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. 2023 Jan 1;33(1):137–170.

CANO/ACIO Annual Conference Workshop Abstracts

PMCID: PMC9894367  PMID: 36789214
Can Oncol Nurs J. 2023 Jan 1;33(1):137.

W-01-A. Optimizing diagnosis in Canadian cancer care: Findings, recommendations, next steps, and implications for key stakeholders including oncology nurses

Marianne Gagnon 1, Kathleen Barnard 1, Martin Dawes 2, Michael Smylie 3

From June 2020 to March 2021, All.Can Canada conducted a comprehensive analysis to understand the diagnosis landscape in Canada. The multi-part research comprised a structured literature review to identify and catalogue practices or interventions currently being used in Canada to reduce inefficiencies and enhance the individual’s experience during the diagnosis phase, to identify what indicators are currently used in Canada to measure the diagnosis phase, and to summarize what is known about how the social determinants of health impact the diagnosis experience for people in Canada. Thirty qualitative interviews followed cancer survivors across Canada, who were diagnosed within 18 months of the interview, to understand the diagnosis experience from patients’ and caregivers’ perspectives and what mattered most to them during the process. Next was a survey of 42 healthcare providers working in or studying cancer care from across Canada to understand what they perceive to be the main inefficiencies in the diagnosis system, the factors that are essential for a quality diagnosis process, and what practices have been used to manage inefficiencies and enhance quality.

The workshop will begin with a patient story that illustrates the issues uncovered, then present a brief overview of the research methods, findings, recommendations, and next steps. This will lead to a moderated, multidisciplinary discussion between representatives of patients, primary care, oncology, nursing, and policy to discuss the relevance and implications of the findings, plus priorities in moving the recommendations into practice.

Led by patient groups and people with lived experiences of cancer, All.Can Canada is a national, multi-stakeholder platform for cancer care efficiency, with a preliminary aim of optimizing people’s entry into cancer care through swift, accurate, and appropriately delivered diagnoses.

Can Oncol Nurs J. 2023 Jan 1;33(1):137.

W-01-B. Integration of oncofertility screening, assessment and supports for adolescent and young adult (AYA) cancer patients: A workshop for oncology nurses

Claire Link 1, Andrea DeIure 2, April Hildebrand 2, Linda Watson 2, Lindsi Chmielewski 2, Sarah Thompson 2

Adolescent and Young Adult (AYA) cancer patients, aged 15–39, have been recognized as a unique cancer population with distinct needs. The Canadian Partnership Against Cancer (CPAC) published the Canadian Framework for the Care and Support of Adolescents and Young Adults with Cancer in 2019, in collaboration with the Adolescent & Young Adults National Network (AYANN). Oncofertility is a priority action in this national framework. To address this priority, AYAs need to be informed of the impacts that their cancer and its recommended treatment(s) may have on their future fertility, provided timely information about preservation options, and referred for fertility preservation if desired.

Nurses play a pivotal role in supporting patients with oncofertility concerns by providing information and resources, collaborating with the care team, and ensuring referrals are facilitated to fertility specialists and AYA navigators (if available). With the support of CPAC, Cancer Care Alberta (CCA) has developed an oncofertility referral pathway and accompanying toolkit with relevant resources. In this workshop, participants will explore the components of the toolkit, including a provider conversation guide, treatment risk classification guidelines, and “Fertility and You”, a patient education resource.

Participants in this workshop will understand how incorporating routine oncofertility screening for cancer patients during reproductive years can be achieved, and will feel prepared to engage in appropriate discussions in their practice setting. Participants will gain increased knowledge about oncofertility and the types of resources and educational materials that can help facilitate discussions with cancer patients of reproductive potential.

Can Oncol Nurs J. 2023 Jan 1;33(1):138.

W-01-C. Optimizing care – Introducing a toolkit to inform nursing assessment and intervention for age-related changes in older adults with cancer

Allison Wiens 1, Fay Strohschein 2

In Canada, 63% of new cancer cases occur among those aged 65+, and 33% occur among those aged 75+. The health of older adults is heterogenous and impacted by changes across a multitude of domains, such as functional status, mobility, comorbidity, cognition, psychological status, nutrition, poly-pharmacy, social functioning and support, and their own goals and values.

The gold standard to identify vulnerabilities across these domains that may not be identified in typical oncology care is to use a Comprehensive Geriatric Assessment (CGA), a multidimensional and interdisciplinary approach to planning care. However, not all jurisdictions have access to geriatric oncology services that conduct CGAs.

Through roundtable discussions held with nurses across Canada from 2018–2020, we identified the desire and need for a practical resource for oncology nurses caring for older adults with cancer. The Oncology & Aging Special Interest Group formed a working group that developed a TOOLKIT for General Oncology Nurses Caring for Older Adults with Cancer. In this resource, we highlight the importance and relevance of each domain to cancer care and treatment, presenting screening and assessment tools that can be used to identify concerns and possible nursing interventions that may be used to address these concerns. A nursing pathway to guide care of older adults with cancer is also provided.

The purpose of this interactive workshop will be to introduce the completed TOOLKIT. Presenters will walk participants through case studies where they can practise using this new resource in simulation of caring for older adults with cancer.

Can Oncol Nurs J. 2023 Jan 1;33(1):138.

W-02-A. Health equity and equity-oriented cancer care: What it is, and why it matters to oncology nursing

Tara Horrill 1, Jagbir Kaur 1, Leah Lambert 1,2, Scott Beck 2

Alarming inequities exist across the cancer continuum. People who are the most socially disadvantaged are significantly more likely to be diagnosed with cancers that are preventable, be diagnosed with cancers at more advanced stages, die from cancers that are typically curable, and receive inadequate cancer treatment. These outcomes are often linked to the compounding effects of stigma, discrimination, and other barriers to accessing care at all points across the cancer continuum. For example, those experiencing poverty are significantly less likely to be seen by an oncologist after a cancer diagnosis and less likely to receive cancer treatment.

Knowing the challenges some patients face, this workshop is an opportunity for oncology nurses to deepen their understanding of health equity, with particular attention given to its relevance for oncology nursing practice. We will discuss the concepts of health and health care equity including how inequities manifest in the cancer care sector, and introduce approaches to delivering equity-oriented health care. Using case-based scenarios, interactive learning activities, and drawing on our own work in advancing health equity in BC, participants will have an opportunity to reflect on how to apply an equity lens into their practice and strategies for integrating equity-oriented approaches in their organization.

Learning objectives

  1. To learn about health and healthcare equity, and how inequities impact patient experiences and outcomes in the cancer care sector.

  2. To practice applying an equity lens in clinical settings and practice.

  3. To explore strategies and existing tools for integrating equity-oriented approaches at a systems level.

Can Oncol Nurs J. 2023 Jan 1;33(1):138–139.

W-02-B. Leading the way: Increasing nurses’ contributions to genomics and precision healthcare

Lindsay Carlsson 1, Jacqueline Limoges 2,3, Rebecca Puddester 4

Advances in cancer genomics have transformed cancer care, where genomic considerations inform cancer screening and prevention recommendations for high-risk individuals and families, and guide treatment decisions with targeted therapies for individuals living with cancer. These advances have contributed to the emergence of precision healthcare. Oncology nurses have a vital role in precision healthcare and are ideally situated to support the safe, equitable and patient-centred care. As new treatments, care pathways and the needs of patients and families evolve, nurses can support patients and families to make informed decisions related to genetic testing, cancer screening, treatment, and participation in research. Augmenting foundational nursing skills such as health teaching, care coordination, and advocacy with knowledge of genomics can enhance health outcomes.

This workshop uses the Canadian Nursing and Genomics Engagement Framework to demonstrate how a structured approach can support genomics-informed nursing practice. Two case studies will demonstrate how nurses across the five domains of practice use inter-and intra-professional collaboration, leadership opportunities, cultural safety, and ethical practices to support patient-centred care. The first case follows the clinical trajectory of a person with colon cancer, highlighting the role of genomics at different clinical time points and how genomics informed nursing can impact health outcomes. The second case follows a woman with breast cancer, specifically highlighting unique ethical, equity, psychosocial and familial considerations associated with genetic testing.

Oncology nurses are early adopters of genomics and with leadership, education and engagement, can demonstrate nurses’ unique contributions to precision health care.

Can Oncol Nurs J. 2023 Jan 1;33(1):139.

W-03-A. Hematology nursing workshop

Jennifer Wiernikowski 1, Donalda MacDonald 1, Komal Patel 1, Gayatre Maharaj 2, Jiahui Wong 1

Introduction

The need for increased resources focused on malignant hematology has been a priority for healthcare planners in Canada for a number of years due to increasing demand. This has led to a large increase in the number of nurses now encountering hematology patients in many areas of the healthcare system including tertiary centres/cancer centres, emergency rooms and community clinics. Increasing numbers of patients, as well as rapid advancements in systemic and cellular therapies, make it imperative that we ensure nurses feel confident and prepared to provide the highest possible standard of care for these individuals and their families.

Objectives

In order for oncology nurses to provide safe and comprehensive care to hematology patients’ specialized knowledge and skills are required. Increasingly, these patients are eligible for various types of cellular therapy including autologous stem cell transplant, allogeneic stem cell transplant, and more recently, chimeric antigen receptor T cell therapy (CART). This three-hour workshop will include a review of the types of cellular therapy used in treating hematological malignancies with a focus on the nursing assessment and how to anticipate and plan for complications related to these unique treatment modalities. Through case studies we will explore various clinical scenarios and the important role nurses play in maximizing the best possible outcomes for this very complex patient group.

Audience

This workshop will be a good learning opportunity for all nurses working with hematology patients, especially those with 1–5 years of hematology practice experience. Novice hematology nurses are encouraged to attend.

Can Oncol Nurs J. 2023 Jan 1;33(1):139.

W-03-B. Oncologic emergencies workshop

Komal Patel 1, Donalda MacDonald 1, Jennifer Wiernikowski 1, Gayatre Maharaj 2, Jiahui Wong 1

Introduction

Patients with cancer often experience oncologic complications as a result of their cancer and/or cancer therapy. Life-threatening complications, which are often acute in nature, are referred to as oncologic emergencies. These emergencies are not confined to the period of initial diagnosis and active treatment. Awareness of a patient’s cancer history and its possible complications are an important part of nurses’ foundational knowledge in cancer care.

Objectives

For prevention and early detection on oncologic emergencies, nurses must thoroughly assess the patient at each visit, and adequately educate patients and families about preventive measures and reporting of symptoms. Quite often, various clinical signs are evident before an emergency occurs; therefore nurses, whether in a cancer centre, general hospital or community setting must recognize the signs and symptoms promptly. Once recognized, aggressive management of any oncologic emergency is required in order to prolong survival and improve quality of life, even in the setting of terminal illness. The workshop will cover four common oncologic emergencies: tumour lysis syndrome; febrile neutropenia; spinal cord compression, and hypercalcemia.

Audience

This interactive session will introduce nurses to common oncologic emergencies seen in practice through problem-based case studies. Incidence and prevalence, etiology and risk factors, clinical manifestations, treatment, and nursing considerations of each of the oncologic emergencies will be discussed.

Can Oncol Nurs J. 2023 Jan 1;33(1):139.

W-04-A. Excellence in oncology nursing leadership – Nursing leadership in times of crisis

Ruby Gidda 1, Joy Tarasuk 2

Leadership skills are pivotal for oncology nursing roles. The leadership skills of an oncology nurse range from being an advocate for high-quality patient care, an excellent communicator, a preceptor, mentor, role model, to inspiring others in their nursing practice. Nurses in all different types of oncology roles can benefit from leadership education and support to maximize their leadership potential and help them to become confident leaders. CANO is committed to providing its members with meaningful hands-on opportunities for leadership development at our conference. The goal of this leadership workshop is to discuss and share how leadership is vital during a time of crisis. Having strong leadership (formal and informal) can, in turn, enhance oncology nurses’ ability to deliver excellent care and influence patient, team, organizational, and system outcomes.

The workshop will be informed by the LEADS framework (Canadian College of Health Leaders, 2016). CANO believes that effective personal leadership can be learned and practised. The LEADs framework highlights a comprehensive approach to leadership development, which contains five domains: 1) Leads self, 2) Leads others, 3) Develops coalitions 4) Achieves outcomes, and 5) Affects system transformation.

Can Oncol Nurs J. 2023 Jan 1;33(1):140.

W-05-A. I’d tap that: Am I here in vein?

Janny Proba 1

Background

Oncology nurses must be knowledgeable in the care of a variety of vascular access devices. Having appropriate vascular access is of utmost importance for patients with cancer because it affects the type and duration of treatment. It can also influence the likelihood of complications, which may have life-limiting or life-ending implications. The publication of effective guidelines and toolkits have helped to standardize the selection, care, and maintenance of vascular access devices and therapy in Canada. These evidence-based guidelines provide guidance to organizations to standardize care in settings and reduce harm indicators such as sepsis and thrombosis, among others. Since many healthcare organizations grapple with constant nursing shortages and turnover, there is opportunity to emphasize the importance of using these evidence-based resources. These guidelines help to ground oncology nurses in evidence-based care and practice, and advocate for changes in their organizations.

Problem

There are continued pressures across Canada to ‘do more with less’, and most organizations are using LEAN methods to address gaps in knowledge and care. Oncology patients receive complex therapies in multiple settings, so a comprehensive approach to assessment, use, and complication management is needed for oncology nurses.

Proposed solution/application

This workshop is provided by the Canadian Vascular Access Association (CVAA), and will provide details and resources for implementing best practices related to vascular access therapy in organizations. Additionally, education tools and resources will be shared to expand on existing vascular access knowledge for oncology nurses to support the complex needs of their patients. This discussion will be valuable to those in formal and informal leadership roles, nurse educators, and oncology nurses who are interested in learning more about vascular access and change management in their healthcare setting.

Can Oncol Nurs J. 2023 Jan 1;33(1):140.

W-05-B. Canadian Indigenous cancer strategy across the spectrum

Lea Bill 1, Angeline Letendre 1

Canadian Indigenous Nurses Association (CINA) representatives will present an overview of recommendations and strategies to promote the integration of Indigenous approaches to cancer care across the spectrum of cancer care activities and needs: from initial diagnosis to end-of life. Included in the presentation is the Indigenous cancer care framework and mapping to support healthcare professionals in this important work. The use of traditional medicines and the influence of medical procedures on the health and well-being of indigenous peoples will also be explored.

Can Oncol Nurs J. 2023 Jan 1;33(1):140.

W-06-A. International partnerships in cancer care – Cultural bridging for oncology nurses

Reanne Booker 1, Savitri Singh-Carlson 2, Amanda Choflet, Marg Fitch 3, Andrea Knox 2, Lewelyn Rigor 1, Lori Spies 4

The vision for CANO/ACIO regarding international work is to be a leader in raising awareness and adding its voice to the advancement of cancer care nationally and internationally. Not only should Canadians across the cancer care spectrum have timely access to high-quality nursing, but individuals across the globe should also have equitable access to cancer care. The increasing globalization of health care and need to strengthen nursing workforces worldwide creates an imperative for collaborative partnerships. CANO/ACIO members interested in engaging in global initiatives need to understand the relevance and benefits of international partnerships, as well as the processes to engage in these types of initiatives. The CANO/ ACIO working group developed guiding principles for future international partnerships. However, participating in international initiatives with diverse groups requires more than just a framework; it requires cultural humility and continuous self-reflection to understand personal and systemic biases. Central to cultural humility is the concept of cultural bridging which involves utilizing multiple approaches to promote understanding and respect amongst project team members regarding the culture, social norms, customs, and values of a different country. Developing the knowledge, skills, values and competencies for effective cultural bridging is key to promoting culturally safe international partnerships.

Learning objectives. By the end of this workshop, participants will be able to:

  1. Explain the relevance and benefits of international partnerships to the Canadian context

  2. Describe how to establish and participate in international partnerships

  3. Describe the concept of cultural bridging

  4. Describe how the concept of cultural bridging can be applied in oncology practice.

Can Oncol Nurs J. 2023 Jan 1;33(1):140–141.

W-06-B. Reflecting and connecting: Optimizing sexual health and intimacy after a cancer diagnosis

Reanne Booker 1

Sexual health and intimacy are integral aspects of being human. There are innumerable ways that a cancer diagnosis can impact sexual health and intimacy. Changes in sexual health after cancer are common, affecting patients of all ages, and are not limited to any particular type of cancer. Such changes can occur at any point along the disease trajectory, from time of diagnosis through to survivorship, as well as during end-of-life care.

In this workshop, an overview of the potential changes in sexual health that may arise following a cancer diagnosis will be presented. Strategies and therapeutic options (pharmacological and non–pharmacological) to help manage sexual health concerns will be discussed. A summary of the resources available for oncology nurses, as well as for patients and their partners, will be provided. Case studies will be shared to highlight how nurses can assess and assist in managing sexual health concerns in the context of cancer care.

Oncology nurses are ideally suited to help patients prevent and manage changes in sexuality and, ultimately, optimize their sexual health and well–being.

Can Oncol Nurs J. 2023 Jan 1;33(1):141.

W-06-C. Writing for peer-reviewed journals: Getting started

Margaret Fitch 1

This workshop is designed for oncology nurses who are interested in learning about writing articles for submission to peer-reviewed journals. Novices and those with experience in writing and publishing are all welcome. Firstly, we will discuss the peer review process and how that influences your decisions about producing an article. We will then talk together about the writing process itself and share ‘tips’ for getting started and being successful in producing a manuscript for submission to a peer-reviewed journal. The session will be interactive and we look forward to responding to the questions you have about writing and any ideas you might have in mind for an article.

