Oncology Nursing Society 2007 Advanced Practice Nursing Conference Poster Abstracts
The abstracts appear exactly as they were submitted and have not undergone editing or the
Oncology Nursing Forum
Editorial Board’s
review process. If any errors or omissions have been made, please accept our apologies. Abstracts that are not being presented do not appear.
title:
DEVELOPING A MULTIDISCIPLINARY PROSTATE CANCER CLINIC
FOR THE NEWLY DIAGNOSED PROSTATE CANCER POPULATION—
DEFINING THE ROLE OF AN ONCOLOGY APN
Focus Area:
Clinical/Evidence Based Practice
Authors:
Lydia Madsen, RN, MSN, OCN
®
, AOCNS
®
, University of Texas
MD Anderson Cancer Center, Houston, TX; Jane Williams, RN, MSN, FNP,
University of Texas MD Anderson Cancer Center, Houston, TX; Catherine
Craig, RN, MPH, University of Texas MD Anderson Cancer Center, Hous-
ton, TX; and Deborah Kuban, MD, University of Texas MD Anderson Cancer
Center, Houston, TX.
Content:
A multidisciplinary Prostate cancer clinic (mPcc) provides
opportunity to present multiple treatment options for newly-diagnosed
prostate cancer patients in a single setting.
A mPcc was started in 2003 at this nci designated comprehensive
cancer center. The primary objective was to provide patients with a
setting where all appropriate treatment choices related to their prostate
cancer diagnosis were presented. The first year of operation, 203 patients
were evaluated by physicians from radiation Oncology and urology
in a common clinical setting. The second year of operation, the clinic
expanded and developed more specific guidelines for patient inclusion.
An Oncology APn was recruited at the end of the second year, to ad-
dress the following objectives: 1) Provide a coordinated experience for
each patient, including comprehensive assessment, diagnostic testing,
ancillary services, summary of treatment recommendations, and follow-
up during the decision-making process; 2) Provide patient education
regarding treatment choices and available clinical trials; 3) Assess clinic
performance by compiling treatment statistics and incorporating relevant
survey instruments; 4) increase utilization of the mPcc by patients for
information, decision-making and treatment.
in the third year of operation, 419 newly-diagnosed prostate cancer
patients were seen in the mPcc. The APn has compiled a database
with demographic and clinical data of the 1050 patients seen to date and
assisted in the development of a QOl protocol to compare the various
treatment decisions. A letter, designating treatment recommendations
and corresponding educational information, is provided by the APn at
the conclusion of each patient visit. The APn routinely provides patient
follow-up to address questions and give additional treatment-specific
information. communication between the multidisciplinary team mem-
bers during clinic and subsequent follow-up disposition is facilitated
by the APn.
The addition of an APn has created opportunity for detailed patient
education at the initial visit and follow-up as the patient moves toward a
treatment decision. Formal evaluation of the mPcc has been conducted
by an outside agency; patient experience mapping results demonstrate
patient satisfaction with the clinic and the role of the oncology APn
during the complex decision making process in this newly diagnosed
cancer patient population.
AbstrAct 2480
cago, IL; Amy Davidson, RN, BSN, OCN
®
, Hope Center for Cancer Care,
Youngstown, OH; Martha Griffis, RN, BSN, OCN
®
, South Georgia Medical
Center, Pearlman Cancer Center, Valdosta, GA; Robin Sommers, RN,
APRN, BC, AOCNP
®
, Dana Farber Cancer Institute, Boston, MA; Pamela
Hallquist Viale RN, MS, CS, ANP, AOCNP
®
, University of California at San
Francisco, San Francisco, CA; and Linda Smith, MSN, RN, CNN, Meniscus
Health Care Communications, West Conshohocken, PA.
Content:
Oncology APns caring for patients with colorectal cancer
(crc) are challenged to gather current, evidence-based information to
guide patient care. However, information from textbooks and journal
articles is often outdated and difficult to access, and learning needs indi-
cate a lack of alternative information sources for APns and staff nurses
in clinic, office, and academic settings.
The purpose of this project was to provide current, evidence-based
support for nurses caring for crc patients in various treatment settings
by developing a dynamic, informational, open-access Web site.
An Expert Panel of crc nursing leaders representing the continuum
of care was recruited to develop and maintain the Web content, includ-
ing evidence-based, peer-reviewed information on patient manage-
ment and links to validated resources, such as treatment guidelines,
assessment and teaching tools, and current journal articles. currency
is ensured through a weekly news feature alerting nurses to new find-
ings. interactivity allows users to submit questions to the Panel with
prompt feedback.
metrics have assessed trends in use of the Web site since its launch in
march 2006. individual page views have reached an average of 1,400/
month. new users represent 89% of daily visitors, averaging 1.74 page
views/visit; returning users average 3.23 page views/visit. Over 50% of
the visitors are outside the united states. Oncology nurses use this site
for professional and patient education.
Oncology APns must promote dynamic and contemporary learning
and provide clinical support for staff and clinic nurses. The learning
needs for APns and staff nurses on crc nursing prompted development
of an interactive, open-access Web site. The content is revised through
regular monitoring of the literature, and posted text is revised every 6
months. metrics are monitored monthly as to number of users (new and
repeat); number of unique page views; duration of page visit; and top
content. The metrics suggest that this informational Web site, focusing on
a specific disease type and oncology nursing implications, is a cost- and
time-efficient way to increase exposure to evidence-based practice. The
success of this model supports recommendations for similar Web sites
featuring other diseases.
AbstrAct 2490
AbstrAct 2488
title:
SUPPORTING EVIDENCE-BASED PRACTICE VIA AN INTERACTIVE
WEBSITE FOR NURSES CARING FOR PATIENTS WITH COLORECTAL
CANCER
Focus Area:
Education
Authors:
Susan Moore, RN, MSN, ANP, AOCN
®
, CancerExpertise, Chi-
title:
SO YOU FOUND A BREAST MASS
Focus Area:
Education
Authors:
Ashley Towler, RNC, WHNP, University of Texas MD Anderson
Cancer Center, Houston, TX; and Mary Ann Zalewski, ANP, University of
Texas MD Anderson Cancer Center, Houston, TX.
Content:
in 2004, an estimated 216,000 women were diagnosed
with breast cancer. Women’s Health nurse Practitioners assess count-
less numbers of these women. Therefore, it is imperative that the nurse
practitioner be adequately prepared and informed when dealing with the
unique issues of breast health and awareness, especially in this time of
our ever-aging population.
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A woman’s yearly Well-Woman exam is often performed by the nurse
practitioner. While performing a clinical breast exam, how does one
distinguish between a suspicious mass and a cyst? What are the steps
to take if a suspicious mass is found? is the redness and swelling in
the breast inflammatory breast cancer or just mastitis? The diagnosis
and management of a new breast mass or irregularity requires that
certain diagnostic studies be performed to assure that the patient is
presented with all the available options, and receives the appropriate
care and support.
The purpose of this poster is to inform the nurse practitioner about the
diagnoses, management and follow-up for a patient with a suspicious
breast mass. Also, it serves to improve the assessment technique of the
nurse practitioner for determining benign versus suspicious mass or
breast changes.
We will lay out a step-by-step diagram for the management, diagnosis
and follow-up for a new found breast mass, as well as pictures and tips
on how to determine between a benign or possibly cancerous mass, and
how to distinguish between mastitis and inflammatory breast cancer.
Our hope is that the reader will be more aware of what resources should
be used if the practitioner finds a breast mass. The outcomes is applicable
to the Oncology APn, in that many nurse practitioners perform many
clinical breast exams daily and would be the first to find the new breast
mass or breast changes, or are the link for the patient who self palpates
a new breast mass or notices changes.
