accuracy. This comprehensive process allowed for a thorough and meaningful interpretation of the phenomenon.

Findings and Interpretations

Data analysis revealed five key themes that encapsulated the lived experience of women’s sexuality after gynecologic cancer treatment: (1) hopelessness, (2) pain after treatment, (3) losing former sense of sexuality, (4) lacking conversation about women’s sexuality, and (5) survivorship. These themes emphasize the need for holistic nursing care.

Discussion

Grounded in Max van Manen’s hermeneutic phenomenology, this study unveiled the complexities women face as they navigate unfamiliar experiences with their sexuality after treatment. Participants’ narratives highlighted numerous challenges affecting their physical, psychological, and social well-being. These insights contribute to a deeper understanding of women’s experiences after gynecologic cancer, offering valuable knowledge to inform further research and guide the development of psychosocial support within survivorship care plans. By addressing sexuality as a fundamental need, nurses can adopt a holistic approach that fosters optimal patient outcomes and supports women in their cancer survivorship journey.

Oncology Nursing Forum. 2025 Mar 1;52(2):61–62.

05. Developing Accompani: African American Childhood Cancer Multiprong Psychosocial Nurse Intervention Using Feedback from Thought Partners

Ijeoma Julie Eche 1, Ijeoma Julie Eche 2, Teri Aronowitz 3, Benjamin Herold 4, Amerie Jackson 5, Amerie Jackson 6, Joanne Wolfe 7, Joanne Wolfe 8, Angela Feraco 9, Angela Feraco 10

Purpose

To develop the content and delivery characteristics of African American Childhood Cancer Multiprong Psychosocial Nurse Intervention (ACCOMPANI) using feedback from thought partnerS.

Significance

There is pressing need for culturally tailored psychosocial interventions for African American parents of children with cancer. African American parents face chronic stressors such as disparate exposures to poverty, single-parent households, and discrimination due to structural racism. Available psychosocial interventions for parents of children with cancer were developed and tested predominantly among White parents. African American parents remain inadequately sampled. While nurses are ideally positioned to support parent psychosocial needs, research on nurses’ readiness to deliver nurse-led psychosocial interventions for African American parents of children with cancer is limited.

Methods

Our deductive thematic qualitative investigation was guided by the Structural Racism Framework and ORBIT model for intervention development (Phase Ia). Collectively, 7 purposively sampled thought partners were recruited and completed 5 focus group sessions via HIPAA-complaint Zoom. We offered individual interviews for participants unable to attend focus groups. All interview sessions (60–90 minutes) were audio-recorded, de-identified, and professionally transcribed. The thought partners included clinicians (n=4, pediatric oncology nurses, social worker and disparity scholar); African American community partner (n=1); and African American parents of children with cancer (n=2). These thought partners engaged with and shaped an emerging ACCOMPANI.

Findings and Interpretations

Thought partners endorsed key ACCOMPANI domains, to be delivered over 4 weekly interactive 30-minute videos using efficient and self-guided teaching strategies: 1. Attitudes: Unseat nurses’ implicit and explicit biases by centering on the lived experiences of African American parents of children with cancer through storytelling. 2. Knowledge: Inform about available culturally relevant psychosocial resources through didactic modules. 3. Skills: Promote communication skills acquisition through nurse interaction with realistic animated representationS.

Discussion

ACCOMPANI is a novel nurse-targeted educational intervention focused on enabling nurses to address psychosocial needs for African American families affected by childhood cancer. Future research is warranted to refine ACCOMPANI as well as assess its usability and acceptability.

Oncology Nursing Forum. 2025 Mar 1;52(2):62–63.

06. Nutritional Status and Survival in Pancreatic Cancer: Predictive Value of the Geriatric Nutritional Risk Index at Diagnosis and Influence of Patient Factors

Christina Grinstead 1, Saunjoo Yoon 2

Purpose

To investigate the association between nutritional risk at diagnosis and survival in patients with PC and explore the potential impact of patient factors.

Significance

Pancreatic cancer (PC) remains a leading cause of mortality, compounded by the high prevalence of malnutrition and cachexia. Poor nutritional status impairs treatment efficacy, diminishes quality of life(QoL), and reduces survival. Current strategies to identify malnutrition and implement timely interventions are insufficient. The Geriatric Nutritional Risk Index (GNRI), a nutritional assessment tool, has potential for use in early identification of at-risk patients. However, its relationship with survival outcomes in PC is understudied.