Can Oncol Nurs J. 2023 Jan 1;33(1):141.

I-1-A. Connection, reflection and celebration: Coming together to develop a sexual and gender diversity in cancer care (SGDc) program

Samantha Scime 1, Nazlin Jivraj 1

Background

Sexually and gender diverse (SGD) individuals with cancer face distinct challenges across the cancer continuum. These can include increased cancer risk, less access to screening and preventative services, unique mental health concerns, heteronormative and cisnormative practices of care, limited provider knowledge of SGD needs and intersectionality. To address these challenges, a team of interdisciplinary health care providers (HCPs) and researchers have established the Sexual and Gender Diversity in Cancer Care (SGDc) program at the Princess Margaret Cancer Centre.

Methods

Grounded in the pillars of clinical, research, education and community, the SGDc program has initiated a change process focused on improving access to inclusive cancer care for SGD patients and their chosen families. Current initiatives include a comprehensive needs assessment, curriculum development for HCP education and the creation of a patient-facing website with a depository of resources.

Discussion

This presentation will introduce the SGDc program, define the four dimensions of SDGc (gender identity, sexual orientation, relationship diversity and pronouns) and highlight resources available to HCPs, patients and their chosen families. In addition, we will review our current initiatives, preliminary findings from SDGc program research and identify how the results have informed our ongoing and future work.

Can Oncol Nurs J. 2023 Jan 1;33(1):141.

I-1-B. Examining the unmet needs of Panjabi-Sikh patients during the treatment phase of cancer care

Jagbir Kaur 1,2, Fuchsia Howard 1, Leah Lambert 2, Sally Thorne 1, Satwinder Bains 3

Some individuals and populations experience added barriers and challenges in accessing and navigating the cancer care system due to various individual and system-level factors. Inequities – unjust, modifiable differences between groups – are compounded by a broad range of social and structural determinants such as socioeconomic differences, social disparities, experiences of stigma, discrimination, and racism within the healthcare system, and are most often encountered amongst identifiable groups in Canada, including new immigrant and racialized communities. A multiphase mixed-methods study aims to further our understanding of experiences, unmet needs, and potential disparities that Panjabi-Sikh patients and their families experience during active cancer treatment. This study, focused on one of Canada’s largest visible minority populations, seeks to inform the development of systems-level strategies to best address the potential needs of this racialized and ethnic minority group. This presentation will focus on sharing preliminary findings from the first phase of the study – a scoping review that maps the current state of the literature regarding Panjabi-Sikh cancer care experiences within the treatment phase, with a specific focus on unmet needs, disparities, and the ways in which the cancer care system does or does not respond accordingly to those needs.

Can Oncol Nurs J. 2023 Jan 1;33(1):142.

I-1-C. A time for reflection: Exploring the unique perceptions and experiences of Black patients with mental health issues at end of life

Corsita Garraway 1

Background

Together again, it is time for reflection on the Canadian healthcare system that, although it is known to be a multicultural society, is designed around a Eurocentric white colonial framework. Patients are provided treatment that this system has established without considering the possibilities that each person requires something specific to their cultural norms. Persons who have a life-limiting illness deserve to have their stories told in their voices, so that healthcare providers will be educated about providing meaningful care together with patients who require palliative care and their loved ones that would ensure best outcomes for all.

Methods

I conducted a traditional (narrative) literature review to aid the understanding the palliative care needs of Black patients with mental health issues at end-of-life using a mixed research methodology.

Results

Review of the literature conducted, demonstrated a paucity of literature that discusses this important topic.

Next steps

I will be conducting a qualitative method survey of Black adults aged over 30 years who are diagnosed with mental health issue(s) and end of life. The findings will be presented as a first stage of the research necessary to celebrate the possibilities of contributing to what is currently known when we know what the Black patients want to create resources that are culturally appropriate and user friendly.

Can Oncol Nurs J. 2023 Jan 1;33(1):142.

I-1-D. Digital information needs and ehealth literacy of older adults with cancer

Lorelei Newton 1, Claire Fullerton 1, Helen Monkman 1

Canadians are surviving cancer at unprecedented rates. Although older adults (70+ years) are disproportionately affected by cancer, they are also more likely than ever to survive cancer. Emerging research around the transition of Canadian older adults to cancer survivorship suggests that a key concern is the availability and provision (or lack thereof ) of relevant and reliable information. However, little evidence exists as to how older adults use digital information to supplement understandings of their unique situation in order to manage, and make decisions about their ongoing cancer-related concerns. Contrary to persistent ageist assumptions regarding the use of technology by older adults, recent research highlights that digital information is a substantial source of information for this group. Despite increased uptake, there are aspects of digital information sources that may be suboptimal, as simply having access to health information does not necessarily equate to being able to understand or use it. Expectations that older people have difficulty parsing medical information persist, yet digital tools may be creating or exacerbating barriers to use and understanding. To this end, we will share findings of our study regarding the digital information needs and experiences of older adults, including digital health literacy, during the survivorship phase of their cancer journey. Geriatric oncology is an emerging subspecialty, yet little research is available to guide practitioners to support the digital information needs of this group, as they transition from active treatment to survivorship. This project will contribute to a better understanding of the digital information needs of this population, as such knowledge is crucial to enhance care and quality of life of older Canadians across the trajectory of their cancer care.

Can Oncol Nurs J. 2023 Jan 1;33(1):142.

I-2-A. Understanding factors influencing Canadian oncology nurses’ discussing cannabis use with patients experiencing chemotherapy-induced nausea

Tianhao Xiao 1

Background

Cannabis has been legalized in Canada since October 2018 and shown to be effective for chemotherapy-induced nausea (CIN). Oncology nurses in Canada will see more patients inquiring about medical cannabis for their CIN, but little is known about oncology nurses’ approach to discussing cannabis to manage CIN with patients.

Purpose

To understand factors that influence Canadian oncology nurses’ discussing cannabis use with patients experiencing CIN.

Methods

We conducted a descriptive, cross-sectional study guided by the Ottawa Model of Research Use. We sent a questionnaire to 678 members of the Canadian Association of Nurses in Oncology and 131 oncology nurses in Ottawa and eastern Ontario from February 8 to April 10, 2022. We adapted the questionnaire from a commonly used barrier survey to assess factors influencing knowledge use in clinical practice. It included closed-and open-ended questions focusing on oncology nurses’ clinical practice, attitudes, and knowledge of cannabis. We analyzed findings descriptively.

Preliminary results

There were 23 responses. Typical respondents were females (n = 22, 95.7%), aged 30–39 (n = 12, 52.2%), and worked in oncology for 11–15 years (n = 6, 26.1%). Almost half (n = 11, 47.8%) correctly answered the knowledge question about the effectiveness of cannabis. Most participants (n = 18, 78.3%) disagree or strongly disagree that they felt confident providing guidance on use of cannabis for CIN. All 23 participants believe that they needed to participate in continuing education about providing guidance on the use of cannabis. The top three barriers identified are social stigma, lack of knowledge, and lack of support at the workplace.

Conclusion

Few Canadian oncology nurses discuss cannabis use for CIN and most feel inadequately prepared to provide guidance for patients. Identified barriers need to be addressed for oncology nurses to be prepared to discuss use of cannabis for CIN.

Can Oncol Nurs J. 2023 Jan 1;33(1):143.

I-2-B. Utilizing patient reported outcomes (PROs) and toxicity assessment to improve efficiencies in nursing practice: A stepped assessment approach

Claire Link 1, Andrea DeIure 2, April Hildebrand 2, Linda Watson 2, Lindsi Chmielewski 2, Louise Smith 2

Oncology nurses in Canada are facing a difficult reality. Patient acuity and clinical workloads are daunting, and burnout from the COVID-19 pandemic has made nursing in general a challenging profession. Competing priorities within a patient’s ambulatory visit must be balanced while providing high-quality, person-centred care, highlighting the importance of finding clinical efficiencies to help oncology nurses work smarter, not harder.

Identifying, assessing, and managing symptoms in an ambulatory cancer population is central to a nurse’s role, as is called out in two of CANO’s Standards for Specialized Oncology Nurses: Comprehensive Health Assessment, and Management of Cancer Symptoms and Treatment Side Effects. Increasing time constraints in ambulatory settings make head-to-toe assessments difficult; innovative ways to conduct efficient but comprehensive assessments and manage symptoms accordingly are needed. But which assessment framework is best for targeted assessments? Some settings use the Common Terminology Criteria for Adverse Events (CTCAE) framework to assess and document adverse events related to cancer therapeutics. Others use Patient Reported Outcomes (PROs) as the guiding tool for symptom management.

This presentation will explore synergies between PROs, nursing practice, and toxicity assessment, highlighting how the collection, review, and discussion of PRO data is an effective first step in the oncology nursing assessment process. PROs quickly identify areas where further assessment using a toxicity grading approach can be applied. This stepped approach increases efficiency, as nurses only need to further assess areas where patients report issues. Information from PROs and from a nurse’s own targeted assessments can be communicated to the clinical team to aid in responsive actions, such as altering treatment plans or providing patient coaching. Examples of how stepped assessments have improved efficiencies in Alberta will be shared.

Can Oncol Nurs J. 2023 Jan 1;33(1):143.

I-2-C. Chewing the fat: A nurse’s guide to understanding the role of adipose tissue in cancer cachexia

Susan McClement 1

People living with cancer-associated cachexia present with variable losses of skeletal muscle and adipose tissue. The involuntary weight loss and marked depletion of skeletal muscle are highly recognizable in advanced cancer patients who resemble victims of famine. In the face of such wasting, nurses may not consider the role of adipose tissue in cancer cachexia. Research demonstrates, however, that adipose tissue contributes to the metabolic dysfunction that occurs in primary cachexia and contributes to its development and progression. It is, thus, important that nurses understand the contributions of adipose tissue to this condition. While pathophysiological processes are taught in nursing curricula, the literature suggests that nurses often lack confidence in both applying their general knowledge of pathophysiology to practice and discussing it with patients or other healthcare providers. The purpose of this article is to discuss the different types of adipose tissue involved in cachexia and describe their role in contributing to increased energy expenditure and negative energy balance. Armed with this knowledge, nurses will be better positioned to understand the clinical picture of cachexia, appreciate the rationale for proposed therapeutic interventions, and confidently dialogue with patients, families, and members of interdisciplinary health care teams about this prevalent condition.

Can Oncol Nurs J. 2023 Jan 1;33(1):143.

I-2-D. Streamlining care: A nurse-led inter-hospital febrile neutropenia project

Luisa Luciani Castiglia 1, Jeff Mangerpan 2

This project aimed to improve the experience of patients with febrile neutropenia (FN) by developing a standardized protocol for the outpatient (urgent care) and emergency department (ED) settings across three cancer centres. The Rossy Cancer Network (RCN) funded a nurse-led interdisciplinary project to create this protocol, with multiple stakeholders from oncology-hematology, emergency department, infectious disease and pharmacy.

We will describe the process to establish protocols and collective orders for assessment, early intervention, and management of patients with FN across the three hospitals. Our approach included a literature review and protocol benchmarking, followed by the creation of an algorithm and draft protocols based on suspected FN low-risk FN. Initial feedback was sought from all stakeholders using the Delphi Method (agreement strategy) followed by meetings at each site to discuss protocol development and address differences.

Ultimately, a single protocol could not meet the needs of each hospital. Thus, separate protocols were created for outpatient and ED settings. Facilitating factors included in-person meetings rather than email to find commonalities and broad input of interdisciplinary feedback. Difficulty reaching quorum, complex protocol approval processes, and the pandemic were significant barriers.

Standardization across cancer centres must consider leadership support, as well as differing processes and templates. The use of virtual meetings may facilitate future projects. Next steps include final approvals and training/implementation.

Can Oncol Nurs J. 2023 Jan 1;33(1):144.

I-3. Enhancing competency-based learning in systemic therapy administration using a standardized and blended online and workshop model

Jiahui Wong 1, Donalda MacDonald 1, Gayatre Maharaj 1, Jennifer Wiernikowski 1, Shankavi Vigneswaran 1

Introduction

Systemic therapy administration is complex and should be provided by nurses with evidenced-based knowledge and skills. CANO/ACIO recommends that all nurses providing care for person’s receiving systemic therapy engage in an initial competency program and yearly competency maintenance process.

Objectives

To describe an Ontario-based standardized curriculum, a provincial standardized chemotherapy and biotherapy (PSCB) course that combines didactic online learning with an in-person workshop at course conclusion. During the COVID pandemic, a virtual workshop format was developed and trialed to address access constraints.

Methods

During the workshop, the team will demonstrate the online learning modules and engage the audience in the embedded case-based PBL activities. The design and delivery of the virtual workshop will be illustrated and compared with the in-person offering. Learning outcomes will be measured and reported.

Results

A total of 159 nurses enrolled in the January and April 2022 offering from across Canada. All participants will complete the online modules. For workshops, nearly half of the participants will attend virtually led by two APN educators while the other half will attend the in-person workshops offered locally. The presentation will use examples of systemic therapy regimens and nursing implications focused on the assessment and management of adverse effects to illustrate best practices in online education. Because both workshop formats are being offered to the same cohort, it allows the project team an opportunity to compare and assess the effectiveness of both options for our learners.

Conclusion

Nurses value standardized curriculum and case-based learning. The impact of a well-developed curriculum with flexible format to support nursing practice and its system-wide impact will be discussed.

Can Oncol Nurs J. 2023 Jan 1;33(1):144.

I-4-A. Designing a proof-of concept of an app to coordinate nurse-provided respite care services for families coping with palliative-stage cancer

Aimee Castro 1

Background

Families coping with palliative-stage cancer need comprehensive community services to support dying at home. Respite care is a service that allows family caregivers to experience short breaks from their intensive role. Respite care can be a critical support for families, especially when services are flexible and staffed by trusted providers, such as nurses. However, many families forego respite because scheduling is inflexible and services are not staffed by providers with palliative care training.

Objectives

The objective of this multi-phase research program is to develop an app to facilitate more flexible coordination of nurse-provided respite care for families coping with palliative-stage cancer. Phase 1 research will explore how an app might address families’ respite care support needs. Phase 2 will be used to design a proof-of-concept for such an app.

Methods

For this virtual, user-centred design study, 20 nurses, 15 adults with palliative-stage cancer, and 20 of their caregivers were recruited in Quebec. During Phase 1 (spring 2022), individual interviews were conducted to explore participants’ respite care experiences and their ideas for how apps could improve service delivery. During Phase 2 (summer/fall 2022), several proofs-of-concept app designs were created. Participants will be asked to share feedback on the different proofs-of-concept, and to decide which features should be prioritized for the final app. All data will be descriptively analyzed and triangulated to determine core app features for the final app prototype, which will undergo usability testing in Phase 3. Phase 2 results will be available for the conference.

Implications

This research will offer key insights into families’ respite care and mHealth preferences, helping to ensure that the final app is designed with and for palliative care families. Such an app could better support death at home, which is where most families and patients wish to be.

Can Oncol Nurs J. 2023 Jan 1;33(1):144–145.

I-4-B. Implementing virtual care overnight: A pilot project evaluating the available technologies for virtual patient care

Colleen Graham 1

When COVID emerged as a global pandemic in early 2020, clinicians providing care for cancer patients in the outpatient setting were challenged to change their way of practising overnight. Prior to the pandemic, cancer care was primarily provided in-person and, therefore, a rapid transition to virtual care was required. Due to that rapid transition, the required processes and quality implementation were not available.

Cancer Care Ontario defines virtual care as referring to any interaction between patients and healthcare providers, occurring remotely, using any form of communication or information technology. Virtual care has historically been underutilized by the clinical team. However, during the pandemic, cancer patients faced difficult challenges in their care including physical distancing, increased risk of infection and treatment delays due to a ramping down of clinical care, making virtual care a necessity.

Technology is an essential requirement for virtual care. Virtual care by telephone was often the first and quickest option in an effort to maximize the efficiency of healthcare delivery during the pandemic. However, as the pandemic continued, it was identified that due to the limitations of telephone technology, this approach was not meeting the care requirements for all patients.

At the GRRCC, a pilot project was developed to introduce physician virtual care by video conference utilizing the secure system provided by the Ontario Telemedicine Network (OTN). This pilot project was designed to measure the effectiveness of this specific technological option from patient, clinician and operational points of view.

In this presentation, we will review the outcomes of the OTN Pilot Project at the GRRCC looking at the experiences of our patients and clinician teams. We will explore the patient education materials, clinician education requirements, and infrastructure required to launch a successful virtual care program, utilizing video as the preferred method.

Can Oncol Nurs J. 2023 Jan 1;33(1):145.

I-4-C. Connecting the “bots”: Leveraging digital technology to better serve our patients and their families

Joy Bunsko 1, Megan Crosby 1, Justine Sanders 1

The Digital Assistant (aka ‘bot’) has been one of the digital tools to support the pandemic. It’s a novel approach to engage citizens, which sits on BC Cancer’s website, and provides a direct channel for the public and has the ability to service thousands of requests simultaneously. Call centres, including BC Cancer’s regional telephone nursing care lines, have seen demand increase steadily year over year, which has led BC Cancer to consider how technology can create efficiencies and provide enhanced support for patients. A Regional Cancer Centre is exploring the opportunity to expand the bot’s functionality to include (1) information regarding patient education and symptom management, (2) the ability to escalate requests to an oncology nurse for more complex inquires, introducing an omni-channel for patients and nurses to engage beyond traditional call centre phone lines. After identification of key stakeholders from Regional Cancer Centres and externally through PHSA and CGI, a team was assembled to support the proof of concept. This presentation will review the stages of the project, key findings, and recommendations toward expanding the use of the digital agent and launching the “bot” across the remaining regional centres. This innovative approach provides another means to connect with our patients, to reflect on alternative and transformative ways to meet patients’ informational needs, and celebrate the successes in delivering person-centred care in the comfort and convenience of a patient’s home.