The implications are identified on the poster and shown in easy to
follow algorithms.
status and ongoing (daily) mental status evaluation at the bedside by
the nursing staff. next steps include putting the assessment tools online
for computer-based charting and auditing compliance with the docu-
mentation of cognitive function. guiding the nursing staff in the use of
evidence-based research for their clinical practice is an integral activity
of the APn.
title:
EVIDENCE BASED PRACTICE: DEVELOPMENT OF A PLAN FOR THE
EARLY DETECTION AND INTERVENTION FOR DELIRIUM IN PATIENT
WITH CANCER
Focus Area:
Clinical/Evidence Based Practice
Authors:
Barbara Gobel, RN, MS, AOCN
®
, Northwestern Memorial Hos-
pital, Chicago, IL; Kim Slusser, RN, BSN, CHPN, Northwestern Memorial
Hospital, Chicago, IL; Colleen O’Leary, RN, BSN, OCN
®
, Northwestern
Memorial Hospital, Chicago, IL; and Lesley Vancura, RN, MS, CNP, He-
matology Oncology Associates of Illinois, Chicago, IL.
Content:
During a falls quality improvement project, it was identified
that 35% of patients admitted to the oncology units who fell had devel-
oped mental status changes during their admission. Delirium was also
reported in patients anecdotally by nurses.
An Evidence-based practice journal club was formed and led by the
Advanced Practice nurse to develop a plan for the early detection and
identification of evidence-based nursing interventions to prevent or mini-
mize the experience and negative consequences of delirium.
The journal club, consisting of oncology nurses and a gerontology
nurse practitioner, met every three weeks to review the research related
to delirium in the oncology population. Based on the review of the re-
search, appropriate screening tools were identified. The initial screening
tool that is used on admission to the hospital is the short portable mini-
mental status exam. This tool identifies underlying cognitive pathology,
which allows an increased awareness of cognitive function of the patient.
The confusion Assessment method (cAm) tool was chosen for daily
mental status assessment of the patient. This tool was found through
the research review to be valid, reliable, easy to use, and applicable
to the oncology patient population. review of the research on nursing
interventions yielded little research data. Expert opinion and published
practice guidelines were used as the basis for developing guidelines for
delirium interventions.
nurses in the Oncology Department were educated on the importance
of assessing for mental status changes and the tools chosen for assess-
ment of delirium and other cognitive changes. Delirium assessments
and interventions are added to the annual rn competency training for
oncology.
As a result of the journal club findings and recommendations, changes
in practice have been made that include initial assessment of cognitive
AbstrAct 2497
title:
PROTON THERAPY AS A CANCER TREATMENT OPTION
Focus Area:
Clinical/Evidence Based Practice
Authors:
Haihong Cai, ANP-C, University of Texas MD Anderson Cancer
Center, Houston, TX; Anita Mahajan, MD, University of Texas MD Anderson
Cancer Center, Houston, TX; and James Cox, MD, University of Texas MD
Anderson Cancer Center, Houston, TX.
Content:
radiation therapy is a safe and effective modality of cancer
treatment for patients of all ages. There has been vast improvement in the
equipment and delivery of radiation treatment over the past 20-30 years.
High energy photon is the most common form of radiation. However,
because of the damage caused by the similar dose to surrounding normal
tissues, less than desired dose is used, which might in turn contribute to
treatment failure.
Proton therapy is another form of external beam radiation. The large,
energized proton slows down as they pass through tissues, depositing
most of their energy at the end of their path (Bragg Peak). Because of its
precise targeting, higher dose could be applied to tumor to achieve better
local control, while sparing normal surrounding tissues.
Proton therapy has been used to treat lung cancer, skull based tumors,
prostate cancer, and in pediatric population at mD Anderson cancer
center. Patients with stage iiiA, iiiB nsc lung cancer were treated 74
cgE with concurrent chemoradiation; stage i/ii, non-operable nsc lung
cancer were treated with 87.5 cgE; 23.4-36 cgE was used in cranial
spinal cases; 45-50.4 cgE were used in rhabdomyosarcoma cases.
in 70 nsc lung cancer patients, the occurrence of grade 3 esophagitis
is between 10-15%, much lower than the reported cases in imrT or 3 D
conformal treatment. Patients with poor pulmonary function, otherwise
not a candidate for any radiation treatment, were also treated with proton,
with no progression of dyspnea. The biggest concern in the pediatric
population is the arrest or retardation of neurologic or physical develop-
ment. Because of the absence of an exit dose, in craniospinal irradiation
cases, the dose to the vertebral body can be controlled and the dose to
the, liver, kidneys are reduced to nil which can minimize organ dysfunc-
tion and reduce the risk secondary malignancies. in cases of skull based
tumor, the dose to surrounding critical structures, such as optic chiasm,
pituitary gland are also dramatically decreased, which in turn reduced
the long term toxicity.
Overall, proton therapy offers treatment advantages in certain types of
cancer cases. nevertheless, more research and follow ups are needed.
AbstrAct 2499
title:
GETTING TO THE POINT: PENILE REHABILITATION WITH INTRA-
CAVERNOSAL INJECTION THERAPY POST-PROSTATECTOMY
Focus Area:
Clinical/Evidence Based Practice
Author:
Joseph Narus, MA, APRN-BC, Memorial Sloan-Kettering Cancer
Center, New York, NY.
Content:
An estimated 218,000 new cases of prostate cancer will
be diagnosed in 2007 making it the leading diagnosed cancer in men.
men undergoing a radical prostatectomy commonly experience erectile
dysfunction (ED) regardless of “nerve sparing” procedures. With higher
cancer survival rates, this result has a significant negative impact on
men’s quality of life as it can take 18 to 24 months for pre-operative
erectile function to return. Penile rehabilitation with oral agents and/or
intracavernosal injection (ici) therapy has demonstrated beneficial out-
comes to improve erectile function. This nci-designated comprehensive
cancer center has a men’s sexual medicine program which addresses ED
through penile rehabilitation.
AbstrAct 2501
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A survey was conducted at our institution to determine advanced prac-
tice nurses’ (APrns) comprehension of penile rehabilitation therapy and
their comfort and confidence in discussing ED with patients.
A needs assessment survey utilizing www.surveymonkey.com was
electronically mailed to all APrns [(n=188): nurse Practitioners
(nPs) n=145, clinical nurse specialists (cnss) n=43]. responses
were anonymous and encrypted to protect identity. APrns were asked
twenty-eight ED questions and ten demographic questions. 54% of
APrns (71 nPs, 24 cnss, 7 not identified by role) responded. results
revealed 90% of APrns (n=87) are unfamiliar with pharmacologic
penile rehabilitation therapy (65 nPs, 21 cnss). Only 33% of APrns
(22 nPs, 7 cnss) were comfortable introducing the subject of ED,
while 22% of APrns (17 nPs, 4 cnss) were confident discussing
ED with a patient.
To address the survey results, a comprehensive presentation was
developed to increase core knowledge regarding penile rehabilitation
and our program, and to empower APrns to address sexual health
issues. A series of lectures were delivered to reach APrns within the
institution. APrns will be re-surveyed and referrals monitored to assess
outcomes.
APrns are instrumental in educating patients, family, and staff about
early intervention of ED to improve quality of life and decrease adverse
outcomes. This presentation will include survey results, lecture contents
and teaching materials to encourage all APrns to have an open dialogue
with their patients regarding sexual health concerns and refer patients
when applicable.
Presently, the project is in the third phase of implementation. 83/360, or
23% of nursing staff have registered for TnEEl and 16% have completed
the course and received a TnEEl certificate.