Methods

Design

Retrospective correlational design was applied using de-identified data from the electronic health record from the Institution’s Integrative Data Repository. Inclusion criteria: 1)18 and older at the time of PC as a primary cancer diagnosis and 2)GNRI score within 90 days of diagnosis.

Measurements

Survival days, demographics, smoking exposure, stage, GNRI score. GNRI calculated using the Lorentz formula for ideal weight (WLo): men: H –100-[(H −150)/4] women: H-100-[(H − 150)/2.5] and GNRI = [1.489 × albumin (g/L)] + [41.7 × (weight/WLo)]. Analysis: Patients categorized into two groups: Any risk (GNRI ≤ 98) and No risk (GNRI > 98). Multivariate Cox proportional hazards models assessed the impact of the GNRI risk group with covariates on survival. The final model was selected using the Akaike Criterion, Bayesian Criterion, and likelihood ratio tests. Stratification addressed proportional hazard violations for the stage variable, with Kaplan-Meier analyses illustrating the relationship between survival, stage, and GNRI.

Findings and Interpretations

Of 592 patients (Table 1), the univariate analysis showed GNRI group (p<0.0001, HR: 0.659), age (p=00387, HR: 1.013), and stages II (p=0.00231 HR: 1.8337) and III/IV (p<0.0001, HR: 3.2564) to be significant. The multivariate showed only GNRI group (p=0.00521 HR: 0.7442) and age to be significant (p=0.00303, HR: 1.0139) (Table. 2 and Fig. 1). Kaplan-Meier curves with GNRI group by stage showed significance for stages I (p=0.0056) and IV (p=0.017) (Figure 2). Findings confirm that nutritional risk critically impacts survival in PC, even after accounting for additional patient factors.

Discussion

Significant differences in survival between GNRI groups were observed in PC stages I and IV, with higher nutritional risk showing worse survival. Timely interventions in those with any GNRI risk may improve survival and QoL. Further research is warranted to develop age-stage-specific nutritional interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):63.

07. Psychometric Evaluation of Instruments Adapted to Measure Health Beliefs Related to Breast Cancer Chemoprevention

Kristin Keller 1, Adetunji Toriola 2, Joanne Schneider 3

Purpose

Champion and colleagues designed and evaluated instruments to operationalize health beliefs regarding mammography. We adapted these instruments to operationalize health beliefs for taking breast cancer chemoprevention. The purpose of this study was to examine the psychometric properties of Champion’s adapted instruments. Specifically, we aimed to examine (1) underlying dimensions, (2) internal consistency, and (3) construct validity of each adapted scale.

Significance

Researchers estimate that 15% of U.S. women have elevated risk for developing breast cancer. Yet only 5% to 16.3% of eligible women elect to use breast cancer chemoprevention. Health beliefs including fear, perceived susceptibility, perceived benefit, barriers, and self-efficacy are related to engagement in health promoting behaviors. Currently, validated instruments that measure health beliefs regarding breast cancer chemoprevention do not exist. Understanding the specific health beliefs that interfere with taking breast cancer chemoprevention are key for designing interventions to expand its utilization among women who stand to benefit from it. To this end, scales that operationalize salient health beliefs are needed to advance this area of research.

Methods

We recruited 400 post-menopausal women, 50–64 years old, for a study on mammographic breast density. Women completed the 8-item Champion Breast Cancer Fear Scale (CBCFS), a 12-item adaptation of the self-efficacy scale, and a 21-item adaptation of the susceptibility, benefits, and barriers scales. We conducted item analyses, exploratory factor analysis, evaluated different factor structures, estimated internal consistency, and examined construct validity.

Findings and Interpretations

All items in the CBCFS loaded onto one factor (a=.93). The susceptibility, benefits, and barriers scales had an underlying factor structure of 4 dimensions with the 4-items related to susceptibility loading onto one factor (a= .94), 4-items related to benefits loading onto one factor a=.90, and the 13-items related to barriers loading onto two factors (a=.85; a=.87). The 12-item self-efficacy scale demonstrated a two-factor solution (a=.75, a =.86). The factor solutions were parsimonious yet theoretically sound and the subscale analysis provided evidence of reasonable internal consistency and construct validity.