Can Oncol Nurs J. 2023 Jan 1;33(1):145.

I-4-D. Transitioning breast cancer surgery education online: A COVID-19 quality improvement project

Jayne Grigorovich 1, Sarah Rotstein 2

Due to restrictions brought on by COVID-19, breast oncology nurses at Princess Margaret Cancer Centre and Mount Sinai Hospital shifted the delivery of surgical education from an in-person to a digital format. Instead of learning in person, patients were asked to watch pre-recorded videos on surgical preparedness and participate in live online group discussions. To ensure the shift from in-person to online learning aligned with current best practices in patient education, the authors conducted a literature review on the topic of web-based breast cancer surgery interventions. The purpose of this review was to get an overview of what kind of health interventions exist and how they are evaluated. The authors found that surgical teaching can be delivered using smart-phone apps, online learning modules, websites, DVDs, and telehealth services. The key findings were that digital interventions based on experiential knowledge and self-directed learning are in line with principles of adult learning (andragogy). Moreover, the needs of patients with low digital literacy need to be balanced with those who benefit most from digital education. Finally, the authors designed a patient feedback questionnaire to evaluate the new online curriculum along parameters of acceptability, readability, accessibility, surgical preparedness and anxiety. Questionnaires were received following online education sessions between November 2021 and April 2022. This oral presentation will focus on the results of the surveys, lessons learned and changes implemented based on the feedback received.

Can Oncol Nurs J. 2023 Jan 1;33(1):145–146.

I-5-A. Critical shortages of chemotherapy-certified nurses and practice challenges: Management of HDMTX toxicities

Preetal Makan 1, Kassie Nguyen 1

Due to the shortage of chemotherapy-certified nurses created by the COVID-19 pandemic, new graduate nurses are desperately needed to take the chemotherapy certification course while still being in the novice nurse learning stage. A novice nurse’s limited experience, knowledge, and judgment with chemotherapy administration may have contributed to a critical practice error. Although, high-dose methotrexate (HDMTX) is frequently given as a treatment option for many hematological malignancies, its administration is still considered a high-risk medication practice requiring careful attention. There are many components to administering HDMTX correctly. An alkalinization process using a sodium bicarbonate infusion begins 5–6 hours prior to chemotherapy administration to achieve a prerequisite urine pH >7 before proceeding with the HDMTX infusion. Giving HDMTX before proper alkalization of the urine, can result in renal toxicities, increased hospital stay, and administration of additional (and difficult to obtain) medications. The HDMTX toxicity event resulted in creating a quick reference guideline for nurses/physicians, changes to organization-specific chemotherapy workshops, changes to instructions detailed on the MAR/OPIS programming, and the utilization of a urinalysis machine.

Can Oncol Nurs J. 2023 Jan 1;33(1):146.

I-5-B. Common symptom clusters in advanced cancers

Stephanie Lelond 1

Improving the quality of life, functioning, and ability to receive treatment for our advanced cancer oncology patients often requires more advanced symptom management. In advanced cancer, symptoms can be numerous and significantly burdensome. Traditionally, symptoms are explored and treated individually, causing undertreatment of less-severe symptoms and an underestimation of the compounding effect of multiple symptoms. Symptom clusters are two or more interrelated symptoms that may or may not have a common underlying mechanism. Learning to recognize symptom clusters in different advanced cancers and how to effectively address all contributing symptoms can help optimize patient outcomes and quality of life.

Can Oncol Nurs J. 2023 Jan 1;33(1):146.

I-5-C. Early intervention of harm reduction for hematology patients with substance use disorder

Mei Wang 1, Karen Szeto 1

Malignant hematology patients often need to start chemotherapy soon after their diagnosis is confirmed. Although not common, there are still some patients who have substance use disorder (SUD) prior to their malignant hematologic disease. Oncology nurses specialized in complex malignant hematology (CMH) have extensive training on the different types of leukemia, associated signs and symptom management from chemotherapy, and oncology emergencies such as febrile neutropenia. Yet, CMH nurses are unprepared to care for patients with SUDs. With lack of training in managing patients with SUDs, the approach of patient care not only impacts on the patient’s cancer treatment journey, but also heightens the level of moral distress in nurses. The case presented in the paper is a patient who was newly diagnosed with acute myeloid leukemia and had a pre-existing SUD. Many nurses experienced moral distress when providing care for the patient who continued to use injectable substances during his chemotherapy treatment. The continued habit of substance uses during the patient’s chemotherapy had negative impacts on his cancer treatment. Harm reduction was adopted and integrated into nursing practice when caring for this patient with SUD. This case study has provided an opportunity for nurses to learn that harm reduction strategies have positive influences on the outcomes of patients with malignant hematologic disease and the quality of care for the patient’s journey.

Can Oncol Nurs J. 2023 Jan 1;33(1):146.

I-5-D. Surgical insertion of tunneled drainage catheters: Implications for care in palliative patients

Janny Proba 1

Background & purpose

This level one tertiary facility provides oncology care for patients in various stages of their cancer journey. Surgery is often the first modality utilized for diagnostic indications, treatment with curative intent or for palliative purposes. The insertion of tunneled drainage catheters in palliative patients has often created confusion for oncology nurses in the care and management of these devices intended to alleviate respiratory discomfort resulting from complications of their disease since they are typically used for pleural effusions or for malignant ascites in oncology patients.

Findings

Many oncology nurses are unfamiliar with how tunneled drainage catheters are surgically inserted and the implications. This affects the nurse’s ability to provide education to the patient and family, as well as limits the opportunities for advocacy and appropriate utilization of products based on the location and function of the catheter. Knowledge of the procedure, as well as the products used for specific indications, will help to guide the oncology nurse in determining and advocating for best care. The lack of educational resources, standardized products and consensus on care and maintenance were identified as significant risks to patient safety and needed to be addressed using an organization-wide approach.

Recommendations

It is imperative to develop cohesive partnerships between healthcare disciplines and departments within the hospital setting, as well as with community partners, for the care and management of tunneled drainage catheters in palliative patients. Education and resource development are crucial for the continued provision of care. Additionally, the standardization of products is beneficial in augmenting the oncology nurse’s understanding. Addressing these challenges will support evidence-informed practices that will allow palliative patients to be cared for in the setting of their choice at end of life.

Can Oncol Nurs J. 2023 Jan 1;33(1):146–147.

I-6-A. Care coordination: Optimizing the scope and role of oncology nurses to meet the individual needs of patients and families within cancer care

Joy Bunsko 1, Theressa Zapach 1, Kornelia Filipowski 1

Nurse care coordination has developed itself as an important role and function in the patient care process, as a way to reduce barriers to accessing healthcare, enhance patient centred cancer care and improve efficiencies within the system. The creation of a team-based model of care approach challenged Regional Cancer Centres in BC to examine current nursing practice, evidence for optimizing scope of practice for Licensed Practical Nurses and Registered Nurses, and to examine tumour site-specific care coordination (navigation) within a team-based model. This presentation will describe steps taken to: define the role, scope and function of an oncology nurse (LPN/RN) within a team-based care model; better understand the phased approach for care along the patient journey from referral to discharge; and pilot the nurse coordination role within BC Cancer Regional Centres. Early evaluation and quality assurance metrics will be shared. Our aim is that through nurse care coordination, connections will be established bridging the gap to provide seamless care within transition points in a cancer patient’s care, placing the patient in the centre of the team and providing truth to the statement: “One Team, My Team!”

Can Oncol Nurs J. 2023 Jan 1;33(1):147.

I-6-B. Connecting resources and fostering partnerships to build capacity in the outpatient systemic therapy setting

Yvonne Davidson 1, Jesse Haas 1

The need for outpatient systemic therapy services has increased over the last several years and will continue to see growth in the coming year with new therapies providing more treatment options. The need for services includes the need for specialized oncology nurses to support this patient population and the physical space to treat patients, all within the fiscal constraints in the current healthcare landscape.

In partnership with the Grand River Hospital Retail Pharmacy, a non-chemotherapy injection clinic has been established. The all RPN team is supported by the outpatient clinics team and utilizing the retail pharmacy. This initiative is revenue generating for the hospital and creates capacity in our chemotherapy suite, while providing high-quality care.

In a review of nursing roles and resources within the Cancer Program, a supportive treatment unit was established. This RPN-led unit works closely with the outpatient team to provide non-chemo therapy treatments, such as hydration, blood transfusions and electrolyte replacement.

Through a review of our scheduling process, we identified a group of patients that would often be deferred on the same day as treatment causing an under-utilization of chair time. To alleviate these same-day deferrals, we’ve moved to a two-day medical directive model that has provided support to oncology patients through telephone nursing assessments by a specialized oncology nurse and in consultation with our oncology pharmacists. This intervention has improved the use of chair time in our systemic suite by recognizing patient’s needs prior to them presenting on the day of treatment.

These interventions have increased the capacity in the systemic suite, which allows for more services to be provided to support our community. As we reflect on the challenges to come in future, innovative strategies will continue to be required to provide safe, cost efficient, and compassionate care to outpatient oncology patients.

Can Oncol Nurs J. 2023 Jan 1;33(1):147.

I-6-C. Enhancing practice for oncology nurses – Systemic therapy initial and continuing competency education

Suganya Vadivelu 1, Laura Sinke 1, Cheryl Page 1

In 2021, Cancer Care Ontario (CCO) updated their competency standards for registered nurses (RNs) administering systemic therapy for patients with cancer in Ontario. These new standards had requirements for centres administering systemic therapy in the province. Administering systemic therapy is a specialized nursing skill in which oncology nurses require additional education and skill training to provide high quality and safe patient care. Organizations had responsibility to align their education, policies, and protocol with these new standards. We are sharing an example showcasing how these standards were met by one regional cancer program – Hamilton Health Sciences.

Process

In response to the new CCO standards, a comprehensive education process was developed by Clinical Educators to support the oncology nurses for systemic therapy administration. The education plan included processes for initial and continuing education. The initial education process includes an external approved education course (via Oncology Nursing Society or de Souza), enriched by a full-day practical workshop and competency sign off in the clinical area with the preceptor. The process for continuing competency for the certified nurses comprises an external approved maintenance course, supplemented by routine systemic therapy review sessions, online self-assessments (Canadian Association of Nurses in Oncology and CCO Standards) and unit-specific training.

Implications

The new standards education process was implemented for the oncology nurses practising in both ambulatory and inpatient oncology areas. As per Kirkpatrick’s levels of evaluation framework, the nurses receiving the updated systemic therapy education were evaluated using a standard, valid questionnaire. These CCO standards assisted the organizations and leaders to identify the education requirements for nurses in their subspecialty and support the ongoing maintenance of certification.

Can Oncol Nurs J. 2023 Jan 1;33(1):147–148.

I-6-D. The pan-Canadian Oncology Symptom Triage and Remote Support (COST aRS) online tutorial: Retrospective pre-/post-test study

Dawn Stacey 1, Lynne Jolicoeur 2, Meg Carley 2, Andra Davis 3

The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides were designed to help oncology nurses provide symptom management. Studies evaluating their implementation into nursing practice identified the need for an educational program. The COSTaRS team initially developed an in-person, 60-minute workshop that included a didactic presentation with role-play using the COSTaRS practice guides and group discussions. The challenge with providing in-person workshops was reaching large numbers of nurses providing home care services across large urban and rural areas. Using the same content as the in-person workshop, the COSTaRS online tutorial was created.

The aim of this study was to evaluate the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) online tutorial, an open-access cancer symptom management educational program. From 2017 to 2021, 749 nurses completed the online open-access tutorial. The average knowledge score was 4.4/6 (73%) with 83% achieving passing scores. Compared to baseline, nurses improved their perceived confidence in assessment, triaging, guiding patients in self-care (p<0.001), and perceived confidence in their ability to use COSTaRS practice guides (p < 0.001). The nurses rated the COSTaRS tutorial as easy to understand (95%), just the right amount of information (92%), providing new information (75%), overall good to excellent (89%), and willing to recommend to others (83%).

In summary, almost 750 nurses completed the online tutorial. Nurses who completed the tutorial demonstrated good knowledge and improved their perceived confidence in cancer symptom management.

Can Oncol Nurs J. 2023 Jan 1;33(1):148.

II-1-A. Medical Assistance in Dying for mature minors

Priscilla Chataika-Smyth 1

In 2016, Bill C-14 was enacted as an amendment to the Criminal Code of Canada to allow people aged 18 or older, who are capable of making medical decisions and are suffering from a grievous and irremediable medical condition, to request medical assistance in dying (MAiD).

People diagnosed with life-limiting conditions such as metastatic cancer often experience devastating physical and psychosocial symptoms. Some of these symptoms can be managed or alleviated by palliative care. However, due to multifactorial stressors on the healthcare system, palliative care referrals for most people take place in the last two months of their life, if at all. For some of these suffering people, the choice and selection of MAiD provides salvation.

As the MAiD movement continues to grow in Canada, disease advocacy groups have called for legislative expansion to include those suffering from chronic mental illness and other neurodegenerative diseases such as dementia. While Bill C-14 will always be remembered as one of tremendous change, rooted in compassion, to end suffering, and restore personal autonomy, it currently neglects that autonomy in children due to a perceived lack of capacity.

Little is known of how capable children perceive and voice what death, dying, or end of life (EOL) means to them. Examining these gaps in policy and theory will be guided by the following questions: Is Canada’s current MAiD legislation abandoning mature minors to live with suffering that has been deemed intolerable for adults? What is the nurse’s role as advocate and change agent?

Can Oncol Nurs J. 2023 Jan 1;33(1):148.

II -1-B. Psychosocial effects of the COVID-19 pandemic on pediatric cancer survivors followed in adulthood: Lessons learned and future implications

Connie Richardson 1

On average, 1,000 children in Canada are diagnosed with cancer every year. Fortunately, treatment advances have resulted in accurate exceeding 85% for children with cancer. Despite this, 75% of childhood cancer survivors develop late treatment-related effects that affect their physical, mental, and social well being. Thus, requiring long-term specialized monitoring to prevent and manage these late side effects for the rest of their lives. At the age of 18, pediatric cancer survivors treated at the children’s hospital of Eastern Ontario in Ottawa undergo a transition of care to the specialized Pediatric Oncology Group of Ontario (POGO) Late effects clinic. At The Ottawa Hospital, the Pogo program is equipped with a multidisciplinary team that monitors the late physical effects of cancer treatment, as well as supporting patients’ social and emotional needs as they learn to navigate the maintenance of their health in adulthood. During annual visits, each patient gets specialized care from a pediatric oncologist, radiation oncologist, an oncology nurse, and social worker attending to individualized concerns.

However, the challenges of the COVID-19 pandemic forced our program to limit the number of patients seen in-person, and required the team to step up and undergo a rapid remodel into visits conducted over virtual platforms. These changes proved to cause a lot of stress and anxiety for patients and required nursing to adapt their approach to meet the patients’ unique needs in creative ways.

Can Oncol Nurs J. 2023 Jan 1;33(1):148–149.

II-2-A. Nursing leadership in the pre-diagnostic phase of care of suspected patients with lung cancer (bilingual session)

Sonia Joannette 1, Sophie Burelle 2

Nursing leadership has a significant impact on patients under investigation for lung cancer. A resource person as soon as the presence of cancer is suspected, the nurse assesses, participates in the decision-making process, educates and encourages the patient to adopt healthy lifestyle habits, teaches strategies to manage symptoms from the outset and coordinates efforts during the pre-diagnosis phase.

With her in-depth knowledge (pneumology and oncology) and her communication skills, she improves the patient’s experience throughout and his quality of life and that of his close relatives. The arrival of the nurse on the investigation team of the Montérégie Integrated oncology centre contributed to effectively reduce the pre-diagnosis phase, which was down to 11 days in 2018–2019, to 10 days in 2020–2021 and further doubled the number of patients taken in charge, from 249 to 503 for that same year.

During this workshop, we will cover 1) Demonstration of the clinical leadership for the automatic referral to the fast-track single access window to pulmonary investigation and the proper monitoring of the health indicators set by the health ministery; 2) exchange on the nurses’ knowledge development and daily activities; and 3) discussion on the true impact of health promotion.

Can Oncol Nurs J. 2023 Jan 1;33(1):149.