Our findings to date indicate that implementation of palliative care
education in a large organization such as the vA requires systematic
approaches and follow-up to maximize and then measure the impact on
patient outcomes.
AbstrAct 2506
title:
IMPLEMENTATION OF A HOSPITAL-BASED END-OF-LIFE NURSING
CONTINUING EDUCATION PROGRAM
Focus Area:
Education
Authors:
Jennifer Tiffen, RN, MS, APN, University of Illinois–Chicago Col-
lege of Nursing, Chicago, IL; Lynne O’Donnell, MS, RN, APN-BC, Jesse
Brown Veterans Administration Medical Center, Chicago, IL; Kathy Wirtz
Powell, DNSc, RN, Jesse Brown Veterans Administration Medical Center,
Chicago, IL; and Diana Wilkie, PhD, RN, FAAN, University of Illinois–
Chicago College of Nursing, Chicago, IL.
Content:
According to the Oncology nursing society Position on
End-of-life care, mandatory palliative care nursing curriculum and
continuing education programs are essential to improving quality of life.
many programs do not include sufficient preparation for end-of-life care,
and both faculty and practicing nurses face constraints such as time and
resources in accessing the information they need.
A solution to this problem is to distribute information via the web or
other computer-based technology. The Toolkit for nurturing Excellence
at the End-of-life Transition (TnEEl), funded through the robert
Wood Johnson Foundation, is an innovative, easy-to-access, package
of electronic tools for palliative care education. TnEEl is presented
in six modules (comfort, connections, ethics, grief, well being, impact)
and addresses AAcn’s “competencies necessary for nurses to Provide
High-Quality care to Patients and Families During the Transition at the
End of life.” in 2006, the Jesse Brown veterans Administration medi-
cal center (JBvAmc) was awarded a grant to improve end-of-life care
through evidence-based learning.
A central component of the grant was a four phase integration of
TnEEl into JBvAmc nursing continuing education. in phase one, three
Advanced Practice nurses conducted a TnEEl how-to workshop for all
JBvAmc Pain/Palliative care resource Professionals (PrPs). All PrPs
were then given three months to independently complete the six TnEEl
modules. in phase two, PrPs attended a hands-on workshop to learn
how to utilize TnEEl for practice, including developing palliative care
competencies for nurses and developing in-services for staff. in phase
three, we plan to have 20% of the nursing staff complete TnEEl. in
the fourth phase of the project, we will select four nurses to complete a
series of three palliative care courses offered by the university of illinois-
chicago college of nursing.
title:
EVIDENCE BASED PRACTICE: MEASUREMENT OF KNOWLEDGE,
ATTITUDE, SKILLS & HABITS OF PARTICIPANTS BEFORE AND AFTER A
FORMAL EBP PROGRAM.
Focus Area:
Clinical/Evidence Based Practice
Authors:
Susan Storey, RN, MSN, OCN
®
, AOCNS
®
, St. Vincent Hospital,
Indianapolis, IN; and Kathleen Hubner, MSN, RN, CNRN, St. Vincent
Hospital, Indianapolis, IN.
Content:
studies have shown that Evidence Based Practice (EBP) im-
proves outcomes by 28%; decreases costs by standardizing and stream-
lining care and implementing protocols that result in better treatment of
acute and chronic health conditions; and promotes critical thinking and
autonomy in practice. A multi-phase EBP program was developed by
the cns’s and offered to interested st. vincent Hospital associates. in
this newly developed program, there was a need to measure baseline as
well as post program knowledge, attitudes, skills and habits (KAsH) to
determine impact of the content.
To determine if a formal EBP educational program impacted the KAsH
participants held toward EBP.
Objectives:
1. Define current KAsH of st. vincent rns toward Evidence Based
Practice prior to participation in a formal EBP educational program.
2. measure the impact of a formal EBP educational program on the
KAsH of participants in the program.
using a validated EBP Questionnaire (EBPQ) with a scale of 1 (poor)
to 7 (best), program participants’ KAsH prior to and immediately follow-
ing completion of a 4 month Phase i EBP program were compared.
31 of 38 participants completed the post questionnaires (7 were lost
due to inability to fulfill class commitments). self assessment scores of
5 and above on the pre-EBPQ related to knowledge and skills ranged
from 16-63% to 61-87% resulting in p values from 0.000 to 0.031.
self assessment scores of 5 and above on the pre-EBPQ related to at-
titudes and habits ranged from 39 – 84% to 52 – 97%. While there was
no statistical significance at this time, we anticipate a greater change
over time as knowledge and skills are assimilated into attitudes and
habits.
Participants consistently rated their KAsH much higher after they com-
pleted Phase i of the program. These initial results support our hypothesis
that KAsH toward EBP may be increased by implementing a formal EBP
educational program. By understanding and learning more about EBP
and the process, nurses can become more aware of how important it is to
ask questions regarding their daily practice and the evidence supporting
it. By ensuring nursing practice is evidence based, patient outcomes can
be positively affected.
AbstrAct 2507
AbstrAct 2510
title:
IMPROVING PERSISTENT FATIGUE IN BREAST CANCER SURVI-
VORS USING A HOLISTIC GROUP-BASED MIND-BODY INTERVENTION
Focus Area:
Research Study
Authors:
Susan Appling, MS, CRNP, Mercy Medical Center, Baltimore, MD;
Susan Scarvalone, MSW, Mercy Medical Center, Baltimore, MD; Maureen
McBeth, MPT, Mercy Medical Center, Baltimore, MD; Bindu Kalesan, MSc,
MPH, Mercy Medical Center, Baltimore, MD; Lisa Gallicchio, PhD, Mercy
Medical Center, Baltimore, MD; Sandra Hoffman, MPH, Johns Hopkins
University School of Public Health, Baltimore, MD; and Kathy Helzlsouer,
MD, MHS, Mercy Medical Center, Baltimore, MD.
Content:
Persistent fatigue following breast cancer treatment affects
30 to 40% of patients. contributing factors are diverse and include
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stress, pain, sleep disturbance, depression, decreased physical activity
and menopausal symptoms. The multi-dimensional underlying etiology
of fatigue calls for broad based interventions aimed at managing stress,
improving diet and exercise patterns and short term cognitive therapy
supporting attitudinal and behavioral changes.
The purpose of this study is to test the effectiveness of a ten week holis-
tic, group-based mind body intervention to treat persistent fatigue among
breast cancer survivors. The Ons research priority topic addressed is
“identifying modifiable factors that can be targeted with interventions
to reduce the late effects of cancer treatment”.
The conceptual model guiding this study is Piper’s integrated Fatigue
model.
A quasi-experimental study design using a before/after evaluation of
change in fatigue scores was used to evaluate program effectiveness.
subjects were between six months and five years post-completion of
adjuvant chemotherapy and/or radiation therapy for breast cancer with
a baseline fatigue score of < 50 as measured by the vitality subscale of
the sF-36 Health survey. sixty-eight women entered the study but seven
dropped out after attending less than two of the ten weekly sessions. The
primary outcome assessed was change in severity of fatigue as measured
by the Piper Fatigue scale. student’s paired t test was used to measure
change in fatigue severity.
The mean age of participants was 56.8 years; 74% were caucasian
and 18% were African-American; mean time since breast cancer diag-
nosis was 2.6 years. The mean Piper Fatigue score showed improve-
ment from a score of 6.0 (sD 1.6) at baseline to 4.2 (sD 2.0) at the end
of the intervention (p<0.0001). Two months after program completion
fatigue scores continued to improve compared to baseline (mean 3.5,
sD 2.0; p<0.0001). six month follow-up data is still being collected
but for those who completed the final assessment (n=26), fatigue scores
remain significantly improved (mean 4.0, sD 1.9; p<0.0001). These
findings support the use of a holistic integrated mind body interven-
tion to reduce persistent fatigue, a common problem in breast cancer
survivors.
is provide free tobacco cessation assistance integrated with concurrent
cancer treatment. combining standard and specialized interventions, an
advanced practice nurse and addiction psychiatrist developed a clinical
treatment pathway to provide structured plans of care.