Discussion

Using responses from post-menopausal women at the time of screening mammography, we provided preliminary evidence that Champion’s adapted instruments can reliably be used to measure salient health beliefs about breast cancer chemoprevention. Future researchers might consider continued research aimed at refining these adapted instruments to understand factors that both prevent and promote the uptake of breast cancer chemoprevention among at risk-women.

Oncology Nursing Forum. 2025 Mar 1;52(2):63–64.

08. Factors Influencing Rural Cancer Survivors’ Use of Symptom Self-Management Strategies

Kristine Kwekkeboom 1, Yoonsoo Eo 2, Rachel Hawn 3, Katrina Phelps 4, Jennifer Stevens 5

Purpose

To identify rural cancer survivors’ perceptions of factors that influence use of symptom self-management strategies.

Significance

Individuals with cancer often face a heavy symptom burden and self-management is an important component of supportive care plans. Like other health behaviors, rural cancer survivors’ engagement in symptom self-management may be influenced by social factors and access to healthcare that are associated with rurality. Little is known about rural cancer survivors’ use of symptom self-management strategies and factors perceived to influence their use. Such information may help explain health disparities and provide targets for intervention to improve symptom management.

Methods

We selected a purposive sample of N=10 rural cancer survivors from a pool of respondents to a symptom management survey. They participated in a series of eight focus group meetings held virtually over 6-months. We provided participants with symptom self-management educational materials and discussed their knowledge and opinions about the strategies, likelihood of use by people in their community, and rural-specific issues that impact their use. Focus group transcripts were analyzed using content analysis.

Findings and Interpretations

Participants included 6 females and 4 males, aged 39 to 72 years old. Seven had completed treatment and all lived in “disadvantaged” rural areas based on health care capacity, insured rate, education, and economic status. Six categories of influencing factors were identified. 1) Credibility was described as important and based on personal experiences and testimonials from other patients, friends, and neighbors. 2) Symptom experiences included symptom type and severity. 3) Perceived outcomes included symptom and non-symptom benefits, and safety. 4) Accessibility of the strategy included perceived ease of implementation and availability of resources. 5) Consistency with personal preferences included attitudes such as desire for personal control and willingness to accept help. 6) Motivational supports included social support and measures to enhance accountability in using self-management strategies. Rural-specific responses were concentrated in the category of accessibility (e.g., internet / broadband access, geographic distance to join a group or class, public transportation).

Discussion

General and rural-specific factors influence rural cancer survivors’ willingness to use symptom self-management strategies. To reduce suffering and improve quality of life, interventions that enhance accessibility should be prioritized for rural patients. Interventions components should also highlight credible messaging, target specific symptom types and severity, set accurate outcome expectations, tailor recommendations based on personal preferences, and include motivational support.

Oncology Nursing Forum. 2025 Mar 1;52(2):64.

09. Factors Influencing HPV Vaccination Rates Among U.S. Males: An Analysis of Healthcare Access and Demographic Variables Using NHANES Data

Grace Kyei 1, Evans Kyei 2, Rockson Ansong 3

Purpose

This study aims to identify the key determinants of HPV vaccine uptake among males, with a specific focus on routine healthcare access and frequency of healthcare visits, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

Significance

Understanding factors influencing HPV vaccination rates in males is critical for public health strategies aiming to increase vaccine uptake, particularly in underserved populations. This research addresses gaps in vaccine coverage among diverse demographic groups and informs targeted interventions.

Methods

Data from 3,585 males aged 18–64 years were drawn from NHANES cycles 2015–2016 and 2017–2020. The primary outcome measured was HPV vaccine uptake. Predictor variables included routine healthcare access and the number of healthcare visits, with control variables such as age, race/ethnicity, education level, and marital status. Chi-square analyses and multivariate logistic regression were employed to assess associations.

Findings and Interpretations

Bivariate analysis showed significant associations between HPV vaccination and variables such as age, race/ethnicity, education level, and marital status. Multivariate logistic regression revealed that routine healthcare access did not significantly impact HPV vaccination uptake (OR = 0.69). Older age groups had lower odds of vaccination, with individuals aged 25–34, 35–49, and 50–64 years having significantly reduced odds compared to those aged 18–24. Non-Hispanic Black (OR = 0.65, p < 0.05) and Non-Hispanic Asian (OR = 0.56, p < 0.05) males were less likely to be vaccinated. Higher education was positively correlated with increased vaccination rates. The number of healthcare visits did not significantly influence vaccine uptake, but significant interactions between race and age group were observed.