II -2-B. Une théorisation ancrée sur l’évolution des perceptions du rôle des infirmières lors du soin de l’aide médicale à mourir

Maude Hebert 1, Myriam Asri 1

Résumé

Il est primordial d’explorer comment les infirmières du Québec vivent leur nouveau rôle dans l’aide médical à mourir (AMM), passant de la “”guérison”” aux “”soins en fin de vie”.” Le fait de ne pas savoir comment les infirmières vivent ce changement de rôle constitue un fossé entre la nouvelle législation et la réalité en milieux cliniques. La présente étude avait pour but d’explorer comment les infirmières québécoises font face personnellement et professionnellement à la nouvelle pratique de l’AMM et à l’évolution de leur rôle. Un devis de théorie ancrée a été utilisé. Nous avons recruté 37 infirmières de plusieurs régions administratives du Québec qui ont participé ou coordonné au moins une AMM. Des entretiens semi-structurés et des groupes de discussion ont été menés et enregistrés sur bande audio-numérique. La collecte et l’analyse des données ont suivi les étapes de Strauss et Corbin (2008). Les résultats démontrent que les infirmières considèrent l’AMM comme un soin émotionnel qui respecte les dernières volontés du patient. Elles ont appris à faire face à la charge émotive de ce soin et au jugement de leurs collègues. De plus, elles ont fait face à huit dilemmes au niveau: 1) confrontation sur la mort, 2) choix, 3) moment de la mort, 4) charge émotionnelle, 5) nouvelle loi, 6) relation avec la personne, 7) habiletés communicationnelles et 8) contexte de soin.

Cette recherche innovante permettra de soutenir les infirmières dans leur nouveau rôle et facilitera le développement de l’intervention de soins centrés sur le patient dans le parcours de fin de vie.

Can Oncol Nurs J. 2023 Jan 1;33(1):149.

W-II -3. Cancer and social justice: What’s advocacy got to do with it?

Scott Beck 1, Sarah Cleyn 2, Joanne Crawford 3, Andrea Knox 1, Carolyn Roberts 4, Morgan Stirling 5, Allison Wiens 6, Gabriella Wong Ken

Social justice, or the equitable distribution of social benefits and burdens in a society, has long been a core value within the nursing profession. But when you think of social justice issues, does cancer as a social justice issue come to mind? Research suggests that groups who are impacted by health and social inequities (often referred to as marginalized, vulnerable, or underserved) are significantly more likely to be diagnosed with cancers that are preventable, be diagnosed with late-stage disease for cancers with well-established screening programs, receive no treatment or poor-quality treatment, and die from cancers that are generally curable. These are serious injustices, and as oncology nurses, we have a professional responsibility to begin to address these injustices. In this workshop, we will explore cancer as a social justice issue, the role of nursing advocacy as one tool among many to work towards social justice in oncology.

Learning objectives

By the end of the workshop participants should be able to:

  1. Explain why cancer is a social justice issue

  2. Describe how advocacy can be used as a tool to address social injustices across the cancer care system

  3. Describe strategies for oncology nurses to advocate with/for underserved populations in cancer care.

Can Oncol Nurs J. 2023 Jan 1;33(1):149–150.

II-4-A. Educating patients on immune checkpoint inhibitors: Ensuring a patient-centred learning approach

Kristyn Cole 1

Patient education is central to the role of the Cancer Clinic Nurse and with new and complex cancer treatments emerging, it is imperative they have the knowledge and resources to optimize patient education. Immune checkpoint inhibitors (ICI) have emerged as the newest pillar of treatment in oncology, first gaining traction in Canada in 2011 with the approval of Ipilumumab, the first treatment in history to increase survival of patients diagnosed with advanced melanoma (Cancer Research Institute, 2021). With the increasing use of ICI in clinical practice, it is critical that Cancer Clinic Nurses be able to assess patient learning needs, identify educational barriers, and provide patient-centred education with a focus on the unique action and toxicities of these medications.

I will discuss what I learned during a literature review of current patient-centred learning approaches to educating patients, as well as strategies for educating patients using a universal precautions approach to health literacy. I will review how immune checkpoint inhibitors work and the unique toxicities that are associated with these treatments. Finally, I will share my findings from an environmental scan of what resources cancer centres across Canada are using for patient education and symptom management. By coming together, we can build our connections by sharing our resources to better educate and support our patients, as new treatments emerge.

Can Oncol Nurs J. 2023 Jan 1;33(1):150.

II-4-B. Unveil the experiential knowledge acquired by healthcare professionals to accompany people touched by cancer: Educational perspectives

Karine Bilodeau 1, Asma Fadhlaoui 1, Lynda Piché 1, Cynthia Henriksen 1

Learning to accompany people touched by cancer (PTC) is a challenge for healthcare professionals (HCPs). It requires an accumulation of knowledge and experience working with vulnerable populations. Learning from the experiential knowledge of others is key to providing all that requires accompanying a PTC before, during and after treatment.

The purpose of this presentation is to discuss the experiential knowledge acquired by HCPs, including nurses, who accompany patients with haematological cancer. Insight will be provided to guide HCPs who accompany this unique clientele.

We used a qualitative methodology to conduct in-depth interviews (N = 9) with HCPs (oncologist, nurses, nutritionist, psychologist) who accompany PTHC. Interview questions were structured to capture the experiential knowledge gained from working with PTC. Data were transcribed and configured as biographical narratives. Participants validated their narratives.

Our results revealed a cumulation of experiential knowledge linked to one’s role as a HCP, to the personalization of one’s approach toward each patient, and the struggle HCPs may experience navigating between empathy and sympathy. Indeed, HCPs specialized in oncology become deeply committed to their profession and clientele.

Finally, this presentation sheds light on the tacit learning of the role of HCPs in oncology and provides insight for those who already practice their profession and for those just starting out.

Can Oncol Nurs J. 2023 Jan 1;33(1):150.

II-4-C. ELSKA – A simple patient reported outcome and teaching tool developed by an old bedside nurse

Janet Funk 1

Oncology nurses can and should lead the way as patient care evolves.

Oncology nurses have complex patient care to perform. One of these is teaching patients how to manage the side effects of chemotherapy, side effects that can be deadly. This puts an enormous burden on nurses. We want to get it right, and I found, as a bedside oncology nurse, we don’t have a lot of tools available. As an emergency nurse, I have also seen the outcomes of patients waiting too long to get medical treatment or come to the hospital when their symptoms were not urgent and spent hours in the environment of the ER waiting room.

With a simple tool inspired by nurses, we can educate patients and give them a resource that is interactive, engaging, and safe. This tool, ELSKA, can easily evolve with ongoing nursing input, as side effect management and patient care is what we nurses do best. Results from a small trial at a small oncology clinic proved ELSKA had a positive impact on patients’ life while on chemotherapy.

Can Oncol Nurs J. 2023 Jan 1;33(1):150.

II-5-A. Urgent CancerCare Clinic – An introduction

Christine Eisma 1

Manitoba’s Urgent CancerCare Clinic (UCC) was birthed in 2013 with the purpose of providing specialized quality care to CancerCare patients who are suffering from treatment- and cancer-related side effects. This presentation aims to introduce UCC to the audience by overviewing the current clinical processes, trials, tribulations and successes. UCC is an outpatient two-bed clinic located in CancerCare Manitoba MacCharles site. It is staffed by one clinical provider (physicians and nurse practitioners), three registered nurses and one nursing assistant. Patients who wish to access care from UCC must be active patients within the CancerCare Manitoba system with appropriate follow-up in place from a hematologist, medical oncologist, surgical oncologist, or radiation oncologist. The clinic schedules one to two patients per hour with flex space to add potential walk-in patients. UCC aims to operate similarly to a regional urgent care centre, but it is currently limited in the acuity of care that it can provide. Any patients requiring emergent care must be transferred to a regional emergency department through a formal transfer process. The clinic sees anywhere from 150–170 patients in a month and demand for the UCC service continues to grow. It is our hope that UCC will continue to expand in order to support CancerCare patients in a unique and comprehensive manner.

Can Oncol Nurs J. 2023 Jan 1;33(1):151.

II -5-B. A smart move: The development and implementation of a nurse-led, non-hazardous infusion clinic

Kathy Carothers 1, Kirsty Wield 1, Angela Boudreau 1

Chemotherapy visits at a large, ambulatory cancer centre increased over the course of the pandemic. This resulted in a strain on resources and the need to re-examine internal processes. In September 2021, an interprofessional team examined strategies to address issues that required immediate attention. Prioritized issues included pressures from wait times, patient wait lists, and staffing challenges.

Strategies considered included the extension of weekly operational hours, including weekends, management of clinical trials and new patient bookings. Collaborative conversations inspired the concept of an infusion clinic. It was anticipated that this clinic could redirect specific treatments from our chemotherapy suite to relieve some of the pressures examined. We considered the best possible types of infusions that could be relocated. This resulted in the implementation of a non-hazardous, low-risk, high-patient-volume infusion clinic.

The infusion clinic was developed and integrated into an existing nurse-led area that continues to evolve. The pre-established area includes a nurse-run injection and COVID-19 assessment clinic, as well as a nursing assessment area that is currently under development.

Our presentation will highlight the planning, development, implementation, and evaluation process of the infusion clinic. Incidental and anticipated benefits and challenges will be shared, and future directions will be explored. By bearing witness to persistent adversity experienced mutually by staff and patients, we collectively endeavour to advance and meet the evolving needs of oncology nursing care.

Can Oncol Nurs J. 2023 Jan 1;33(1):151.

II-5-C. An integrative review of cardio-oncology interdisciplinary clinics and the role for nursing

Tara Reber 1

Background

Cancer and cardiovascular disease are the two leading causes of death worldwide. Although cancer treatments are resulting in better cancer-specific survival rates, there is an increased risk of cardiovascular complications. Many cancer centres worldwide have developed ‘cardio-oncology’ clinics aiming to address this growing problem. However, there are no recommendations or set standards regarding how these clinics should operate to provide comprehensive and optimal patient care.

Aim

The purpose of this review is to explore what aspects in the spectrum of care within cardio-oncology clinics has the profession of nursing contributed to, and how nursing can assist in creating a worldwide standard of care within this setting.

Method

An integrated review was performed using a structured literature search from four major databases on September 1, 2021. Inclusion criteria were peer reviewed articles, qualitative, cohort or RCT studies, English language, about interdisciplinary cardio-oncology clinics, between the years 1998 and 2021. Articles were screened by two independent reviewers for relevance to nursing practice using a web-based software platform (Covidence).

Results

Sixteen studies were identified and organized into categories: a) Cardio-oncology Clinics and Multidisciplinary Team Composition; b) Cardio-oncology Clinics and Assessments for Patient Screening, Surveillance, and Management; c) Cardio-oncology Clinic Referrals and Reasons for Referral; d) Cardio-oncology Clinics and Cancer Treatment Outcomes; e) Cardio-oncology Clinics and Cardiology Interventions.

Conclusion

Current studies on cardio-oncology clinics are not focused on the clinical impact of nursing and advanced practice nurse roles, nor are they randomized control trials. Research into evidenced-based practices in cardio-oncology clinics and the nursing role is essential to improve the quality of existing nursing care and establishing the role of nursing in this specialized clinic setting.

Can Oncol Nurs J. 2023 Jan 1;33(1):151–152.

II-6-A. Early integration of palliative care

Jean Ann Ryan 1

Palliative care is a specialized discipline focused on delivering supportive care to patients with life-limiting illnesses. A growing body of evidence supports the implementation of Early Integration of Palliative Care. Findings indicate that integrating palliative care early in the disease trajectory can result in improvements in patients’ quality of life, reducing symptom burden, improvement in the patient and families understanding of disease, and reduce costs on the healthcare system. This early connection encourages conversations surrounding advance care planning and goals of care, focusing on empowerment and respecting the patient’s final wishes. It can reduce anxiety and help patients and loved ones feel more in control. EIPC should be approached as a patient-centred experience surrounded by a multi-disciplinary team and should align with the patients’ goals and cultural beliefs. In order for this to be achieved, implementation of a process for triaging patients with palliative disease with high symptom burden is necessary.

For our program, the Early Integration of Palliative Care Triage focused on a cohort of patients with high symptom burden. It includes:

  • Glioblastoma Multiforme

  • Lung cancer, stage IIIB/IV

  • Upper GI cancers, stage IV

  • Stage III inoperable pancreatic cancers

This triage pathway ensured these patients were offered early and supportive palliative care.

The project also enhanced inter-professional palliative care education using Learning Essential Approaches to Palliative Care (LEAP), assessed provincial resources and developed a Provincial Palliative Care Resource Guide for HCP, and rolled out an electronic collection of patient reported outcome tools (ESAS and CPC).

Project evaluation included a patient and family survey, a healthcare provider survey, and a survey of LEAP education one year post-training. The project went through three performance measurement (data pull) indicators during its four years and was very successful.

Can Oncol Nurs J. 2023 Jan 1;33(1):152.

II -6-B. Automatic referrals to palliative care for newly diagnosed stage IV lung cancer patients: Connecting research and clinical practice

Vanessa Slobogian 1

Patient and caregiver-reported acceptability of an “automatic” palliative care referral for advanced lung cancer patients with translation into clinical practice.

Timely palliative care interventions can help alleviate the distress people experience after a diagnosis of an incurable, life-threatening cancer. This study co-designed with patients and providers, implemented and evaluated the acceptability of an early palliative care call for patients with newly diagnosed stage IV lung cancer. The objective of this study was to determine acceptability of a phone call from a palliative care nurse offering consultation, automatically (without referral) after first oncologist appointment.

Two specialist palliative nurses screened out-patient clinic lists at a tertiary cancer centre and called all eligible patients offering an in-home consultation. Eligibility: >18 years, newly diagnosed/ Stage IV NSCLC and had first medical/radiation oncologist visit. Patients could have a cancer therapy plan pending, confirmed, or have no further care planned at the cancer centre. Patients/caregivers were surveyed about the acceptability (five-point Likert scale) of consult call.

Nearly all patients/caregivers found the call offering consultation to be acceptable and the majority of patients accepted the consultation offer. Patient’s view of the consult, which was done in the patient’s home, was also overwhelmingly positive. Based on the positive results, our team has transitioned this research into a new standard of practice with the collaboration of the Cancer Centre and the community palliative consult service.

Can Oncol Nurs J. 2023 Jan 1;33(1):152.

III-1-A. Reflection: Making the connection between advanced testicular cancer and the COVID-19 pandemic

Rebecca Stewart 1, Cindy Railton 2

Purpose

Patients receiving cancer treatments experience many symptoms and adverse side effects. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy compared to usual care on health service use, quality of life, and symptom severity.

Methods

A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Sub-analysis was conducted on reactive and scheduled telehealth interventions.

Results

Of 7,749 citations screened, 10 studies were included (eight randomized control trials, two quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference −0.54; 95%CI −0.88, −0.19). Significant heterogeneity prevented meta-analysis for most outcomes.

Conclusion

Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes.

Can Oncol Nurs J. 2023 Jan 1;33(1):153.

III-1-B. Early new patient assessment at BC Cancer – Victoria: A patient and staff experience survey

Cloe Bailly Vignola Edwards 1

In 2020, BC Cancer – Victoria’s nursing team started providing early contact to newly referred patients by calling patients at home. This call occurred one week prior to their first consultation appointment with an oncologist to conduct a comprehensive assessment and to provide navigation and support. Prior to 2020, patients filled out an intake questionnaire they would hand over at their first visit. If the patient identified a problem or a need for information on their intake form, a nurse would contact them three days later. In this process focused on problems, only 50% of patients would be contacted by a nurse. This led to gaps and delays in patient care and navigation.

In spring 2022, we conducted a survey for patients and staffs to measure their experience of receiving and providing this new service and to verify if this change constitutes a true improvement.

In this presentation, we will be reviewing the results of this survey using the lens of quality improvement. We will identify ways to continuously improve the role of nurses in supporting patients prior to their first visit, at their first visit, and throughout our patients’ cancer care experience.

Can Oncol Nurs J. 2023 Jan 1;33(1):153.

III-1-C. Can you hear me? The shift to virtual patient education classes during a global pandemic

Sarah Vanderhelm 1

In response to the ongoing global pandemic, the Cancer Centre of Southeastern Ontario pivoted from offering in-person Systemic Treatment Patient Education Classes for patients and families to virtual classes.

A multidisciplinary team was created to support the patient identification, eligibility criteria, scheduling and delivery of virtual patient education classes. Team members included representatives from program leadership, privacy, risk management, nursing, administrative, and patient education departments.

Patients who are registered for virtual classes receive an email with Microsoft Teams meeting information and a soft copy of the class presentation. We created a Virtual Cancer Care Education resource to inform patients of patient education opportunities when they are not at the Cancer Centre. After participating in the virtual patient education class, patients and family members are sent a web-based Patient Education Class Evaluation form. To date, patient and family feedback has been very positive. Patient suggestions will be incorporated to improve process and experience.

Patients have expressed appreciation for being able to receive valuable information from the comfort of their own home. Virtual classes have facilitated the participation of family members and have helped patients feel more prepared to receive systemic treatment. Future steps include development of a standard operating procedure, flow map, and continued promotion of virtual patient education classes.

Can Oncol Nurs J. 2023 Jan 1;33(1):153.

III-1-D. Provincial oncology nursing telepractice standards development and evaluation during the pandemic response

Lorraine Martelli 1, Colleen Fox 1, Priyanka Jain 1

The role of oncology ambulatory care nurses has continuously evolved and better meets the needs of patients and families. As a consequence, nursing telepractice has expanded to become an essential component of comprehensive ambulatory oncology care. With increased complexity of telepractice care, it is crucial to apply effective verbal communication, develop therapeutic relationships, adopt a systematic approach to assessment, apply critical thinking and decision-making skills, and complete thorough documentation of telepractice encounters.

In 2017, a current state assessment of Ontario’s regional cancer centres revealed that telephone management made up a large component of the oncology nurse’s role, but varied greatly in how it was prioritized, supported and delivered. In response, Ontario Health (Cancer Care Ontario) convened a multi-stakeholder Oncology Nursing Telepractice Working Group and completed a jurisdictional and evidentiary scan to develop the Oncology Nursing Telepractice Standards. A framework for quality oncology nursing telepractice was developed and the recommendations were aligned to the components of oncology nursing expertise, evidence-informed guidance, documentation, call time points, organizational leadership, and monitoring quality.