This pathway supports the interdisciplinary clinical management of
care including pharmacotherapy; behavioral therapy, motivational inter-
viewing, and supportive counseling. individualized treatment plans and
ongoing counseling are informed by an initial assessment of patients’
cancer experience, tobacco use and motivation to quit, psychosocial,
medical, mental health, and substance use histories. Evidenced-based
counseling components include: 1) promoting self-efficacy; 2) benefits
of quitting, 3) risk awareness; 4) alternative coping strategies; 5) relapse
prevention; and 6) management of cancer related distress, depression and
anxiety. Pharmacotherapy options balance current cancer therapies with
optimal tobacco cessation interventions. in-house and outside referrals
are made as indicated.
Overall treatment efficacy is based on point prevalent abstinence rates
biochemically verified with expired carbon monoxide readings post
program completion.
This clinical pathway focuses on the quality and coordination of care
and is presented as a model for future tobacco treatment programs in
comprehensive cancer centers.
AbstrAct 2519
AbstrAct 2516
title:
DEVELOPMENT OF A CLINICAL TREATMENT PATHWAY FOR A
UNIQUE TOBACCO CESSATION PROGRAM WITHIN A COMPREHENSIVE
CANCER CENTER
Focus Area:
Clinical/Evidence Based Practice
Authors:
Mary Lou Heater, MSN, APRN-PMH, BC, University of Texas MD
Anderson Cancer Center, Houston, TX; Maher Karam, MD, University of
Texas MD Anderson Cancer Center, Houston, TX; Michael Mallen, PhD,
University of Texas MD Anderson Cancer Center, Houston, TX; Mark
Evans, LCSW, University of Texas MD Anderson Cancer Center, Houston,
TX; Janice Blalock, PhD, University of Texas MD Anderson Cancer Center,
Houston, TX; and Paul Cinciripini, PhD, University of Texas MD Anderson
Cancer Center, Houston, TX.
Content:
current tobacco users or recent quitters are estimated to
comprise 24% of all patient admissions at The university of Texas mD
Anderson cancer center (uT-mDAcc).
continued tobacco use after a cancer diagnosis negatively impacts
survival rates, quality of life, and treatment efficacy. An estimated 40% of
patients continue to smoke post diagnosis. Admission to a cancer facility
has been described as a “teachable moment” yet few studies assess the
design or impact of targeted smoking cessation programs for cancer pa-
tients. Primarily aimed at general clinical practice, the u.s. Department
of Health & Human services Treating Tobacco use and Dependence
clinical Practice guideline (Fiore, 2000) offers evidenced-based recom-
mendations resulting from systematic review and analysis of scientific
literature. However, given complex treatment/medical challenges, often
including psychiatric and substance dependence co-morbidities, nicotine
dependent cancer patients may represent a unique population. Therefore,
applying general clinical guidelines may not meet their special needs.
Taking an interdisciplinary approach, the treatment team at uT-
mDAcc developed a Tobacco Treatment Program (TTP) whose goal
title:
LEPTOMENINGEAL DISEASE
Focus Area:
Education
Authors:
Christi Bowe, RN, APN, University of Texas MD Anderson Cancer
Center, Houston, TX; and TaCharra Woodard, RN, MSN, ACNP, University
of Texas MD Anderson Cancer Center, Houston, TX.
Content:
Dissemination of cancer cells to the lining of the central
nervous system, also known as leptomeningeal disease (lmD), is a
devastating diagnosis that carries a grim prognosis. About 5%-10% of
patients with metastatic cancer will develop lmD. For most, survival is
about six weeks without therapy and six months with therapy. Distress-
ing symptoms associated with lmD can include: convulsions, confu-
sion, dysphagia, diplopia, drowsiness, difficulty breathing, weakness
and numbness. These distressing symptoms can respond to nursing and
pharmaceutical interventions thus promoting patient comfort. The APn
plays a key role in identifying patients at risk for developing lmD and
recognizing signs and symptoms at early stages. Once lmD is suspected
it is important for the APn to be knowledgeable in ordering diagnostic
tests and initiating the appropriate referrals.
The purpose of this project was to enhance the APn’s competence
and proficiency in the identification and management of patients with
lmD.
A review of the literature was conducted and a neuro-oncologist
representing a renowned cancer center was interviewed as to current
clinical practices in that institution. A power point presentation was
then developed and presented to oncology APn’s. The information
contained in the presentation included the pathogenesis, signs and
symptoms, and treatment options for lmD. An algorithm was devel-
oped from the evidence based literature and was included in the pre-
sentation to guide the APn in management of the patient with lmD.
Three case studies were presented and the audience participated by
using the evidence based algorithm to suggest plans of care for the
patient. The APn who is proficient in educating the patient regarding
the disease process and therapies will be effective in partnering with
the patient in planning treatment.
After completion of presentation, surveys were collected to evaluate
effectiveness of intervention
Knowledge gained through attendance of this presentation increased
the oncology APn’s understanding and management of the patient with
lmD. Early recognition of lmD and its devastating symptoms can pro-
mote patient comfort and improve quality of life. information presented
can be translated into evidence based practice guidelines applicable to
oncology APn’s.
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AbstrAct 2521
title:
AN ANALYSIS OF THE ADVANCED PRACTICE NURSE WORK EN-
VIRONMENT
Focus Area:
Clinical/Evidence Based Practice
Authors:
Lisa Fuson, RN, MSN, ANP-C, University of Texas MD Anderson
Cancer Center, Houston, TX; Brenda Hagen, RN, MSN, FNP, University of
Texas MD Anderson Cancer Center, Houston, TX; Jana Kelley, RN, MSN,
ANP/GNP, University of Texas MD Anderson Cancer Center, Houston,
TX; Annette Bisanz, RN, MPH, CNS, University of Texas MD Anderson
Cancer, Houston, TX; and Harriett Chaney, RN, PhD, CNS, Self Employed,
Portland, OR.
Content:
The purpose of this study was to obtain information from
Advanced Practice nurses that could be used to increase awareness of
issues associated with their work environments and to support relative
improvements.
A review of the literature was performed using Pubmed utilizing key
words: advanced practice nurse, job satisfaction, and work environment.
various studies have demonstrated that nursing is a stressful occupation
with a high incidence of stress-related burnout. Difficulties in retaining
and recruiting nurses are documented.
A committee of five APn’s at The university of Texas m. D. Ander-
son cancer center was formed to assess the working environment of
APns within our facility. We e-mailed 2 surveys anonymously to 250
APns currently employed at our institution. The purpose of the first
survey was to collect data about work hours and work environment.
The follow-up survey was used to collect additional data related to
work environment. The findings were analyzed by descriptive and
inferential statistics.
Eighty-eight nurses responded to the first survey and 91 to the second
survey. Eighty-five percent of respondents reported working 41 to 60
hours/week in clinic, and 69% reported working an additional 1 to 5
hours/week at home completing administrative tasks (i.e., paperwork
and dictation). Over half reported having no designated time for profes-
sional development. Over 80% had attended conferences but had to use
vacation time. many were unaware of the institution’s policy limiting
them to a maximum of 60 work hours/week. All respondents indicated
a desire to work 40- to 50-hours/week, time during the work hours to
complete administrative tasks, and for a flexible work-hour scheduling
option. several felt that a “float pool” would provide staffing support to
allow APn’s to complete administrative tasks and pursue professional
development.