Discussion

The findings highlight demographic disparities, with age, race, and education emerging as key determinants of HPV vaccine uptake. Routine healthcare access and healthcare visit frequency alone did not predict vaccination rates, suggesting that addressing social determinants of health and targeting underserved groups may be more effective in improving male HPV vaccination rates. Public health interventions should focus on these demographic differences to reduce vaccine inequities.

Oncology Nursing Forum. 2025 Mar 1;52(2):64–65.

010. Navigating Distress and Recovery: A Qualitative Exploration of Pain, Nausea, and Coping Strategies in Women Undergoing Breast-Conserving Surgery

Jennifer Majumdar 1, Jaime Gilliland 2, Margaret Barton-Burke 3

Purpose

This qualitative study aimed to explore the relationships among antecedents, physical symptoms (pain and nausea), psychological symptoms (distress), and coping strategies in women undergoing breast-conserving surgery (BCS) for early-stage breast cancer. The study specifically focused on the qualitative exploration of patients’ open-ended responses to better understand their experiences of distress and coping during the post-operative period.

Significance

One in eight American women will experience breast cancer in their lifetime, with the majority being diagnosed at an early stage when surgery remains the primary treatment. Breast-conserving therapy, which includes BCS followed by radiation therapy, is a common treatment. Alongside managing physical symptoms like pain and PONV, women often experience heightened psychological distress related to their diagnosis and waiting for pathology results. While guidelines recommend assessing and treating distress throughout the cancer care continuum, distress management in outpatient settings remains complex. Research gaps, particularly regarding distress and symptoms in women recovering from BCS, highlight the need for more evidence to guide oncology nursing practice.

Methods

This study employed a qualitative approach using open-ended free-response data from 75 women with early-stage breast cancer who underwent BCS between August 15 and October 15, 2020. Data were collected via email and analyzed using a matrix analysis approach by a qualitative methods specialist and the primary investigator. Responses were coded for primary themes and subthemes, following established methods for analyzing thematic content in qualitative data.

Findings and Interpretations

Twenty-nine participants provided detailed responses. Common themes emerged, including family concerns, fears about cancer recurrence, pain and soreness, and the psychological impact of COVID-19. Coping strategies included support from care teams, adaptations for pain management (e.g., pillows, ice packs), and wellness practices like meditation and exercise. Over time, patients reported improvements in sleep, pain, and anxiety.

Discussion

This study underscores the complex interplay of distress, pain, and coping strategies in women recovering from BCS. Emotional support from care teams played a crucial role in alleviating distress. The findings emphasize the importance of psychosocial assessments and tailored interventions to support recovery. Addressing both physical and psychological needs in the outpatient setting is critical to improving patient outcomes. Future research should explore long-term effects of coping strategies and the role of psychosocial care in home recovery settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):65–66.

011. Investigation of a Mobile Digital Application (MindCap) to Objectively Assess Cognitive Function for Cancer Survivors

Jamie Myers 1, Sridhar Ramakrishnan 2, Lisa Scott Holt 3, Arash Asher 4

Purpose

The pilot study purpose was to demonstrate feasibility for the use of a mobile digital application (MindCap-app) designed to objectively assess cognitive function for cancer survivors.

Significance

Cancer and cancer treatment-related cognitive impairment (CRCI) incidence estimates range up to 75% during treatment and persists for years in about 30% of cancer survivors. Accessible, feasible, sensitive objective measures to longitudinally assess cognitive function and evaluate the cognitive intervention effectiveness in this population are critically needed. MindCap was developed to provide neurocognitive testing sensitive to CRCI-affected cognitive domains (psychomotor, attention, working memory, verbal abilities, visual-spatial search, and executive function). Preliminary research indicated potential sensitivity to cognitive decline during chemotherapy for breast cancer. This research was conducted to assess sensitivity to cognitive improvement in conjunction CRCI interventions.