The standards aim to provide guidance to oncology nurses and administrators to achieve safe, high-quality oncology nursing telepractice. This presentation will present the standards and the results of a provincial survey assessing the applicability and usefulness of the Oncology Nursing Telepractice Standards to guide the rapid increased uptake of telepractice services during the COVID-19 pandemic.

Can Oncol Nurs J. 2023 Jan 1;33(1):153–154.

III-2-A. Preparing for life after primary gynecological cancer treatment: An educational resource for survivors and caregivers

Jacqueline Galica 1

Background

Gynecological cancer affects patients and their informal caregivers (e.g., partner and family members); both groups report unmet needs at the end of primary cancer treatment that could be addressed better. To fill this gap, our goal was to develop an educational resource to support survivors and their caregivers living in Southeastern Ontario during this transition.

Methods

Using our scoping review results, we developed a patient-friendly educational resource that was reviewed by survivors and caregivers via a focus group and individual interviews. A thematic analysis was conducted and content validation by stakeholders with clinical and lived experience identified necessary revisions. The updated educational resource was reviewed once more by survivors and caregivers using the aforementioned qualitative approach.

Results

Participants included six cancer survivors (four ovarian, one cervix and one endometrial) and four caregivers of ovarian (n = 2), cervical (n = 1), endometrial (n = 1) cancer survivors. Both groups reported feeling displacement and uncertainty after finishing primary cancer treatment and some felt reluctant to seek help for their needs. In this regard, all participants indicated that our educational resource would be valuable to support them to prepare for the end of treatment transition. When considering how the resource should be introduced and delivered, participants preferred to learn about the resource from a healthcare professional and that it be available to them through multiple channels (e.g., hard-copy and virtually).

Conclusions

Our educational resource can be used to support gynecological cancer survivors and their informal caregivers to adjust to life after primary cancer treatment. Our experience in developing this educational resource can guide researchers and healthcare professionals to develop similar strategies to enhance patient outcomes in cancer care.

Can Oncol Nurs J. 2023 Jan 1;33(1):154.

III-2-B. Behind cancer survivorship: Three extensive experiential learning pathways

Karine Bilodeau 1, Marie-France Vachon 2, Cynthia Henriksen 1, Virginia Lee 3

For many cancer survivors, post-treatment challenges are mostly related to their personal and social lives. These challenges are part of an experiential learning process linked to a survivor’s identity and independence, their social roles and responsibilities, and their return to normal life.

The purpose of this presentation is to discuss three experiential learning pathways in life after cancer treatment: learning to cope with loss, learning to ask for help and learning to rebuild an authentic social network.

An interpretative descriptive approach was used. Twenty-seven cancer survivors from different age ranges: 15–18 years, 19–34 years, 35–44 years, 45–59 years, ≥ 60 years participated in focus groups (n = 6) and in-depth individual interviews (n = 9). We performed iterative content analysis on data and presented results in the form of fictional vignettes to portray the journey of three experiential learning pathways.

All results share milestones of the experiential learning pathway that include challenges resulting from the end of cancer treatment, triggers that lead to individual reflection and actions employed by survivors to overcome challenges. This process is complex and evolves over time.

These results demonstrate the tacit learning experiences of cancer survivors, as they recover their lives post-treatment. A better understanding of how survivors achieve recovery-related experiential knowledge may inform how and when survivors most need support.

Can Oncol Nurs J. 2023 Jan 1;33(1):154.

III-2-C. Exploring post-treatment concerns for survivors of five common cancers: Alberta results from the pan-Canadian Transitions Study

Linda Watson 1, Claire Link 1, Andrea Delure 1

Completing treatment and transitioning to the survivorship phase of the cancer journey can be challenging for patients. Exiting the cancer program and returning to the community for follow-up care can be stressful, as patients worry about what to do if they encounter challenges. Oncology nurses can help prepare patients to confidently transition by providing information and resources tailored to concerns commonly experienced by patients post-treatment. The Pan-Canadian Transitions Study survey, created and administered by the Canadian Partnership Against Cancer in 2016, was intended to increase awareness of the unmet needs of transitioned patients. We used descriptive analyses and multivariable binary logistic regressions to examine the Alberta sample of 1,833 survey respondents, focusing on exploring the top concerns of patients treated for five types of cancer: breast, gastrointestinal, genitourinary, melanoma, and hematological. Fatigue and anxiety were top concerns for multiple tumour groups, while other concerns, such as sexual intimacy and depression, were more prevalent among patients with certain cancers. The logistic regressions demonstrated that in some tumour groups, younger patients had higher odds of having certain concerns, particularly anxiety. Across cancer types, most patients received more information about treatment side effects than about signs of recurrence and community resources – both highly relevant topics for post-treatment survivors. Oncology nurses can use these findings to increase their own awareness of both the common and unique concerns experienced by patients post-treatment and, in turn, ensure they are knowledgeable about information and resources available to help patients manage these concerns. Having this knowledge, oncology nurses can ensure patients feel prepared for life after cancer treatment, and have the knowledge to manage any concerns they may encounter, as they transition from the cancer program.

Can Oncol Nurs J. 2023 Jan 1;33(1):155.

W-III -3. Finding hope in difficult times: Advancing nursing leadership in climate action

Aubree McAtee 1, Jessica Dakin 2

Objectives

  1. To gain an understanding of climate change impacts on health, and the delivery of health services

  2. To learn about opportunities for nursing actions in addressing climate change in their personal lives and professional lives

  3. To inspire members to create a Planetary Health Special Interest Group within CANO, potentially joining CANE/ CASCADES and, ultimately, building on the synergy of mutual organizational goals to address intersecting concerns.

Can Oncol Nurs J. 2023 Jan 1;33(1):155.

III-4-A. An integrative review on the oncology nurse navigator role in the Canadian context

Jessica Katerenchuk 1

Cancer rates in Canada are exponentially increasing. Canadian provincial cancer agencies have adopted a nurse-led model of patient navigation to decrease care fragmentation in the system. The scope of competencies and role domains of the oncology nurse navigator in a Canadian setting have not been clearly outlined.

Objectives

This integrative review aimed to outline the scope of competencies of the oncology nurse navigator role in Canada. Three databases were used to identify theoretical and empirical articles published between 2006 and 2021. Data analysis and thematic development followed.

Findings

The search was conducted in July 2021. Database searches yielded 110 results. Following title and abstract screening, and full-text assessment, 32 articles were included in this review. Three interdependent role domains were identified. The first domain of “coordinator of care” highlighted the nurse navigator as a coordinator of physical and practical needs, acting as a continuous presence along the care journey. The second domain framed the nurse navigator as a “change agent” through increasing patients’ health literacy, creating partnerships, and trusting relationships. Nurse navigators were also described as a “supporter of wellbeing,” or a champion of emotional, multidimensional needs, and a transformer of the context of care.

Closing remarks

All domains were central to the navigator’s success in addressing structural inequities in care and improving patient outcomes across care settings.

Can Oncol Nurs J. 2023 Jan 1;33(1):155.

III-4-B. Driving a hybrid: Navigating the road to success in creation of a new brachytherapy perioperative course for registered nurses

Joy Bunsko 1, Kornelia Filipowski 1, Renelda Girouard 1

BC Cancer’s capacity to provide state-of-the-art brachytherapy for oncology patients is increasing, and so is the need for specialized oncology nursing. As a procedure taking place within an operating room setting, brachytherapy requires a specific skill set and expertise of oncology nurses to include pre-operative, perioperative, and post-anesthetic recovery skills. A national scarcity of OR/perioperative nurses, especially with a specialized oncology background, has historically provided a challenge in recruitment and retention in these clinical areas within BC Cancer Regional Centres. This history prompted the development of an in-house brachytherapy perioperative nursing education program by one of BC Cancer’s Clinical Nurse Leader’s in partnership with the American Operating Room Nurse Association (AORN). This BC Cancer specific perioperative course hopes to carve a distinct role in the evolving area of oncology brachytherapy nursing that will continue to support innovation and excellence in patient care.

This presentation will focus on the steps taken to develop the course, the theoretical and clinical components essential to ensuring competency and skillset is maintained by nursing who enroll in this program and the plan for evaluation. Let’s connect, reflect and celebrate the future possibilities for nursing within the world of brachytherapy!

Can Oncol Nurs J. 2023 Jan 1;33(1):155–156.

III-4-C. Supporting the novice nurse in an outpatient oncology setting: One centre’s approach to navigating the new oncology nurses’ journey from novice to expert

Jessica Dolinski 1, Lisa Coles 1

Walker Family Cancer Centre underwent a shift in their nursing workforce over the last two years, resulting in a large proportion of novice and advanced beginner nurses in the outpatient oncology clinics and systemic therapy suite. This necessitated examination and revision to the onboarding process and preceptor model to support the success of novice oncology nurses. Using the CANO Specialized Nurse Oncology Learning Pathway as a foundation, the team aimed to develop an onboarding program that supported nurses through their preceptorship to independent practice. The overall goal was to increase nurses’ oncology knowledge to support safe and competent practice, while promoting oncology nurse specialization. A multipronged approach was implemented to achieve a supportive four-to six-week onboarding program. 1) Expansion and revision to the formal didactic and hands-on education with the Nurse Educator from half a day to two days. 2) The Charge Nurse role was revised to include a clinical coach model to support novice nurses after preceptorship in successful transition to independent practice. 3) Development of disease site champion teams to share and review disease site fundamentals and treatments. Using learner confidence as an outcome indicator, surveys were developed referencing the CANO Self Assessment Tool and the Cancer Care Ontario Systemic Cancer Treatment Skills Competency Self-Assessment Checklist, and disseminated to learners, preceptors, and clinical coaches. Results are in the preliminary stages and indicating overall increase in leaner confidence post-preceptorship.

Can Oncol Nurs J. 2023 Jan 1;33(1):156.

III-4-D. Starting from scratch, growing our own

Meghan Garbutt 1, Cynthia Heron 1

The impact of the pandemic on the healthcare system has exacerbated an already tenuous situation with shortages in healthcare and human resources. Experienced nurses have been lost to attrition, thus depleting the pool of experienced mentors to grow and develop novice nurses. Nursing education has shifted to virtual platforms in response to public health recommendations, which hinders the development of competency and hands on skills. This poses a significant challenge for specialty areas, such as oncology.

These stressors have been evident on the inpatient oncology unit. Staff on this unit have expressed knowledge gaps regarding confidence and competence to provide the specialized nursing skills required for antineoplastic administration and management of oncology patients. This led to a collaboration between the nursing staff and the educators of the inpatient and outpatient oncology areas to develop a program to address this gap.

This program involved the use of a ‘Plan, Do, Study, Act’ (PDSA) cycle. A needs assessment was completed to identify specific learning needs and gaps. The results of this assessment shaped the development of the chemotherapy learning experience and skills day; a first of its kind within the Cancer Care program at Southlake Regional Health Centre. The goal of this learning program was to increase the knowledge, skill, and ability of our inpatient Registered Nurse’s to deliver and manage anticancer treatments safely, competently, and confidently.

Post-implementation analysis with those who attended, demonstrated increased competence, comfort, and confidence within the inpatient unit and developed mentors amongst the group. The next stage of the PDSA cycle includes modifying the program to continue to meet the needs of the nurses in both inpatient and outpatient settings, aiming for the program to be offered annually.

Can Oncol Nurs J. 2023 Jan 1;33(1):156.

III-5-A. Nurse-led telehealth interventions for symptom management in patients with cancer: A systematic review

Dawn Stacey 1, Chanel Kwok 1, Narges Moradi 1, Charlena Degen 1

Purpose

Patients receiving cancer treatments experience many symptoms and adverse side effects. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy, compared to usual care on health service use, quality of life, and symptom severity.

Methods

A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Sub-analysis was conducted on reactive and scheduled telehealth interventions.

Results

Of 7,749 citations screened, 10 studies were included (8 randomized control trials, 2 quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference −0.54; 95%CI −0.88, −0.19). Significant heterogeneity prevented meta-analysis for most outcomes.

Conclusion

Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes.

Can Oncol Nurs J. 2023 Jan 1;33(1):157.

III-5-B. Telephone completion of patient self-reporting history by registered nurses: A survey to evaluate its effectiveness and strategies for improvement

Kelly Daigle 1, Mark Clemons 1, Lisa Vandermeer 1, Lucia Ghadimi 1, Nasser Alqahtani 1

Background

In order to adapt to increased volume of virtual care appointments during the COVID-19 pandemic, The Ottawa Hospital Cancer Centre (TOHCC) initiated a program whereby RNs telephone patients before their physician consultation to complete Self Reporting Histories in the electronic health record. A survey of RNs and oncologists was performed to evaluate the program’s effectiveness and identify areas for improvement.

Methods

Between February 22 and March 14, 2022, anonymous surveys were emailed to clinics RNs and oncologists at TOHCC. The surveys collected demographic information, as well as perceptions around the successes and challenges of this program.

Results

The response rates were 71% for RNs and 60% for oncologists. For each RN, the median number of patients called per week was three to six and the median time for each call was 20 minutes. RNs felt the process was associated with; patient satisfaction (70%), RNs satisfaction with the quality and efficacy of care (x/y, agree 60%). RNs felt the telephone calls improve care when the patient comes to clinic (yes, 25/30, (83%). However, they also felt overall telephone report was a good use of their time in only 47% of cases and were neutral in 50%. All (100%) oncologists were aware of the program and used it often. The majority of oncologists, 89%, felt it saved time at the consult visit. Both RNs (67%) and oncologists (72%) felt the program should continue. Areas for improvement included patients completing forms themselves, descriptions of chief complaint, drug insurance status and description of associated symptoms.

Conclusion

COVID-19 has resulted in many changes in oncology practice. RN completion of patient self-reported history has had positive feedback amongst RNs and oncologists. This presentation will discuss the program, results of the survey in greater detail as well as areas for improvement and lessons learned over two years of running this program at TOHCC.

Can Oncol Nurs J. 2023 Jan 1;33(1):157.

III-5-C. The art of variation: Distress screening implementation in Rossy Cancer Network Hospitals

Christine Bouchard 1, Joséphine Lemy Dantica 2, Nathalie-El Haddad 3

Each cancer patient’s experiences are unique. However, one commonality is that they must cope with strong emotions, a variety of symptoms, physical changes, and social/practical concerns. Screening for these issues by integrating the use of patient-reported outcomes (PROs) has allowed the three Rossy Cancer Network (RCN) hospitals to reinforce communication between patients and their healthcare providers, with the goal of proactively managing symptoms and distress.

The three RCN hospitals have collaborated as a network to implement the use PROs in their respective cancer clinics, following the same vision and common principles. Although the experience of maintaining a consistent approach was challenging, the three sites relied on best practice and the literature to guide and align their actions. Indeed, each hospital tailored its approach to its own environments, constraints, and goals towards its own path to success.

The RCN network overcame the challenges in balancing consistency with flexibility, and evolved its approach to ensure project buy-in from all sites and clinicians with different viewpoints. For example, one site preferred to implement remote distress screening, while the other two retained an in-person approach. Each site was free to choose its own electronic platform for the collection of PROs, as well. In terms of the questionnaires used, there was a “common core” established as a baseline for all sites, with the flexibility to add or adapt certain questionnaires (within reason).

Our next steps include ongoing implementation (wider rollout), program adjustments, and the collection of data for outcomes measurement. We would also like to build a pan-Canadian community of practice for distress screening, in order to share challenges and successes across provinces.

Can Oncol Nurs J. 2023 Jan 1;33(1):157–158.

III-5-D. Examining a nurse practitioner-led intervention to provide supportive care for gynecological cancer survivors entering surveillance

Jacqueline Galica 1

Background

Gynecological cancer (GC) survivors report significantly heightened distress and unmet needs at the end of primary cancer treatment. To support them in this regard, our team developed an NP-led intervention through an amalgamation of multidisciplinary expertise in gynecology oncology, results from our scoping review, and CANO/ACIO resources. In this presentation, we present initial findings about the feasibility, acceptability, and potential effectiveness of the intervention.

Methods

GC survivors who recover from the immediate sequelae of primary treatment have a 45-minute 1:1 visit with the NP. The intervention involves a standardized approach with flexibility to individualize content according to participant needs. Qualitative and quantitative data are collected before the intervention and three and six months thereafter. Thematic analysis is used to analyze qualitative data and descriptive statistics are used to analyze quantitative data.

Results

To date, 12 GC survivors (10 ovarian and two uterine) diagnosed an average of 13 months previously (range 7–20, SD±4.8) have participated. All participants had combined surgery and chemotherapy, and one had radiation. Although few unmet needs were identified, the most common was help to manage fears of cancer coming back, although this was only notable prior to the intervention. Pre-intervention qualitative findings indicated that many survivors did not know what to ask about the post-treatment period. Post-intervention qualitative findings revealed suggestions for improved communication from cancer care providers.

Expected implications

Interim findings illuminate the unique importance of oncology nurses to support cancer survivors as they transition out of primary cancer treatment. Mature results will have implications for oncology nurses working in a variety of geographic settings (e.g., rural or regional areas) and the potential for remote (e.g., telephone or virtual) oncology nursing assessment and care.

Can Oncol Nurs J. 2023 Jan 1;33(1):158.