On the basis of our findings, the time allotted for professional devel-
opment has been increased, and recommendations have been made for
instituting a float pool to accommodate routine staffing requirements
and offering flexible work-hour scheduling, such as four 10-hour/day
work weeks. improvements in APns’ work environment will increase
opportunities for professional development and improve job satisfac-
tion.
As the vast majority of falls risk assessment instruments have been
developed for use in long-term care facilities, a case-control study
to determine risk factors for falls within a major cancer center was
conducted, and a new falls risk assessment instrument was devel-
oped. The PPv of the new instrument is 91%, where the PPv of the
previous instrument was 66%. A demonstration project targeting the
neurology/orthopedic unit was initiated in march 2007 and consisted
of implementing a new model of care delivery to reduce patient falls
and falls with injury.
The swiss cheese model, developed by Dr. James reason, provided
the theoretical basis for the training and subsequent care delivery chang-
es. Didactic presentations on safety and change theory, unit-specific falls
and falls with injury data, team work, accountability, communication,
and delegation were developed and presented by unit-based staff with
guidance from nursing directors. All nurses and assistive personnel
attended the day-long training. The staff spent time in small groups
studying patient scenarios to identify safety hazards and also develop-
ing a unit-specific patient safety model. staffing changes for assistive
personnel have been made based on the times of day when fall rates
were highest.
Outcome measures including falls and falls with injury rates, and pa-
tient satisfaction are being tracked prospectively as the program moves
forward. The program has been in place for one quarter, and we have
seen a decline in falls on this unit as compared to the first quarter of
2007 (16 falls vs 8).
Bringing staff together to work as a team towards this common goal is
imperative to reducing falls rates. APns are in a unique role to use their
experience and education to develop and facilitate innovative unit-based
programs to bring all staff on board and improve patient safety.
title:
A MODEL OF CARE DELIVERY TO REDUCE FALLS IN A MAJOR
CANCER CENTER
Focus Area:
Clinical/Evidence Based Practice
Authors:
Nancy Kline, PhD, RN, CPNP, FAAN, Memorial Sloan-Kettering
Cancer Center, New York, NY; Bridgette Thom, MS, Memorial Sloan-
Kettering Cancer Center, New York, NY; Wayne Quashie, MPH, RN,
Memorial Sloan-Kettering Cancer Center, New York, NY; Patricia Bros-
nan, MPH, RN, Memorial Sloan-Kettering Cancer Center, New York, NY;
and Mary Dowling, MSN, RN, Memorial Sloan-Kettering Cancer Center,
New York, NY.
Content:
Falls are a leading cause of injuries sustained by hospitalized
patients. injuries sustained as result of patient falls in a cancer hospital
are often severe, due to the nature of the underlying medical condition.
These can include predisposition for fractures due to bony metastases,
or uncontrollable bleeding from thrombocytopenia or medications used
to prevent deep vein thrombosis.
AbstrAct 2522
title:
IT TAKES A VILLAGE: DEVELOPMENT OF A MULTIDISCIPLINARY
HEAD AND NECK SUPPORTIVE CARE PROGRAM
Focus Area:
Clinical/Evidence Based Practice
Author:
Wendy Crabbe, RN, MSN, AOCN
®
, Cancer Therapy & Research
Center, San Antonio, TX.
Content:
The American cancer society estimates that in 2007 more
than 24,180 men and 10,180 women will be diagnosed with head and
neck cancer (Acs, cancer Facts & Figures, 2007). surgery is the main
treatment for those patients with localized node negative disease; but
pts with recurrent or locally advanced disease often receive combined
modality treatment with chemotherapy and radiation therapy. Advanced
practice oncology nurses (APn’s) play a key role in preparing patients
and educating them in how to manage and cope with the many and
severe symptoms that can occur as the result of combined modality
treatment.
The national comprehensive cancer network (nccn) guidelines for
the treatment of head and neck cancer has a list of multidisciplinary team
members needed to get the head and neck cancer patient through this dif-
ficult treatment; however, the literature is lacking in information about the
supportive care issues that face this patient population as they proceed with
multi-modality treatment. Our multidisciplinary team includes: EnT sur-
geons, radiation oncologists and nurses, medical oncologists and advanced
practice nurses (APn’s), dentists, psychologist, and dietician.
A pre-treatment checklist was developed by the APn to ensure patients
had everything they needed prior to therapy. After working with head
and neck cancer patients for over a year, a clinically evident pattern
emerged of side effects that developed and intensified just before the
second cycle of chemotherapy; such as mucositis, weight loss, difficulty
and painful swallowing, thick, ropy sputum, fatigue, and difficulty cop-
ing with symptoms. The APn now meets with patients once a week to
manage symptoms and call in other team members such as the dietician
as needed. Documentation of symptom management issues and sharing
documentation with the team is essential.
Weekly visits with an APn along with seeing other multidisciplinary
team members regularly keeps patients on track and enables them to
AbstrAct 2528
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have the supportive care they need to finish their treatments and prolong
their survival.
creating a village or a multidisciplinary head and neck supportive care
program is essential in the management of head and neck cancer patients
receiving combined modality treatment.
title:
PROTOCOL TO MANAGE VASOMOTOR SYMPTOMS OF WOMEN
WITH DUCTAL CARCINOMA IN SITU RECEIVING TAMOXIFEN
Focus Area:
Clinical/Evidence Based Practice
Authors:
Carol Bell, RN, BSN, Stanford University Hospital, Stanford,
CA; Christine Schurman, RN, BSN, MSNc, Stanford University Hospital,
Stanford, CA; and Jane Bryce, MSN, Istituto Nazionale Tumore di Pascali,
Naples, IT.
Content:
The rate of Ductal carcinoma in situ (Dcis) has increased
as more women get annual screening mammograms. Dcis now ac-
counts for 20% of newly diagnosed breast cancers. standard treat-
ment of Dcis is surgery, radiation, and adjuvant tamoxifen (TAm)
for 5 years. vasomotor symptoms (vms), predominantly hot flushes
(HF) are problematic for women receiving TAm. studies show that
HF effect over 60% of women on TAm. no single therapeutic option
has proven uniformly successful treating vms. Women experiencing
vms side effects from TAm are less likely to maintain the treatment
regimen over 5 years. Duration of TAm therapy is directly correlated
to decreased breast cancer events and increased disease free survival
rates, attention must be given to relief of HF to promote compliance
with five-year TAm treatment regimen.
The purpose of this protocol is to establish practice guidelines for
nurse practitioners to treat vasomotor symptoms in women with Dcis
on TAm to keep women on treatment over the recommended five-year
period.
A comprehensive search of medline, cinAHl, and Pubmed was
undertaken to identify relevant studies of non-hormonal, pharmacologic
and non-pharmacologic treatments of vms. using current research of
published literature we have written a protocol for the evaluation, treatment
and management of vms of women with Dcis on TAm. The review of
the literature is presented in an Evidence Table with a treatment algorithm
identifying the weight of evidence classification of specific therapies.
This protocol aims to ensure compliance with therapy by minimizing
HF frequency and severity to maintain optimal quality of life.
Therapies evaluated are from studies showing statistical difference
reducing HF. since many breast cancer survivors are interested in non-
pharmacological management evaluations of alternative therapies were
included regardless of statistical significance as long as the treatment
was considered safe. intervention with gabapentin and venlaxifine
reduce HF in a significant number of women and are recommended
for practice. Alternative treatments with acupuncture, hypnosis, and
relaxation therapy hold promise and need further study, but are likely
effective treatments for HF.