Methods

Adult participants (n=57) with stage I-III solid tumors, Hodgkin or Non-Hodgkin lymphoma, (≥6-months-to-≤5-years post-chemotherapy), were recruited from a 3-arm, randomized, wait-list controlled parent study (N=90) investigating two telehealth-delivered formats of a cognitive rehabilitation intervention (Emerging from the Haze). Weekly responses to Patient Reported Outcomes Management Information System (PROMIS) cognitive function abilities-8a and participant satisfaction ratings were collected. MindCap has three phases, practice (two trials with <2 errors), individualized baseline-determination (3 times/day), and testing (3 times/week). Feasibility measures included: time to complete each phase and participant feedback/satisfaction. MindCap detection algorithms comprise 12 neurocognitive performance metrics from two tests (NovaScan and Trail Making). Correlations between MindCap metrics and PROMIS scores were assessed along with sensitivity to change over time. Findings and

Interpretations

Median time for practice-phase completion was 5.82 minutes (n=50). Median time for baseline-determination was twenty-four MindCap tests over 9.13 days (n=36). Fifty-four percent (n=31) completed sufficient tests (39–162) for longitudinal analyses. Survey respondents (80%) indicated satisfaction with testing frequency. MindCap improvement preceded PROMIS improvement for 60%. MindCap-PROMIS correlations (>0.5) were demonstrated for 33.33%. Duration of detected improvement episodes ranged from 18–222 days for MindCap and 1–99 days for PROMIS. No improvement difference was noted between parent study groups.

Discussion /Conclusions

Feasibility was demonstrated for MindCap practice, individualized baseline determination, and testing phases. Mindcap captured changes in cognitive function over time. Testing frequency was acceptable to most participants. Moderate correlation with PROMIS was demonstrated. Further research is needed to assess MindCap sensitivity using comparisons to validated objective neurocognitive measures and to capture individual CRCI-specific cognitive domain profiles.

Oncology Nursing Forum. 2025 Mar 1;52(2):66.

012. Common and Distinct Perturbed Biological Pathways are Associated with Cognitive Impairment and Anxiety in Patients Receiving Chemotherapy

Kate Oppegaard 1, Joosun Shin 2, Bruce Cooper 3, Steven Paul 4, Yvette Conley 5, Christine Miaskowski 6

Purpose

Cancer-related cognitive impairment (CRCI) is reported by up to 65% of patients with cancer and anxiety is reported by 41%. Most studies evaluated risk factors for and mechanisms that underlie each symptom individually. However, these two symptoms are multifactorial and often co-occur. Therefore, it is reasonable to hypothesize that common AND distinct mechanisms contribute to the severity of CRCI and anxiety in patients receiving chemotherapy.

Significance

Purpose was to evaluate for common and distinct perturbed biological pathways across lower versus higher profiles of CRCI and anxiety as single symptoms and lower versus higher joint profiles of CRCI and anxiety (i.e., co-occurrence of CRCI and anxiety).

Methods

Patients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer. Measures of CRCI and anxiety were completed a total of six times over two cycles of chemotherapy. At the enrollment assessment (i.e., prior to the second or third cycle of chemotherapy), whole blood was collected and gene expression was quantified. Latent profile analysis was used to identify subgroups of patients with distinct CRCI, anxiety, and joint CRCI and anxiety profiles. Using the extreme phenotypes for each of the symptom profiles and available gene expression data, pathway analyses were performed using R Studio and the Kyoto Encyclopedia of Genes and Genomes (KEGG) Database. Significance of the pathway analyses was assessed using a false discovery rate of 0.01. Pathways were grouped according to their KEGG classification and common and distinct pathways were identified across the three symptom profiles.

Findings and Interpretations

A total of 79 KEGG pathways were perturbed for CRCI, 41 for anxiety, and 25 for the co-occurrence of CRCI and anxiety. Pathways related to neurodegeneration were common across all three symptom profiles. Distinct endocrine and cell growth/death pathways were identified for CRCI and anxiety, respectively.

Discussion

This study is the first to identify common and distinct perturbed biological pathways associated with lower versus higher levels of CRCI, anxiety, and the co-occurrence of CRCI and anxiety in patients receiving chemotherapy. These findings provide novel insights into potential targets that can be used for the development of mechanistically-based interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):66–67.