III-6-A. Dropping off the treatment wagon: Barriers to cancer treatment and care for people experiencing health and social inequities

Amber Bourgeois 1

Background

A key pillar of Canada’s healthcare system is universal access, yet significant barriers to cancer services remain for those impacted by health and social inequities (e.g., poverty, homelessness, racism). As a result, people are diagnosed late and are dying of cancers that are preventable and treatable. However; little is known about their treatment and care course. The aim of this study was to explore barriers to accessing cancer treatment among people experiencing health and social inequities within a Canadian context.

Methods

We conducted a secondary analysis of ethnographic data informed by critical theoretical perspectives of equity and social justice. The original research draws from 30 months of repeated interviews (n = 147) and 300 hours of observational fieldwork with people experiencing health and social inequities at the end-of-life, their support persons, and service providers.

Results

Our analysis identified four themes presenting as ‘modifiable’ barriers to inequitable access to cancer treatment: (1) housing as a key determinant for cancer treatment, (2) health literacy and ‘missing the window’ for shared decision making, (3) invisibility of the social/structural determinants of health, and (4) navigating a complex and fractured system. These inter-related themes point to how people impacted by health and social inequities are at times ‘dropped’ out of the cancer system and therefore unable to access cancer treatment.

Conclusion

Findings make visible the contextual and structural factors contributing to inequitable access to cancer treatment. Approaches to delivering cancer services that are explicitly equity-oriented are urgently needed.

Can Oncol Nurs J. 2023 Jan 1;33(1):158.

III-6-B. Health and healthcare equity in the Canadian cancer care sector: A rapid scoping review

Tara Horrill 1, Leah Lambert 2

Background

Despite advances in research and treatment, and a publicly funded healthcare system, alarming inequities exist across the cancer care continuum in Canada. Although attention to inequities is increasing, it is not yet clear how health and healthcare equity are being discussed as a goal or aim within the cancer care sector in Canada.

Methods

A rapid scoping review was conducted for published and unpublished literature on health equity in the Canadian cancer care sector. Five biomedical databases, 30 public health and multidisciplinary websites and databases, and Google were searched. Documents available in English, published between 2008 and 2021, and that discussed health or healthcare equity in the Canadian cancer context were included.

Results

We screened 3,678 documents and included 83 for full-text analysis. The prevalence of published and grey literature concerning cancer-related health and healthcare equity increased threefold between 2015–2021 (n = 62) compared to 2008–2014 (n = 20). Yet, only 25% of documents (n = 21) included a clear definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably or in tokenistic ways, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal; goals that were included ranged from broad to specific, with examples from across the cancer continuum. A range of actions were described to address equity goals, including health systems improvements and policy and planning considerations, however most actions had not been implemented, and few documents described measurement of progress toward health equity goals.

Discussion

Although health equity is a growing priority in the cancer care sector, clarity is needed to guide the development of robust measurable equity goals, specific objectives, and meaningful action. If we are to advance health equity in the cancer care sector, a coordinated and integrated approach is required.

Can Oncol Nurs J. 2023 Jan 1;33(1):159.

III-6-C. Choosing MAID: Learning from bereaved family members of cancer patients who chose MAID

Tracy Powell 1,2, Kelli Stajduhar 2

Since MAID became legalized in 2016, more than 21,500 Canadians have chosen this ending-life option and of these deaths, cancer-related diagnoses (~65%) have consistently been reported as the most common underlying health condition, representing approximately 6.3% of all cancer-related deaths. Initiating palliative care to an individual with cancer is an important part of oncology nursing care. According to federal reporting, in 2020 a majority (88.7%) of cancer patients did receive palliative care prior to their MAID event. Research to date also indicates that there are particular demographic and social factors connected to the choice for an assisted death. Along with other aspects of MAID in Canada, since 2016 there has been an evolution in settings where MAID deaths occur and experiences of family members, however, there remain few published studies or reports at this time.

Part of a broader two-province study seeking to understand the experiences of bereaved family members of MAID recipients, in this presentation, we describe the characteristics of those family members who participated in this study, as well as their significant others’ who chose MAID. Here we feature important individual and contextual characteristics, palliative care provision, and the location of the MAID event. This presentation will highlight preliminary findings and early themes and through this, provide important information to oncology nurses, so they can support family members of individuals who choose MAID.

Can Oncol Nurs J. 2023 Jan 1;33(1):159.

III-6-D. Patient-targeted resources to support decisions about Medical Assistance in Dying in Canada: An environmental scan

Alda Kiss 1

Background

Most individuals who seek information about Medical Assistance in Dying (MAiD) have a diagnoses of cancer. Although MAiD was legalized in Canada in June 2016 and extended assisted death to persons whose natural death is not reasonably foreseeable in March 2021, little is known about available resources to support patients and families making this decision.

Purpose

The aim was to identify and quality appraise Canadian patient-targeted MAiD resources to support patients facing this difficult decision.

Methods

An online environmental scan was conducted. Two independent reviewers appraised patient-facing resources using the evidence-informed International Patient Decision Aids Standards (IPDAS) criteria and assessed for health literacy using the Patient Education Material Evaluation Tool (PEMAT). Analysis was used to synthesize data associated with characteristics of the identified resources.

Results

Of 63 eligible patient-targeted MAiD resources, 35 provided current information, and none were classified as patient decision aids. The mean IPDAS defining criteria were 2.6 out of 7 (range 0–5) and none discussed the benefits and harms of all options. The mean PEMAT health literacy scores for understandability and actionability were 73% (range 47 to 100%) and 47% (range 0–80%).

Conclusions

About half of the publicly available resources on MAiD that oncology patients can use provided information on the 2021 legislated changes and none were patient decision aids. Scores indicated that resources would be less helpful for people of lower health literacy.

Can Oncol Nurs J. 2023 Jan 1;33(1):159.

AWA2. Moving away from “watch and wait” to more proactive language – An NPs approach to reducing distress in CLL practice

Helene Hudson Lectureship Sponsored by Amgen Nanette Cox-Kennett1

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) is the most common leukemia diagnosed in adults, and most patients are diagnosed at an early stage. The literature would describe this time as the ‘watch and wait’ stage, which implies an axe is waiting to fall - leading patients to have anxiety regarding the ‘if’ and ‘when’ this will happen. Younger patients report more anxiety and distress. Is there an approach that can improve the patient experience? This presentation will review a CLL case, what the literature tells us about this experience for patients, and review this nurse pactitioner’s approach to improving that patient experience through education re disease, treatments, alternative therapies, and more proactive language.

Can Oncol Nurs J. 2023 Jan 1;33(1):159–160.

IV-1-A. Goals of care discussion: The 7th vital sign for oncology

Milagros Duque 1

Nurse navigators in Manitoba have incorporated Goals of Care discussions into routine practice in an effort to strengthen informed decision making for patients and their families at the outset of a suspicion of cancer and along the cancer care continuum. Within a framework of patient-centred care, nurse navigators actively support the process of helping patients and families think, learn, decide, talk, and document their wishes for their healthcare. These discussions should not be limited to patients facing advanced cancer diagnoses and life-threatening conditions, but available to all patients facing a potential cancer diagnosis.

In Manitoba, where the scope of nurse navigation focuses on getting the patient to timely diagnosis and patient advocacy, Goals of Care discussions are paramount at the outset of the navigation process to ensure informed decision making. As part of the care they deliver to patients, nurse navigators conduct comprehensive telephone health assessments and aim to understand the patients’ health care needs and goals. This assists patients to articulate their wishes about the extent of diagnostic work-up they are willing to undertake and helps them to understand what to expect throughout the cancer journey.

This presentation will describe lessons learned and practice changes in Manitoba around Goals of Care as cancer navigation has grown and evolved.

Learning objectives

By the end of this presentation participants will be able to:

  1. Describe how a nurse navigator is well positioned to approach and engage patients and families in Goals of Care discussions.

  2. Outline the importance of Goals of Care discussion as a standard of care in nurse navigation assessments and care.

  3. Identify challenges in initiating Goals of Care discussions and strategies to overcome these barriers.

Can Oncol Nurs J. 2023 Jan 1;33(1):160.

IV-1-B. Oncology nurses’ perceptions of advanced care planning: A narrative review

Heather Kilgour 1,2, Leah Lambert 1,2, Fuchsia Howard 1, Sally Thorne 2, Michael McKenzie 1

Background

Advanced care planning (ACP) is a process that supports patients to reflect on their values and preferences toward healthcare and to share these preferences with their care providers. ACP enables care that aligns with a patient’s goals and preferences, decreases anxiety and depression at end of life, and increases satisfaction with care. Oncology nurses are well-positioned to support ACP, yet, across British Columbia (BC), opportunities for patients with cancer to engage in ACP are few and inconsistent. This narrative review aimed to provide an overview of ACP in cancer care and to identify what is known related to oncology nursing and ACP.

Methods

Articles were first identified by searching the databases Medline and the Cumulative Index to Nursing and Allied Health Literature. The authors then engaged in a review of the initial articles and conducted subsequent iterative searches and critical reflection of the literature to provide an overview of oncology nursing and ACP.

Results

Few articles specifically focused on oncology nursing and ACP. However, the evidence describing oncology nurses’ experiences with related concepts, such as end-of-life discussions, and ACP perceptions among nurses working in other settings (e.g., home care nurses), offer relevant insights. Insights were inductively arranged into three main categories, (1) nurses’ perceptions of ACP, (2) facilitators to ACP, and (3) barriers to ACP.

Conclusions

The first step to facilitating ACP in cancer care is to understand the support oncology nurses currently receive to engage in ACP and the changes in the cancer care system nurses perceive are necessary to fully support patients in ACP. This presentation will conclude with details of proposed research designed to promote oncology nursing engagement in ACP across BC’s cancer care system.

Can Oncol Nurs J. 2023 Jan 1;33(1):160.

IV-1-C. Evaluation of an electronic patient-provider communication tool to facilitate goals of care discussions

Shawna Ropson 1, Amanda Lamarche 2

Purpose

Many healthcare providers are ill-equipped and/or unable to dedicate the necessary time to ensure our patient’s goals of care contain all the essential and ideal shared-decision making elements needed for patients to make truly informed decisions about their resuscitation preferences. In a non-randomized pilot study, the Royal Victoria Regional Health Centre developed an electronic tool to help facilitate Patient-Centred Goals of Care Discussions (PCGCDs).

Background

One in eight patients with life-threatening illness who die in hospital potentially receive end-of-life care that was discordant with their goals of care. Apart from unnecessary pain and suffering that one may endure, this unwanted care may be contributing to escalating healthcare utilization at the end of-ife across the nation

Method

This pilot study was created to determine if this program model could be effectively and efficiently implemented into the routine care of eligible patients. The contents of the e-tool were all derived from validated instruments and prognostic scoring systems. Throughout the study we evaluated the feasibility of using this e-tool and benefits of including PCGCDs in hospitalized patients.

Conclusion

More than 80% of patients who participated in the study consented to a less aggressive resuscitation plan. This study proved that when a healthcare professionals and patients are given the proper tools, we can ensure patient’s goals of care are achieved.

Can Oncol Nurs J. 2023 Jan 1;33(1):161.

IV-2-A. The evolution of effective collaborative management of PARPi therapy in ovarian cancer

Pam Sweeney 1, Jolene Guenter 2, Michelle Mills 2, Katricia Kent 2

PARPi (poly [ADP-ribose] polymerase inhibitors) have been revolutionizing care for women with epithelial ovarian cancer for the past decade. Clinical trials demonstrating significant PFS and OS led the push to “mainstream” genetic testing to expedite results, so appropriate patients could have timely access to PARPi therapy. Educating staff and counselling patients, as well as managing results, initiating therapy and monitoring potential side effects was an additional workload, with no extra resources. Collaboration between stakeholders to streamline the processes for patients proceeding with genetic testing, starting therapy and surveillance. This included a successful partnership with the genetics team (GO-BRCA). As the indications for patients who were eligible to receive therapy expanded and numbers of patients on PARPi therapy increased, the gynecological oncology (GO) team adapted. Several barriers and opportunities presented themselves leading to the creation of a nurse-led weekly clinic to manage the initiation of PARPi. These patients are primarily managed virtually. The process continues to evolve for the GO team. The nurses, pharmacist, nurse practitioner, and oncologists, as well as GO fellows, are satisfied with this model of care. Unfortunately, work load measures in ambulatory care are not utilized in our facility. However, the sense is that this service delivery is efficacious and next steps include measuring patient satisfaction.

Can Oncol Nurs J. 2023 Jan 1;33(1):161.

IV-2-B. A primary care nurse (PCN) role in the preparation of patients planned for autologous stem cell transplant (ASCT)

Zeinab Yusuf 1

The Medical Day Care Unit (MDCU) is an oncology/hematology clinic that treats a variety of malignant hematology cancers. Our patient population with these diseases often face complex needs and challenges, as they navigate through the healthcare system. These challenges led to the initiation of a trial PCN role in January 2019. The PCN role supports patients throughout their cancer treatment trajectory and works within the principles of cancer care outlined by CANO. However, the role has faced challenges due to the COVID-19 pandemic and staffing shortages that contributed to temporarily discontinuing the role. Despite these challenges, we strived to standardize the PCN role to allow for ongoing support and continuity of care. The aim of this presentation is to discuss the PCN’s role in the preparation of patients heading for ASCT and to develop process tools by collaborating with MDCU hematology oncologists, team members from the ASCT centre, and reviewing relevant resources and articles.

Can Oncol Nurs J. 2023 Jan 1;33(1):161.

IV-2-C. Developing a nurse practitioner-led ambulatory clinic for patients with gynecological malignancies

Pam Sweeney 1

Approximately 12,000 women in Canada are diagnosed with gynecological cancers every year. Most advanced stage gynecological cancers require multiple treatment modalities, including systemic therapy, possibly surgery and/or radiation treatment. Services are provided by multiple healthcare practitioners. The experience for patients and their families can be overwhelming. Patients that present with advanced stage disease or recurrent disease often have complex physical needs, as well as possible psychological and emotional distress. Gynecological oncology service stakeholder feedback, in the ambulatory setting at the Tom Baker Cancer Centre, indicated that more comprehensive continuity of care for patients with advanced gynecological malignancies would fill a gap in service for this population. Review of the current gynecological oncology model of care and the possible opportunities to implement a new clinic to meet the identified needs, led to the development of the nurse practitioner-led clinic. This weekly clinic also includes nurses and a pharmacist. The population includes patients requiring support navigating treatment options, survivorship, goals of care and end-of-life decisions. The nurse practitioner level of autonomy and scope of practice is optimized in this service delivery model.

Can Oncol Nurs J. 2023 Jan 1;33(1):161–162.

W-IV-3. Together again – Empowering new oncology nurses through education and mentorship

Suganya Vadivelu 1, Heather Bussey 2, Cheryl Page 3, Kara Jamieson 4, Lynn Kachuik 5, Laurie Ann Holmes 5, Sarah Champ 6, Cynthia Heron 7

Background

Nurses new to the oncology specialty have a steep learning curve due to the complexity of cancer pathophysiology, the multitude of cancer treatments, and cancer-or treatment-related side effect management. Historically, many oncology areas prioritized hiring experienced nurses, enabling orientation to focus on oncology rather than generalized nursing knowledge. Due to the changing nursing landscape, including high turnover of staff and pressures related to the COVID-19 pandemic, there has been an increase in newly graduated nurses, LPN/RPNs, and internationally educated nurses (IENs) hired into oncology settings. These nurses are often inexperienced in general nursing, and IENs have the added challenge of learning and adapting to a new healthcare system/culture.

Problem

These competing situations add pressure on both educators and senior staff members to support these nurses in understanding the complexity of cancer care to facilitate the provision of safe, efficient care to patients with cancer.

Proposed solution/application

This CANO/ACIO education committee workshop will explore the importance of mentorship and provide details and resources for mentoring novice staff. Additionally, CANO/ACIO education tools (e.g., framework, learning pathway) to assess and enhance specialized oncology nursing knowledge will be shared. Educators from across Canada will demonstrate their strategies, processes and experiences in supporting the onboarding of novice oncology nurses. This discussion will be valuable not only to nurse educators, but also for experienced nurses who are interested in learning more about mentorship and supporting new oncology nurses. We can come together again to support, mentor, and empower nurses new to oncology.

Can Oncol Nurs J. 2023 Jan 1;33(1):162.

IV-4-A. What have I done for me lately?: Compassion fatigue and resilience of oncology team members and the creation of a self-care space, “The Well”

Suzanne Scotland 1

As caregivers, the awareness and acknowledgement of burnout and secondary traumatic stress (STS), as components of compassion fatigue, are widely identified as the first step in managing or lessening their effects. In May, 2019, Unity Health Toronto’s corporate Staff Engagement Survey results identified workload stress as one of the most strongly negative work parameters for both the acute in-patient and ambulatory hematology/oncology teams at St. Michael’s. In response, a Healthy Work Environments initiative, Preventing and Mitigating Nurse Fatigue in Health Care (Best Practice Guidelines, RNAO, 2012), was begun at the end of 2019. As a starting point, inter-professional team members of both units were invited to complete the validated Professional Quality of Life (ProQOL) Scale that scores burnout, STS, and compassion satisfaction for individuals working in caregiving roles/ environments (Stamm, 2010). Two half-hour in-service education sessions were planned. The first in-service provided education on burnout, STS, and compassion fatigue and encouraged self-reflection and self-awareness among team members with regards to their own unique experiences and contributing factors. Team ProQOL scores were also shared. The second in-service explored resilience and self-care strategies (personal, professional, organizational) and considered next steps, i.e., possible workplace initiatives for future consideration. However, the second in-service was postponed and then shelved indefinitely, as the pandemic began and priorities shifted. While challenges and delays were experienced and reflected upon over the past two years, an unexpected corporate development opportunity presented itself. We applied for and were awarded funding to create a self-care room called “The Well”, providing staff with a dedicated space to apply wellness strategies and de-stress.