AbstrAct 2529
* is genetic testing appropriate?
* What is the role of mri as a screening tool?
* What can be done in the area of prevention and early detection?
A model, developed at a breast care center in a tertiary care teaching
hospital in the midwest, reflects a practice that allows interdisciplin-
ary collaboration of the APns, genetic counselor, radiologist, and
Primary care Physician (PcP).
Beginning with a targeted phone assessment, patient information is
gathered to direct the course of the patient through the interdisciplin-
ary model of care. A personal surveillance plan is developed for each
patient based on personal and family history, physical examination,
breast imaging findings and psychosocial needs. consideration for
genetic counseling, testing, chemoprevention and prophylactic surgery
is individualized. central to the model is education and psychologi-
cal support. The goal of this model is to provide each patient with an
individualized, risk appropriate surveillance plan. At the “hub” of the
model, are the interventions and focused education provided to the pa-
tient by the APn. if the patient does not have a PcP, or wishes focused
breast care clinical follow up, the APn can continue to see the patient
on a regular basis for continued evaluation.
Patient compliance with clinical management and early recognition
of changes in clinical findings are the outcomes measured in such a
model program.
The APn plays a pivotal role in identifying and meeting the needs
patients at high risk for breast cancer. A model program that utilizes
interdisciplinary roles assures the development of individualized per-
sonal surveillance plans for breast cancer screening, and maximizes
patient compliance and clinical outcomes.
AbstrAct 2530
title:
HIGH RISK BREAST CANCER SCREENING: THE APN ROLE
Focus Area:
Clinical/Evidence Based Practice
Authors:
Anna Purdy, RN, MSN, APRN, BC, Medical College of Wiscon-
sin, Milwaukee, WI; and Julie Griffie, APRN,BC,CS, Froedtert Lutheran
Memorial Hospital, Milwaukee, WI.
Content:
APns that practice in breast care centers have unique
knowledge of breast cancer risk, surveillance, and chemoprevention.
in 2007, over 178,480 women will be diagnosed with breast cancer in
the united states. Advanced imaging technologies, increased emphasis
on the role of family history, genetic testing, risk scale utilization, and
opportunities for breast cancer prevention are areas that women are
requesting personal implications of and guidance for their individual
breast cancer surveillance plan. Providers must determine:
* Who is at greater risk?
* How is risk determined?
title:
BREAKING UP THE MONOTONY: PROTOCOL SPECIFIC PATIENT
EDUCATION PATHWAYS
Focus Area:
Education
Author:
Christine Rimkus, RN, MSN, AOCN
®
, Barnes-Jewish Hospital,
St. Louis, MO.
Content:
Educating blood and marrow transplant (BmT) patients
can be challenging. The challenges include the need to communicate
complicated information coupled with the emotional aspect of a life
threatening treatment. An additional factor is the known cognitive
dysfunction encountered by patients receiving high dose chemotherapy.
This cognitive dysfunction has been described as similar to attention
deficit disorder causing difficulty concentrating and remembering
information. yet another challenge is the variability of information
given by the nursing staff.
The purpose of this project was to develop patient education that was
appropriate for BmT patients as well as easy to administer by the staff.
given these challenges, the clinical nurse specialist on a 26 bed
BmT unit initiated a systematic education process. A protocol specific
education pathway was developed for the most common BmT proto-
cols. The goal of an education pathway is to standardize education
as well as to distribute the education throughout the hospital stay on
a need to know basis. The day before a new procedure, treatment, or
medication is started, a teaching sheet is given to the patient. The nurses
review the teaching sheets with the patients to ensure understanding.
To streamline the process for the nurses, packets are pre-assembled in
the order of distribution and on admission are placed on the patients
working clipboard. All teaching sheets are written at a 6th grade or
lower reading level. The education topics were purposely brief and to
the point having no more than four pages per subject.
staff and patients have evaluated the new education process and their
suggestions for improvement have been incorporated. Patients feel that
it is very helpful to get the information as needed instead of all at one
time. One patient commented that she knew that if she received all
sheets at once, she would have read it all but not remembered anything.
The nursing staff feels that the process is easy and has standardized
the education process.
AbstrAct 2531
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This process can be adapted to other general oncology admissions
such as pain control, nausea/vomiting/dehydration and for standard
chemotherapy admissions.
title:
“TELL ME YOUR STORY”: USE OF AN EXPLANATORY MODEL IN
NURSING EDUCATION
Focus Area:
Education
Authors:
Genevieve Hollis, CRNP, MSN, AOCN
®
, BC, University of
Pennsylvania School of Nursing, Philadelphia, PA; Janet Deitrick, PhD,
FAAN, RN, University of Pennsylvania School of Nursing, Philadelphia,
PA; Kim Mooney-Doyle, MSN, CRNP, CPON
®
, University of Pennsyl-
vania School of Nursing, Philadelphia, PA; Catherine Barrell, MSN,
NP, CPON
®
, Morgan-Stanley Childrens Hospital, New York, NY; and
Beth Storey, MSN, CRNP, CPON
®
, Childrens Hospital of Philadelphia,
Philadelphia, PA.
Content:
A gap in published curriculum guidelines for undergraduate
oncology nursing education exists regarding synthesis of bio-medical
aspects of disease with critical cultural and psychosocial competencies.
This deficit was highlighted in student evaluations of an undergraduate
cancer case study at the university of Pennsylvania school of nursing
which revealed significant anxiety when communicating with cancer
patients and families and attempting to provide psychosocial support.
To address this striking need, the advanced practice nurses (APns) co-
ordinating this course decided to incorporate Kleinman’s Explanatory
model (Em) into the courses didactic, clinical experiences, and evalua-
tion methods. This clinical anthropological assessment model has been
used in clinical practice and research to elicit a patient’s personal beliefs
and perceptions regarding the illness experience which are influenced by
ethnicity, social environments, past experiences, and personal knowledge.
Eliciting personal beliefs and perceptions may enhance the patient-
provider relationship and facilitate the development of treatment plans
that are tailored to the patient’s Em with the goal of increased adherence
and improved outcomes
To describe the impact of integrating an Em into an undergraduate
cancer case study on students understanding of the patients and families’
personal beliefs/perceptions regarding the cancer experience, comfort
communicating with patients and families, ability to provide psychoso-
cial support, and future nursing practice
use of an Em in leading discussions with a panel of cancer patients
and families, analysis of fine arts/literature/videos, and guiding student
interviews with cancer patients and families. interviews were analyzed
in self-reflective clinical logs and shared during case presentations
Analysis of pre- and post- course surveys and significant themes
extrapolated from student’s clinical logs indicated that students had
significantly increased knowledge of Ems, heightened insight into the
beliefs/perceptions of cancer patients and families, increased comfort
in eliciting beliefs/perceptions of health and illness and communicating
with patients and families across the illness continuum, and anticipated
using Em in future nursing practice
integration of an Em into an undergraduate cancer case study by APns
is feasible and enjoyable with many positive outcomes experienced by
students. recommendations include expanding classroom opportunities
for students to further develop competency in tailoring interventions
based upon assessment of personal beliefs/perceptions
AbstrAct 2532
a prospective, 10 patient trial to assess the practical implementation of
the consensus treatment algorithm from this meeting.