013. Exploring the Landscape of Palliative Care Provision for Black Patients with Hematologic Cancers: A Scoping Review

Osborn Owusu Ansah 1, Sophia Smith 2

Purpose

This narrative scoping review aims to identify and describe the utilization of palliative care (PC) among Black patients with hematologic malignancies (HM) in the United States, highlighting existing inequities and informing future interventions to improve access and outcomes.

Significance

PC, recognized as a human right to health by the World Health Organization (WHO), significantly enhances the quality of life (QOL) and overall survival for cancer patients. Despite its benefits, PC is underutilized among patients with HM, particularly Black individuals, who face higher symptom burdens and lower survival rates compared to White patients. Addressing these inequities is crucial for equitable healthcare.

Methods

This review followed the Joanna Briggs Institute approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Comprehensive searches were conducted in PubMed, Embase, CINAHL, Scopus, and Web of Science, focusing on Black/African American patients, hematologic cancers, and palliative care. Articles were screened and selected based on predefined inclusion criteria, and data were extracted and analyzed to identify relevant themes.

Findings and Interpretations

Out of 443 studies identified, 7 met the inclusion criteria. The included studies were predominantly retrospective and utilized data from large national databases such as the National Cancer Database (NCDB) and the National Inpatient Sample (NIS). Four of studies highlighted that Black patients with HM were less likely to receive or use PC compared to White patients, mirroring findings from studies on solid cancers. Some studies reported that access to PC led to better outcomes for Blacks, such as lower hospital charges and a reduced likelihood of dying within 30 days of initiating palliative radiotherapy.

Discussion

This scoping review reveals limited literature about PC use among Black patients with HM and highlights the need for more diverse study designs, including prospective studies and qualitative research, to provide a deeper understanding of the barriers and facilitators to PC use within this community. Diverse methodologies can offer richer insights and help develop targeted interventions to reduce disparities and enhance palliative care access and quality for this underserved population.

Oncology Nursing Forum. 2025 Mar 1;52(2):67.

014. The Experience of Being Cancer Ghosted: A Netnographic Study

Jennifer Stephens 1, Carlos Garcia 2, Jenifer Thomas 3

Purpose

The overarching research aim has been to illuminate the phenomenon known as “cancer ghosting” and to explore recommendations for healthcare provider education and patient interventions.

Background & Significance

Ghosting, originally associated with online dating apps, describes the experience of having communication terminated without warning. Increasingly, oncology patients have reported being cancer ghosted. There are few studies of oncology patients and the phenomenon of cancer ghosting available. This presentation reports the results of phase one of a two-phased qualitative study designed to explore cancer ghosting in a way that informs survivorship care.

Methods

Phase one of the larger study involved a comprehensive netnographic study of multiple social media platforms. Through extensive searches of public posts on sites including Twitter (X), Facebook, Reddit, chat rooms, and Linked-In as well as numerous blogs, over 150 entries within the past five years were analyzed. These posts specifically referred to being “ghosted” due to a cancer diagnosis. Using a comprehensive netnographic approach described by Kozinet (2019), this research revealed a wide range of public social media posts describing cancer ghosting either directly or indirectly. These posts were analyzed using netnographic technique as well as thematic analysis (per Naeem, Ozuem, Howell, & Ranfagni, 2023 and Sundler, Lindberg, Nilsson, & Palmér, 2019) to generate knowledge around the experience.

Findings and Interpretations

Investigations into the occurrence of ghosting and its growing prevalence over the past five years has provided rich descriptive data as well as recommendations for healthcare provider interventions. Themes arising from this work included cancer stigma, existential crisis, impacted quality of life, isolation and loneliness, and mental health decline.

Discussion

The netnographic approach of this research allowed for novel insight into cancer ghosting as an impactful psych-oncology experience. The increasing frequency of posts has demonstrated that cancer ghosting is a rising phenomenon, taking on an increasingly harsh and punitive tone over the last five years. Recommendations for healthcare professionals include ghosting-specific support groups and increased awareness of ghosting that can affect quality of life in survivorship. Additionally, the opportunity exists to explore alternative methods of communication by patients to deter, or to address, ghosting experiences. Future directions (phase two) for this research focuses on short interviews with patients describing ghosting using critical incident technique (Flanigan, 1954) for each occurrence.

Articles from Oncology Nursing Forum are provided here courtesy of Oncology Nursing Society

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