This session will explore compassion fatigue and resilience of oncology team members. Suggestions and lessons learned through this initiative will be shared in order to inform and encourage oncology nurses and team members in caring for themselves and each other.

Can Oncol Nurs J. 2023 Jan 1;33(1):162.

IV-4-B. From wellness baskets to remote anti-cancer drug administration: Empowered nurses drive key COVID successes

Carolyn Roberts 1, Jennifer Newton 1

Working during the pandemic has taken a toll on nurses both mentally and physically. Though the challenges were innumerable, oncology nurses have been unwavering in their commitment to cancer patients and their families. Successes with nurse-driven initiatives within our Indigenous Cancer Program helped to keep us grounded in our purpose and provided an opportunity to celebrate the contributions of nurses to positive patient experiences.

One of the pillars that supports the work of our team members is a focus on building and promoting meaningful and respectful relationships with our patients and partner organizations. Our ability to connect with First Nations, Inuit, and Métis patients, families, and healthcare providers was challenged over the past two years because of lack of face-to-face engagement. During this presentation, we will highlight how we leveraged the COVID-19 crisis to identify and capitalize on windows of opportunity to make a meaningful difference for a family, a community, and a Territory – and how these actions, in turn, positively impacted nursing emotional health.

Can Oncol Nurs J. 2023 Jan 1;33(1):162–163.

IV-4-C. Help we are in crisis – On the path to a stronger, more connected team

Colleen Graham 1

Clinician burnout has been identified as a major concern in both the US and Canada, and is exponentially increasing as the worldwide COVID pandemic continues. Organizations that seek to reduce burnout and improve well-being can create a better work environment through approaches that focus on fixing the workplace, rather than “fixing the worker.”

A current literature review indicates that provider burnout has implications for patient safety and there is evidence that the largest benefits result from interventions that improve work-place processes, promote team-based care, and provide support for electronic medical record documentation.

As we come together to connect, reflect and celebrate we need to recognize the challenges that have occurred over the past two-and-a-half years to learn, grow, and strengthen our teams. In this presentation, we will examine the development and implementation of a multi-year quality improvement project aimed at understanding the local current state of burnout, share results from the local clinician and staff wellness survey (utilizing the Maslach Burnout Inventory) and share the Grand River Regional Cancer Centre approach to tackle healthcare provider burnout.

Can Oncol Nurs J. 2023 Jan 1;33(1):163.

IV-5-A. The role of the patient representative in the cancer patient journey

Heather Purvis 1

Navigating the health system is often very challenging, and a body of research over the past decade has supported the concept of nurse navigation to assist patients, as they proceed toward their oncologic care. Navigation nurses, for example, work closely with a patient’s healthcare team, and offer patients and their family members information, guidance and support from the time of a clinical suspicion of cancer through the diagnostic period and treatment.

Patients, however, continue to have questions, concerns, and complaints (and compliments) regarding the cancer care system while they await their appointments. This may trigger team members to refer to the Patient Representative Office. The mandate of the Patient Representative Office is to act as a liaison between patients and their families/caregivers, and CancerCare Manitoba staff. This confidential service strives to address concerns, answer inquiries and act on suggestions in a respectful, compassionate and timely manner. Feedback received by the Patient Representative helps CancerCare Manitoba identify areas of concern, design new or modify existing programs, streamline processes, and improve the quality of patient care.

The importance of this role is underlined by the fact that the Patient Representative Office will always have an open line of communication with the CMO and CEO. This access provides important medical direction and liaison to oncologists if urgent attention to a patient’s case is warranted.

A review of the Patient Representative role, along with examples of how the office functions, will be discussed during this session.

Can Oncol Nurs J. 2023 Jan 1;33(1):163.

IV-5-B. MyChart patient portal: A patient empowerment tool

Jennifer Lounsbury 1, Julian Owen 1, Michele Cardoso 1, Yelena Potts 1, Wendy Bursey 1, Faren Hill 1

In an evolving healthcare system, patient empowerment through optimizing technological advances is an important aspect of clinical care for oncology nurses. Patient portals increase the opportunity for patients, as partners in care, to be informed and to have increased accessibility to their personal health information. In concert with their healthcare team, patients are able to establish mutually negotiated plans of care and information sharing within a secure digital platform. An acute care healthcare system committed to the strategic priority of implementing a patient portal with distinct features including: full accessibility to all test results, oncology nursing notes and a patient-facing self-care page. The purpose of this project was to empower patients and families to enhance their access to healthcare information and to improve their self-care management through increasing access to digital tools.

The ADKAR change management model (Prosci Inc., 2022) was utilized to evaluate the strengths and areas for improvement for the patient portal deployment through a multi-site program-centric implementation approach within an acute care healthcare system. The components of awareness, desire, knowledge, ability and reinforcement were followed. Engagement sessions prior to the implementation of the portal with patient and family advisors and oncology nurses will be reviewed. As well, data on the uptake of the portal and key performance indicators within an outpatient oncology setting will be shared.

Can Oncol Nurs J. 2023 Jan 1;33(1):163.

IV-5-C. Connecting and reflecting: The nurse practitioner role in supporting research to assess unmet needs of men diagnosed with testicular cancer

Cindy Railton 1

Testicular cancer (TC) is the most common solid malignancy affecting males aged 15–44. However, TC is a rare cancer, which tends to effect young men. Because of its rarity and curability, research-based information for the provision of nuanced care is lacking. The role of the nurse practitioner (NP), as the primary oncology provider for this population, has provided a unique perspective that segued into academic inquiry with an international multidisciplinary research team looking at the unmet needs of this population in domains such as information and supportive care. This role and being a board member of a community-based testicular support program were instrumental in recruiting participants for this research project.

Purpose

To better understand the unmet biopsychosocial needs of TC patients from diagnosis to discharge from cancer care services.

Method

TC patients were recruited to participate in one of four focus groups examining their lived experiences from diagnosis to present. Focus groups were recorded and transcribed. Clear themes emerged and will be presented.

Results

Twenty-one males participated. The importance of support from clinicians and psychosocial professionals varied greatly based on time from diagnosis and age. Many participants expressed that the focus group itself was therapeutic.

Implications

The need for psychosocial support early in their trajectory was clear and provisions for this should be considered. The uniqueness of this population requires a refined approach to care by nurses and NPs.

Can Oncol Nurs J. 2023 Jan 1;33(1):164.

IV-6-A. Supportive care needs of young women with gynecological cancer

Catriona Buick 1, Alessia Lamanna 2, Danielle Vicus 2, Lilian Gien 2

Background

Younger women with gynecological cancers often face aggressive treatment interventions and have complex physical and psychosocial care needs (Beesley et al., 2007). Therefore, an understanding of their supportive care needs is important to informing and tailoring healthcare services in order to best meet those needs.

Methods

This cross-sectional, quan-qual study examined 50 younger women (<40 y) diagnosed with a gynecological malignancy within the previous five years. Between December 2019 and March 2021, demographic characteristics, clinical and sociodemographic study measures were collected via survey and chart audit. Qualitative data for the present study were drawn from seven open-ended survey questions framed around supportive care priorities, challenges, and barriers.

Results

A total of 50 women were included in this study. Questions probed supportive care needs across five domains (priorities, improvements, barriers, networks, and accessibility). Responses were explored through a supportive care needs lens (physical, emotional, practical, and informational) (Fitch et al., 2008), with three sub-themes (accessibility, family and caregiver burden, and COVID-19) identified and threaded across each domain. The results will be presented to highlight key factors contributing to unmet supportive care needs.

Discussion

Alongside quantitative findings from this sample, this qualitative analysis provides initial insight into the supportive care needs of young women experiencing a gynecological malignancy. By understanding unmet supportive care needs, future work can focus on identifying strategies and interventions for young women at greatest risk.

Can Oncol Nurs J. 2023 Jan 1;33(1):164.

IV-6-B. Understanding the use of telephone triage by cancer patients in Alberta: Exploring the data

Linda Watson 1, Claire Link 1, Andrea Delure 1, Siwei Qi 1

Telephone triage has become an increasingly important part of oncology care over the last 20 years, with more patients receiving cancer treatments in ambulatory settings than ever before. Starting in 2008, the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides were developed to enhance the quality of symptom support provided by nurses over the telephone. Thirteen symptom practice guides were made available through CANO.

Cancer Care Alberta adopted these guides in 2018 and developed a corresponding documentation process to capture reasons for calls and actions taken. Standardizing documentation enabled the analysis of telephone triage data along with other provincial datasets, including Patient Reported Outcomes (PROs) and health service utilization.

This study examined links between telephone triage and PROs-derived symptom complexity. The sample included patients aged 18 and older who visited any of the 17 provincial cancer centres and completed at least one routine PROs symptom questionnaire between October 1, 2019 and April 1, 2020. Telephone triage calls were matched to questionnaires completed in the seven days prior, to understand symptom burden of patients who called. 2,703 patients made 4,246 calls, 45.5% of which did not have a documented reason. Of the remaining calls, pain (33.2%) was the most common reason, followed by skin reactions (12.8%) and nausea/vomiting (11.4%). PROs questionnaires that were linked to telephone triage showed, on average, higher symptom complexity than questionnaires that were not linked to a call.

Research of this type is quite novel, as telephone triage and PROs data could not be linked prior to adoption of the COSTaRS guides and resulting standardized call documentation. This type of knowledge can help ensure telephone triage nursing staff are appropriately trained to provide patients with symptom management and/or advice, understanding that these patients may have high symptom complexity.

Can Oncol Nurs J. 2023 Jan 1;33(1):164–165.

IV-6-C. Age analysis of patient-reported outcome measures: Understanding the symptom experience and concerns of older Albertans with cancer

Fay Strohschein 1, Linda Watson 2, Claire Link 2, Siwei Qi 2, Sandra Davidson 1

Patient-reported outcomes (PROs) are routinely collected throughout Cancer Care Alberta (CCA). However, although 53% of new cancer cases in Alberta occur among those aged 65+, and 25% occur among those aged 75+, little consideration has been given to PROs specifically among older Albertans with cancer. The objective of this study is to gain insight into the symptoms and concerns experienced by older Albertans with cancer through an exploratory secondary age analysis of an existing PROs dataset.

Since 2010, PROs have been collected from patients receiving care within CCA using a standardized questionnaire called “Putting Patients First” (PPF), which includes the Revised Edmonton Symptom Assessment System, a validated symptom-rating tool, and the Canadian Problem Checklist. This dataset includes all CCA patients who completed at least one PPF between October 1, 2019, and April 1, 2020. In total, the dataset includes 29,242 patients who completed 62,471 questionnaires, as well as their demographic, clinical, and administrative data (e.g., rurality, comorbidities, hospital visits). Descriptive statistics are conducted to explore patterns across age groups, and inferential statistics are used to understand identified differences between groups.

Initial results suggest that although older adults may demonstrate lower levels of anxiety and depression than younger adults, other symptoms, such as pain, tiredness, lack of appetite, and shortness of breath may be significantly higher. On the Canadian Problem Checklist, older adults were much more likely to check physical concerns, such as walking/ mobility, than were younger adults.

These results provide insight into unmet needs among older Albertans with cancer, contributing to a learning environment within and beyond CCA related to best practices in geriatric oncology. Insights will inform the development of innovations and pathways that offer specialized support for older adults with cancer in Alberta.

Can Oncol Nurs J. 2023 Jan 1;33(1):165.

V-I-A. The experiences of family caregivers caring for their relatives diagnosed with advanced cancer in Ghana

Bisi Adewale 1, Anna Santos-Salas 1, Wendy Duggleby 1

Purpose

In Ghana, family members are usually the sole responsible caregivers for persons diagnosed with advanced cancer. The purpose of this study was to explore the experiences of family caregivers of persons living with advanced cancer receiving palliative care in Ghana.

Method

We utilized interpretive description. Sixteen family caregivers and seven palliative care providers were recruited from the Palliative Care Outpatients Unit at a teaching hospital in Ghana. Family caregiver participants took part in audio recorded telephone interviews. Palliative care providers participated in two online focus groups. Data were transcribed, coded, and categorized leading to the development of themes.

Findings

The majority of family caregivers were spouses and daughters between 18–72 years old. An overarching theme was identified as ‘darkness and light’ and two context-related themes, namely socio-cultural influences, and context of underlying disparities. The overarching theme, darkness and light, reveals the serious struggles of family caregivers performing multiple responsibilities, never-ending care, distress and positive experiences with the healthcare system, and spirituality and valued family relationship as a source of strength.

Conclusion

Findings from this study suggest a need for community palliative care services, the need for policies to improve access to early cancer diagnoses, universal insurance to cover the cost of cancer treatment, and early access to palliative care nationwide. There is potential to learn from the Ghanaian experience in Canada where disparities in access to palliative care also exist.

Can Oncol Nurs J. 2023 Jan 1;33(1):165.

V-I-B. A scoping review of characteristics and outcomes of nurse-led palliative care models in low- and middle-income countries

Nahyeni Bassah 1, Anna Santos-Salas 1, Lisa Vaughn 1

Background

Nurse-led palliative care services are becoming increasingly useful to improve accessibility and affordability of palliative care.

Methods

We undertook a scoping review of the characteristics and outcomes of nurse-led palliative care models in low-and-middle-income countries. We searched Medline, EMBASE, CINAHL, SciELO and Global Health databases using the terms: nurse-led AND palliative care AND low- and middle-income countries. Titles and abstracts were screened by one reviewer. Two reviewers assessed the full-text of potentially eligible articles. We included articles that describe a nurse-led palliative care model supporting adult patients with life-limiting conditions in any setting in a low- and middle-income country.

Results

Twenty articles were included representing 18 studies. Majority were from Sub-Saharan Africa (12/20) and were published between 2010 and 2021. Twelve studies were outcome evaluations, five explored experiences/needs of nurses/ patients within nurse-led palliative care models, and three were model descriptions. These models served patients with advanced cancer and HIV/AIDS. We identified three nurse-led palliative care models: nurse-led empowering care, nurse-led symptom management, and nurse-led generalist palliative care. They were delivered in person, in patients’ homes or hospital units, with few by telehealth care.

Conclusion

Findings suggest nurse-led palliative care models improve access to palliative care, symptom management, and quality of life for patients. The use of nurse-led palliative care in low- and-middle-income countries is in its developing stages. There is a need for research to evaluate its impact.

Can Oncol Nurs J. 2023 Jan 1;33(1):165–166.

V-2-A. Les soins virtuels en cancérologie: le point de vue du patient

Josee Beaudet 1, Sabrina Lapointe 1, Arnela Kovac, Sarah Grenier-Darveau, Yoseline Leunens

Contexte

Depuis 2020, une offre en télésanté (TS) a été progressivement déployée dans les équipes de cancérologie du Québec. S’adressant d’abord aux infirmières pivots en oncologie (IPO), d’autres professionnels en cancérologie ont également intégré cette offre à leur pratique. Ainsi, après deux ans d’efforts pour déployer cette dernière, un portrait sur l’utilisation de la TS a été réalisé tant de la perspective des professionnels que de la perspective des patients (PT).

Méthodologie

Ce portrait de l’utilisation de la TS a été effectué par le biais d’un sondage auprès des IPO et des PT, d’entrevues semi-dirigées avec des PT par une patiente partenaire ainsi qu’un atelier de bilan avec des gestionnaires.

Résultats

Ce portrait met en lumière les enjeux, les conditions gagnantes et les occasions à saisir pour la pérennité de ce service. Le principal enjeu éprouvé par les IPO est associé à la difficulté d’organiser des rencontres spontanées en TS puisque la majorité des suivis ne sont pas planifiés. Il est intéressant de noter que cet enjeu n’est pas vécu par les autres professionnels en cancérologie. Le soutien d’une agente administrative s’est avéré une condition de succès incontournable pour certains professionnels et plusieurs PT également. Parmi les occasions à saisir, des types d’interventions additionnelles propices à la TS ont été établies. Enfin, en donnant la parole aux PT, il a été possible de défaire des mythes généraux, entre autres, sur l’utilisation de la TS en lien avec l’âge de la clientèle, l’utilisation de la technologie et la confidentialité.

Conclusion

Dans un contexte postpandémique, il est impératif de tenir compte des besoins et de la réalité du PT et de sa famille quant au choix de la modalité de soins. La TS est une modalité complémentaire et incontournable en cancérologie.

Can Oncol Nurs J. 2023 Jan 1;33(1):166.

V-2-B. Implantation de l’application Belong en oncologie pour les patients et leurs familles dans leur routine de soins

Gabrielle Rokas-Germain 1, Gabrielle Chartier 1, Cory Burgher, Karine Lepage, Renata Benc

Integrating information technology into healthcare has become a priority for some time now. Mobile health (m-health) applications are now common as a supplement to routine cancer care. These Apps serve multiple purposes including enhancing patient access to relevant information related to their cancer and its management, contributing to quality of life by lowering distress, as well as improving symptom burden.

One such App, “BELONG Beating Cancer Together”, was implemented hospital-wide within cancer care at the Jewish General Hospital (CIUSSS Centre Ouest) in Montreal, Quebec. This App supports patients and their loved ones through access to useful and reliable informational resources and facilitates interactions and social support through closed-community groups.