Objectives: To confirm that the algorithm is effective in treating
erlotinib-induced rash.
methods: The patient’s skin was evaluated at baseline, 2 weeks and
4 weeks after starting the drug. The consensus group recommended
patients should moisturize dry areas of the body twice a day with a thick
alcohol-free emollient and minimize exposure to sunlight. A physical
sunscreen (zinc oxide or titanium oxide) with an sPF ¡Ý 15 should be
applied 1¨c2 hours prior to sun-exposure. should dermatologic toxicity
occur, a three-tiered, toxicity grading system is proposed, allowing the
development of the following step-wise treatment algorithm. mild toxic-
ity: generally localized rash that is minimally symptomatic, with no sign
of superinfection; no impact on daily activities; not requiring intervention
but may be treated with topical hydrocortisone (1% or 2.5% cream) or
clindamycin (1% gel). moderate toxicity: generalized rash, accompanied
by mild pruritus or tenderness; minimal impact upon daily activities; no
signs of superinfection; treated with either hydrocortisone (2.5% cream),
clindamycin (1% gel), or pimecrolimus (1% cream), with the addition of
doxycycline or minocycline (100 mg PO BiD). severe toxicity: general-
ized rash, accompanied by severe pruritus or tenderness; has a significant
impact upon daily activity; has the potential for superinfection. Treat as
for moderate toxicity with the addition of methylprednisolone dose pack.
A reduction in the dose of EgFri is also recommended for severe symp-
toms, in accordance with prescribing information. if the dermatologic
symptoms do not abate, interruption of EgFri therapy is recommended,
but should be restarted once the cutaneous reactions have sufficiently
diminished in severity.
results: This trial will run from June to september 2007. currently 1
patient has been entered into the study. The final patient will be enrolled
by October 1st, 2007 and the results will be available in October 2007.
The implications and suggestions are in the algorithm.
title:
MANAGING ERLOTINIB-INDUCED RASH IN NSCLC PATIENTS; A
PRACTICAL ASSESSMENT OF A PROPOSED ALGORITHM
Focus Area:
Clinical/Evidence Based Practice
Author:
Beth Eaby, MSN, CRNP, OCN
®
, Hospital of the University of
Pennsylvania, Philadelphia, PA.
Content:
introduction: in October 2006, at an EgFri dermatologic
toxicity forum, the underlying mechanisms of EgFri induced toxicities
were discussed and existing therapeutic interventions evaluated. This is
AbstrAct 2536
title:
SAFETY CONSIDERATIONS FOR TEMSIROLIMUS (TORISEL™),
A NOVEL INHIBITOR OF MAMMALIAN TARGET OF RAPAMYCIN, IN
THE TREATMENT OF PATIENTS WITH ADVANCED RENAL CELL CAR-
CINOMA
Focus Area:
Clinical/Evidence Based Practice
Author:
Susan Roethke, CRNP, MSN, AOCN
®
, APRN, BC, Fox Chase Cancer
Center, Philadelphia, PA.
Content:
Temsirolimus, a novel mammalian target of rapamycin
(mTOr) inhibitor, was recently approved by the us Food and Drug
Administration for first-line treatment of advanced rcc. As a central
regulator of the cell cycle and tumor angiogenesis, mTOr is a rational
target for treatment of rcc.
This presentation introduces oncology nurses to the potential adverse
reactions of temsirolimus, as well as important monitoring and manage-
ment considerations.
Temsirolimus is administered weekly as a 25-mg intravenous infusion
lasting between 30 and 60 minutes.
in the pivotal trial, temsirolimus significantly prolonged overall sur-
vival (P=.008) and progression-free survival (P<.001) compared with
interferon alpha, a standard treatment, in previously untreated patients
with advanced rcc and poor-prognostic features (Hudes et al. n Engl
J med 2007;356:2271). The percentage of patients with severe adverse
events was lower with temsirolimus than with interferon alpha (P=.02),
and fewer dose reductions or discontinuations due to adverse events
were required. more temsirolimus patients developed mild-to-moderate
rash, peripheral edema, stomatitis, hyperglycemia, hypercholesterolemia,
and hypertriglyceridemia than interferon patients, whereas asthenia was
more common with interferon. Hematologic abnormalities (anemia,
thrombocytopenia, leukopenia, and neutropenia) were also reported with
temsirolimus. laboratory abnormalities, besides increased glucose and
lipids levels, included hypokalemia, hypophosphatemia, and elevated
aspartate aminotransferase, alkaline phosphatase, and creatinine levels.
AbstrAct 2539
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most laboratory abnormalities associated with temsirolimus were meta-
bolic in nature and hence were manageable without negatively impacting
quality of life. Hypersensitivity reactions, pneumonitis, and renal failure
were uncommon but clinically significant adverse reactions in patients
receiving temsirolimus.
Despite pretreatment with diphenhydramine, patients should be moni-
tored closely for hypersensitivity reactions during temsirolimus infusions;
most are low grade and rarely cause treatment discontinuation. Patients
who experience hypersensitivity may require famotidine or ranitidine and
a slower infusion rate. cimetidine should be avoided because of potential
pharmacologic interactions. routine monitoring should include complete
blood counts, lipid profiles, serum chemistries, and comprehensive
patient assessment. Patients should be monitored for hypokalemia and
hypophosphatemia and repleted as needed. Temsirolimus is a promising
new treatment option for patients with advanced rcc. it is important
that oncology nurses know how to monitor and manage potential side
effects to ensure safe administration and optimal care.
title:
KIDNEY CANCER SURVIVORS: A CLINICAL MODEL FOR FOLLOW-
UP CARE
Focus Area:
Clinical/Evidence Based Practice
Author:
Mary Schoen, CRNP, MPH, OCN
®
, Memorial Sloan Kettering
Cancer Center, New York, NY.
Content:
Kidney cancer, the third most common urological malignancy
will be diagnosed in an estimated 51, 190 Americans in 2007. Over the
past ten years, there has been an increased detection in small renal tumors,
such that 70% of these tumors are less than 4 cm. This phenomenon is
partially explained by the number of incidental tumors detected as a result
of the widespread use of abdominal imaging modalities. Earlier diagno-
sis, improved staging and refinement in surgical technique have made it
possible to tailor treatment to select patients, improving 5-year survival
to over 90%. Kidney cancer survivors require periodic evaluation of their
kidney function, surveillance for recurrence, and monitoring for risk factors
including cigarette smoking, obesity, and hypertension.
in response to the growing number of survivors, our institution ex-
panded its established prostate cancer survivorship program to include
kidney cancer survivors with localized disease. in addition to the routine
surveillance for patients who have undergone either a partial or radical
nephrectomy, the survivorship program offers services with an emphasis
on wellness and cancer prevention. A nurse practitioner with training in
survivorship is the independent care provider.
Patients are referred to the survivorship program at 1 year post surgery
for ongoing surveillance that includes a history with physical examination,
serum chemistries, and radiological testing. This program has a well-
ness component utilizing national screening recommendations, such as
colonoscopy, PsA testing, cervical cancer evaluation and mammography.
Preventive health practices including weight loss and exercise are encour-
aged. After each visit, a follow-up letter is sent to the local physician with
a copy of the physical examination, plus any recommendations.
in the first year of the program 86 patients were referred and seen by
the survivorship nP. The patients ranged in ages from 42 to 84 with
over 75% of the patients undergoing renal sparing surgery, also known
as partial nephrectomy.
The incidence of kidney cancer is growing and will most likely continue
to expand because of the aging of the population and the increase in comor-
bid conditions associated with kidney cancer. Advanced practice oncology
nursing care is critical in providing care to kidney cancer survivors.
AbstrAct 2542
Content:
The role of the APn has a responsibility to provide educa-
tional opportunities about the special needs of the oncology population
to both licensed and unlicensed nursing personnel.
An educational program was developed based on the basic premise that
the nursing assistant needed to understand the physiological processes,
as well as how to function as a strong team member, and support both
the patient and nursing. caring for the physical and emotional needs
of the oncology patient and family, requires an understanding of the
disease itself and the symptoms patients experience as a result of the
treatment process.