Herein, we will present App implementation opportunities and challenges that we faced. From September 2021 to its hospital launch date in February 2022, our team reviewed the literature, worked with patient partners, clinicians, and the app developers to tailor the content and create closed-community groups. Materials and feedback surveys were developed, administered, and analyzed. We report on these findings with feedback received to date.

Our goal is that this App becomes a widely used resource for patients, caregivers and clinicians and this, across the cancer trajectory.

Can Oncol Nurs J. 2023 Jan 1;33(1):166.

V-2-C. Création d’une programme d’orientation en cancérologie (POC) panquébécois

Rosalie Hudon 1

Contexte

Face à l’évolution constante des connaissances dans le domaine de la cancérologie et de la complexité des soins et traitements, les infirmières qui débutent auprès de cette clientèle doivent développer et maintenir un grand nombre de connaissances et de compétences. Pour répondre à ces besoins, un POC panquébécois a été réfléchi pour harmoniser l’orientation, soutenir les infirmières débutantes et guider les gestionnaires du réseau québécois de cancérologie.

Méthodologie

Une revue de la littérature et une recension dans les établissements du Québec ont été effectués. Plusieurs rencontres ont été tenues en comité pour élaboration et rédaction. Le POC proposé a été validé lors d’une consultation auprès des membres du CEPSI, du PQC et d’experts de contenus en cancérologie ou en éducation à la santé.

Conclusion

Le POC permet:

  • faciliter l’orientation et l’évaluation des nouvelles inf.

  • uniformiser les connaissances et compétences minimalement requises

  • soutenir la pratique inf.

  • assurer une sécurité et une qualité dans la prestation de soins

  • contribuer aux sentiments de compétence de l’inf.

  • contribuer à la rétention du personnel infirmier.

Can Oncol Nurs J. 2023 Jan 1;33(1):166–167.

W-V-3. Questions you had about doing cancer care nursing research but were too afraid to ask

Christine Maheu 1, Jacqueline Galica 2, Tracy Powell 3,4, Kylie Teggart 5, Leah Lambert 6,7, Manon Lemonde 8, Kristen Haase 7, Samantha Mayo 9

While undergoing difficult challenges during the pandemic, oncology nurses have reorganized their approach to research; often discovering and implementing novel strategies to sustain their work. Additionally, major shifts in clinical practice, education, and policy have inspired novice nurse researchers to pursue new and important questions for investigation. As we transition through the COVID-19 era, it is important to continue to advance cancer care nursing through research for the benefit of all people living in Canada.

The aim of this workshop is to foster mentorship and collaboration across the community of nurses interested in conducting cancer care research. Using a “speed dating” format, our committee members are ready to support nurses in facilitating the development of studies that will impact people affected by cancer. Participants will be able to share what they have been or would like to be working on, and issues they would like to solve. Participants are invited to bring their questions about any stage of the research process, such as articulating a research question, starting a project, finding funding and resources, overcoming challenges in remote data collection and analysis, applying for graduate studies, and writing for publication. Experienced and novice nurse researchers are invited to participate. This fun and engaging format will allow participants to obtain different perspectives, as members of the committee represent a variety of expertise.

Can Oncol Nurs J. 2023 Jan 1;33(1):167.

V-4-A. Application of a dynamical neurofeedback brain training intervention to address post-cancer cognitive impairment: Results of a pilot study

Marian Luctkar-Flude 1, Jane Tyerman 2

Rationale

Many cancer survivors continue to report distressing and debilitating cognitive problems long after treatment has ended, which compromises their quality of life and ability to participate in social activities and return to work. There is an urgent need for evidence-based therapies to help cancer survivors manage post-cancer cognitive impairment (PCCI) and get on with their lives.

Background

Neurofeedback is a technology that measures a person’s brainwaves and provides feedback to the brain about its own functioning that reminds the brain to self-regulate to improve its efficiency, flexibility, and resilience. We previously completed a wait-list control feasibility study of the effect of a 10-week dynamical neurofeedback intervention on PCCI in a sample of breast cancer survivors, which yielded positive results in terms of self-reported cognitive function and fatigue. We now have expanded our inclusion criteria to include any cancer survivors except those with brain cancers or brain metastases.

Objective

The aim of this pilot study is to collect data about study protocols and recruitment strategies to inform the design of a larger randomized controlled trial (RCT) to study the effect of a NeurOptimal dynamical neurofeedback intervention on moderate to severe PCCI in post-treatment cancer survivors.

Methods

Preliminary screening and baseline assessment will be followed by 20 NeurOptimal sessions over 10 weeks. Data collection is ongoing and is expected to be completed during early fall allowing for presentation of results.

Results/conclusions

Findings will support the design of a larger RCT to demonstrate the effect of dynamical neurofeedback on PCCI in cancer survivors. This research could accelerate the adoption of neurofeedback into mainstream oncology practice and potentially benefit thousands of cancer survivors across Canada and worldwide.

Can Oncol Nurs J. 2023 Jan 1;33(1):167.

V-4-B. Connecting with people when they are living with cancer and cognitive disorders

Kimberly Shapkin 1

Cancer and cognitive disorders are umbrella terms used to describe broad conditions with diverse pathological causes and disease-specific management strategies. The prevalence of cancer and cognitive disorders such as mild cognitive impairment and dementia are highly variable, but it is assumed to be significant in older adults, as the incidence increases with advancing age. To assist with managing these co-existing conditions, older adults and their families are referred for expert treatments and support. But, when a person is living with cognitive losses, they also present with labile symptoms of memory loss, apathy, and anxiety. The combination of these symptoms with the delivery of treatments challenges nurses.

Therefore, to deliver effective treatments, nurses must acknowledge that the person affected and their family are the experts in how care is delivered. Then nurses can adapt and apply new communication strategies to mitigate the risks associated with delivering treatments. Matching what the person sees, hears, and feels is one strategy to ensure care is delivered safely. Nurses must also recognize that the person with cognitive losses may also experience slower processing speed, leading to a delayed response in their actions. This recognition enables nurses to change how quickly they move from one process to another. The aim of this presentation is to provide nurses with strategies to change their practice, thus creating connections with their patients who are living with cancer and cognitive disorders.

Can Oncol Nurs J. 2023 Jan 1;33(1):167–168.

V-5-A. Designing and delivering a distance learning oncology nursing graduate certificate program: A step on the path to becoming an oncology APN

Linda Watson 1, Amy Melnick 1, Carol Baumgarten 1, Catherine Fox 2, Catherine Laing 2, Sydney Farkas 1

In September 2019, the Faculty of Nursing at the University of Calgary (U of C) launched a series of one-year graduate certificates in Advanced Nursing Practice including:

  • Addiction and Mental Health

  • Aging and Older Adults

  • Innovations in Teaching and Learning

  • Nursing Leadership for Health System Transformation

  • Healthcare Innovation and Design.

Theses certificates were designed to provide advanced nursing practice knowledge and practical experience primarily for registered nurses who wish to acquire specialized skills. Each is an on-line cohort-based, one-year, part-time program, consisting of four half-course equivalents of coursework. Each certificate can be used to apply for admission into the Master of Nursing (MN) Laddered Certificate Pathway, where two certificates can be combined with four core Master’s-level courses to achieve a course-based MN. Currently, the U of C is the only graduate nursing program in Canada to use stackable graduate certificates as a route to an MN.

In 2021 collaborative work between the U of C and the provincial cancer agency in Alberta (Cancer Care Alberta) began to develop a sixth graduate certificate in oncology nursing. The first cohort of students were diverse, with learners from Ontario, Manitoba, Yukon, and Alberta. The first course (Sept–Dec) focused on advanced oncology nursing practice and the various ways nursing practice impacts patient outcomes. The second course (Jan–March) explored the variety of ways that oncology nurses contribute to person-centred care. The third course (May–June) addressed the variety of roles nurses play in oncology research, and the final course (July–Aug) centred on the design of a solution to a real-world oncology practice issue. The certificate was taught collaboratively with oncology nursing experts from Cancer Care Alberta and U of C Faculty of Nursing. This presentation will focus on the course design and cohort learning trajectories, as well as the outcomes experienced by learners and faculty.

Can Oncol Nurs J. 2023 Jan 1;33(1):168.

V-5-B. Building health human resource capacity to support complex malignant hematology care

Jiahui Wong 1, Lorraine Martelli 2, Colleen Fox 2, Ada Payne 2

In 2015, complex malignant hematology (CMH) services in Ontario were at a crisis point with long wait times for acute leukemia (AL) care and hematopoietic cell transplants (HCT). Ontario Health (Cancer Care Ontario) (OH/(CCO)) received funding to support the implementation of a provincial strategy, including building nursing health human resource capacity. Two strategies were proposed: developing a CMH course curriculum and a nurse practitioner (NP) mentorship program. Working groups consisting of registered nurses (RNs) and NPs outlined the foundational competency areas for a CMH course and developed the NP mentorship program. The de Souza Institute was a collaborative partner who developed an online curriculum titled, Complex Malignant Hematology, with direct input from the OH(CCO) working group. To date, 393 nurses have completed the course from across Ontario. The mentorship program was designed to be an immersion into the NP role with a strong preceptorship component for up to six weeks and was tailored to the learning needs of the mentee. Ten NP mentees have worked with NP mentors at four mentor sites. Results demonstrate great satisfaction with the learning opportunities, enhanced knowledge and networking, and expanded programs due to NP roles developed. This presentation will highlight the development and outcome phases for both initiatives supporting the recruitment and enhancement of the nursing workforce in CMH and AL care in Ontario.

Can Oncol Nurs J. 2023 Jan 1;33(1):168.

V-5-C. Educating primary care providers about sexual health disturbance in breast cancer survivorship care using virtual simulation: A feasibility study

Amina Silva 1

Background

Primary Care Provider (PCP) involvement in breast cancer survivorship care has evolved in recent years. Still, there is evidence highlighting that PCPs have knowledge gaps, particularly related to psychosocial issues such as sexual health disturbance, that could be addressed through educational interventions. Virtual simulation game (VSG) is an innovative and engaging knowledge translation strategy that improves healthcare providers’ knowledge and skills and can be used to help address these gaps.

Purpose

To evaluate the feasibility of a VSG to improve PCPs (nurse practitioners and physicians) knowledge related to psychosocial effects, particularly sexual health disturbance, in breast cancer survivorship care.

Methods

Mixed-method explanatory sequential design consisting of four phases: (1) a scoping review to map the literature on how simulation has been used to educate nurses and physicians about cancer care, (2) development of a VSG focused on educating PCPs about sexual health disturbance in breast cancer survivors, (3) quantitative pre- and post-test design survey to explore the feasibility/efficacy of the intervention among PCPs, and (4) qualitative descriptive interviews to identify the PCPs’ perceptions of the intervention.

Preliminary results

During phase 1, our scoping review highlighted that simulation-based education demonstrated positive results in educating nurses and physicians across the cancer care continuum and that no studies specific to survivorship care have been published. We are currently developing phase 2 of this study and we have a committee of Canadian experts in sexual help supporting the development of the intervention’s content. This study is undergoing and for phase 3 we expect to have a sample size of 25 PCPs and for phase 4 we anticipate 8 PCPs. We will have mature results from all phases of this research by October, to be presented during the CANO conference. This study has been funded by CANO/ACIO and INACSL.

Can Oncol Nurs J. 2023 Jan 1;33(1):168–169.

V-6-A. Connection, reflection, celebration: The personal impact of the celebratory bell in cancer care

Dustin Mackay 1, Grace Cole 2, Ava Hatcher 3

Background

In many cancer settings, a common celebration occurs through ringing a bell to signify the completion of cancer treatment. Although nurses witness mainly happy bell-ringing moments, some individuals have reported feeling discouraged and excluded, leading to negative feedback regarding the bell’s use in public treatment areas. These factors combined with an organizational decision to relocate the bell from treatment to non-treatment areas inspired direct care nurses to further explore people with cancer’s lived experience of witnessing the ringing of celebratory bell.

Problem

To date, the experiences of bell ringing in cancer care are not well understood. Available information consists mainly of grey literature and anecdotal evidence. Learning this, our research question to further explore this phenomenon was: How do individuals living with cancer feel when witnessing others ring the bell at their end of treatment?

Method

Our research design utilized descriptive phenomenology. This method generates knowledge from contextual realities through the participants’ unique perspective. Using convenience-based and snowball sampling, the team recruited participants from cancer treatment centres and settings in Northern BC that house a celebratory bell. Semi-structured interviews were used to discuss participant experiences and feelings of the celebratory bell. Twelve interviews were conducted to reach data saturation. Using NVivo, the transcribed interview data was then analyzed to reveal the themes.

Outcome

Identified themes provided description on bell experience, meaning, and it’s relation to the cancer journey. These themes have implications on how the bell’s purpose can be described to be inclusive for all.

Presentation objectives

a) to review the research process and unique challenges of conducting research during the pandemic; b) share the study themes; c) discuss practice implications and limitations; and d) discuss next steps.

Can Oncol Nurs J. 2023 Jan 1;33(1):169.

V-6-B. A long road home: Challenges for Inuit patients wanting to return to the North for end of life

Carolyn Roberts 1, Gwen Barton 1

Access to care is a determinant of health, a significant gap for many Indigenous populations living in remote regions of Canada. This gap becomes even larger when patients require specialized care. For Nunavummiut, this means leaving home to travel to a large urban centre – away from their family, friends, community and culture. Historically, many Inuit associated going ‘south’ with the risk of never being able to return home. Sadly, this remains true for some of our patients.

Our Indigenous Cancer Program provides support to individuals coming to Ottawa from the Qikiqtani Region of Nunavut. Significant collaboration between The Ottawa Hospital Cancer Centre and colleagues in the Territory has led to improvements including an enhanced focus on care closer to home. We recognize there is much work left to do – especially regarding end-of-life care.

We will share a case study involving Diane, a patient from Nunavut. While in Ottawa for treatment, Diane experienced a rapid decline and was given only weeks to live. We will review the challenges she faced along this journey, systemic barriers that impacted her ability to spend her last days with her family, and how these barriers are accentuated for marginalized patients dealing with poverty, homelessness, and violence. The case will demonstrate how our team worked with clinicians, funders and medical travel providers to ensure Diane’s voice was heard and her last wishes were met.

Can Oncol Nurs J. 2023 Jan 1;33(1):169.

V-6-C. Historical perspectives: Gynecological oncology nursing and high-dose brachytherapy over the years

Catriona Buick 1, Alessia Lamanna 2, Elizabeth Barnes 2, Eric Leung 2

Introduction

The use of high-dose radiation (HDR) brachytherapy in the treatment of gynecological cancers has been increasing worldwide (StatsCan et al., 2015), as the standard of care and treatment has evolved for women with advanced local disease (Banerjee et al., 2014). While the clinical outcomes of HDR brachytherapy are promising, questions regarding the psychological consequences of (e.g., loss of control, fear, distress, and helplessness), and quality of life after treatment have been raised (Kamer et al., 2007; Warnock et al., 2005). At Sunnybrook Health Sciences Centre, the Odette Cancer Centre has MRI capacity in the brachytherapy operating room, a first of its kind in Canada. This has allowed for applicator insertion, MRI guided planning, and brachytherapy for women under general anesthetic.

Objectives

While there are many obvious clinical advantages to this approach, it is critical to acknowledge the psychological consequences of undergoing brachytherapy.

Methods

This presentation will discuss the historical evolution of brachytherapy and highlight novel approaches to care. Literature regarding our current understanding of the psychological consequences of brachytherapy for women will also be discussed. Finally, an overview of a prospective study – aimed at understanding the prevalence of psychological distress and potential anesthesia complications for women undergoing HDR with a general anesthetic – will be shared.

Conclusions

By employing a patient engagement approach, this study will lay the groundwork for oncology nurses to develop supports for women undergoing brachytherapy.

Can Oncol Nurs J. 2023 Jan 1;33(1):170.

AWA3. Collaborating across settings to shape the future of oncology nursing after-hours toxicity management support

Clinical Award Lectureship Sponsored by Merck Sherry Hnatyshyn-Webster1, Lorraine Martelli 2

Emergency department (ED) visits and hospitalizations are common among patients receiving cancer treatments. Patients are often told to go to the ED after hours due to the lack of alternative models for timely toxicity management support. In alignment with the Ontario Cancer Plan (OCP) IV goals, the Systemic Treatment Provincial Plan (STTP) 2014–2019, and following the initial success of a 24/7 pilot, Ontario Health (Cancer Care Ontario; OH/CCO) entered into a partnership with Bayshore HealthCare to launch the provincial after-hours toxicity management telephone support line, CareChart Digital Health, for patients receiving cancer treatments. The goal was to decrease ED utilization through enhanced toxicity management, and to enhance coordination and communication to improve person-centred care. Since 2018, a team of specialized oncology nurses has supported patients across 73 hospitals after hours (evenings, weekends, holidays), utilizing evidence-based teletriage tools including the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides. Nurses managed most of the calls with self-management strategies and 24% were re-directed to the ED. Patient experience surveys reveal a majority of patients (>90%) agree that they have had a good experience with this service and expressed high satisfaction with the quality of the service on all parameters asked. This presentation will highlight the service model, outcomes, patient experience, and the pivotal role oncology nurses play to ensuring safe, high-quality cancer care through this innovative collaborative model.

Articles from Canadian Oncology Nursing Journal are provided here courtesy of Canadian Association of Nurses in Oncology

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