A series of four classes were developed to educate on topics of cancer,
treatment modalities, symptom management, skin care, nutritional needs,
respiratory therapy, spiritual needs, professional development, teamwork,
and end of life issues. Each class was a four hour session which included
didactic and lab. There was a post test at the end of each class over the
material presented that day and homework assigned for the next session.
There was also a cumulative test completed after the last class.
Evaluation of the effectiveness of the classes will be reviewed both
through the tracking of patient satisfaction scores and through manage-
ment evaluations of the participating staff.
The advanced practice nurse is charged with the responsibility of being
both a role model and a resource to the oncology staff and patients. The
nursing assistants that completed the first four sessions received a certifi-
cate stating they were Duke trained Oncology nursing Assistants and a
pin of recognition. Oncology staff nurses were included as instructors in
some of the classes and made aware of their role in providing leadership
and support to all members of the oncology team. By providing learning
opportunities for the oncology nursing assistants, they have become more
interested in continuing to learn and a small group is interested in receiv-
ing national certification from HPnA within the next year. The APn role
is to provide pathways for growth of oncology personnel and promote
optimal care for oncology patients and support for their families.
title:
TOOLS FOR LEARNING FOR OUR ONCOLOGY NURSING ASSIS-
TANTS
Focus Area:
Education
Authors:
Laura Houchin, MSN, RN, OCN
®
, Duke University Hospital, Dur-
ham, NC; and Katrina Green, BSN, RN, OCN
®
, Duke University Hospital,
Durham, NC.
AbstrAct 2547
title:
ADVANCED PRACTICE ONCOLOGY CERTIFICATION: ROLE SPECIFIC
EXAMINATIONS
Focus Area:
Research Study
Authors:
Julie Ponto, RN, APRN-BC, AOCN
®
, Winona State University,
Master’s Program in Nursing, Rochester, MN; and Cyndi Miller Murphy,
MS, RN, CAE, Oncology Nursing Society, Pittsburgh, PA.
Content:
since January 2005, the Oncology nursing certification
corporation has administered two advanced practice exams. The de-
velopment of these exams was based on a role delineation study of 525
advanced practice oncology nurses which revealed that while overlap
exists among advanced practice roles in oncology, sufficient differences
in the roles exist and warranted separate examination blueprints.
The purpose of this abstract is to describe the role delineation study
which led Oncc to develop two advanced practice exams, and describe
the status of advanced practice certification in oncology to date, includ-
ing, number of current certificants, pass rates and qualitative data regard-
ing the examination and process.
A role delineation study (rDs) is a commonly used framework de-
signed to obtain descriptive information about job activities and knowl-
edge required to adequately perform those activities. Oncc contracted
with The chauncey group international, an expert in rDs, to conduct
survey development and dissemination, compilation of results and test
specifications development.
A role delineation study is conducted at least every five years in ac-
cordance with Oncc policy. A role survey was developed based on
the past survey and content expert interviews and meetings to update
content. A pilot survey was administered to 20 oncology APn’s. The
final survey was distributed to 4447 oncology APn’s and completed by
565 nurses, for a total sample of 625 including content experts. results
were analyzed using descriptive statistics and t-tests for differences
between nP and cns practice groups. Based on these findings, two test
blueprints were developed.
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While oncology nP’s and cns’s share a common knowledge base, sta-
tistically significant differences exist among certain work responsibilities.
These are reflected in the two test blueprints. To date, 495 individuals
have taken the AOcnP
®
exam and the AOcns
®
exam has been admin-
istered to 221 individuals. currently there are 412 AOcnP
®
s and 174
AOcns
®
s. For the past 2 years, the average pass rate for the AOcnP
®
exam was 82% (range 76% - 88%) and for the AOcns
®
exam was 72%
(range 61% - 84%). Qualitative data from satisfaction surveys reflect
very favorable responses to the exams overall. The exams will continue
to be updated based on future role delineation studies.
title:
DEVELOPING ONCOLOGY CNS AND NP COMPETENCIES
Focus Area:
Clinical/Evidence Based Practice
Authors:
Julie Ponto, RN, APRN-BC, AOCN
®
, Winona State University,
Master’s Program in Nursing, Rochester, MN; Cyndi Miller Murphy, MS,
RN, CAE, Oncology Nursing Society, Pittsburgh, PA; and Barbara Sigler,
MNEd, RN, Oncology Nursing Society, Pittsburgh, PA.
Content:
Defining oncology cns and nP practice through basic com-
petencies for each role can lead to standardized oncology APn regulation,
education and practice. While Ons previously published documents de-
scribing standards of advanced oncology practice, role specific competen-
cies are needed to clearly describe current cns and nP practice. clearly
describing role competencies for cns’s and nP’s in oncology will promote
role clarity, provide competency goals for students and may be used by
employers to determine competency standards for cns’s and nP’s.
The purpose of this initiative was to develop oncology cns and nP
role competencies using a national validation and consensus process.
A taskforce including oncology cns and nP educators and practitio-
ners, Ons staff, and representatives from the American Association of
colleges of nursing (AAcn), national Association of clinical nurse
specialists and national Organization of nurse Practitioner Faculties
was convened to review existing advanced practice standards and com-
petency documents and draft oncology specific competencies for each
role. These draft competencies are put through a national vetting process
prior to final publication. Progress to date for each of the role competen-
cies will be described.
Oncology cns and nP competencies are being developed with consid-
eration to existing and developing cns and nP competency documents.
comments received during each phase of the vetting process will be
reviewed and revisions made based on consensus.
Once developed, oncology cns and nP role competencies will pro-
vide important information for educators, practitioners and regulators
and will be a useful guide for future advanced oncology practice. role
competencies will be reviewed and updated on a regular basis to ensure
consistency with current advanced oncology practice.
AbstrAct 2549
The 2007 Ons common Data Elements (cDE) project team was con-
vened to begin to identify and define cDE and instruments that measure
nursing sensitive patient outcomes (nsPO), as well as to begin devel-
opment of policies and procedures for oncology nursing data sharing,
collection and storage. APns must effectively manage nsPOs because
they represent the consequences or effects of nursing interventions and
result in changes in patients’ symptom experience, functional status,
safety, psychological distress, and/or costs. Establishing a data reposi-
tory as a resource for APns through identification of a set of cDEs and
instruments can accelerate the translation of evidence into practice and
facilitate the demonstration of the impact of APn interventions on qual-
ity cancer care.
Building on work done by the Ons PEP (Putting Evidence into Prac-
tice) project team and data collections organized and implemented by
other national groups, the cDE project team defined the cDEs for a pilot
project that will determine the feasibility of using cDEs and instruments,
data capture, analysis, and data sharing.
The focus of this pilot program will be to test the outcomes based on
PEP-defined interventions on patient outcomes and the development of
an oncology data repository. The project team will describe the devel-
oping system for collection of cDEs and the roles for involvement in
collecting and using the data.
The leadership role of APns in clinical, education and research settings
will impact the use of the oncology cDEs and is essential for successful
measurement of the impact of nursing interventions.
AbstrAct 2551
title:
USING COMMON DATA ELEMENTS TO DESCRIBE ONCOLOGY
PRACTIC OUTCOMES
Focus Area:
Clinical/Evidence Based Practice
Authors:
Dorothy Dulko, PhD, RN, MS, NP, Memorial Sloan Kettering
Cancer Center, Manhattan, NY; Christopher Friese, PhD, RN, AOCN
®
, Dana
Farber/Harvard Cancer Center, Boston, MA; Regina Cunningham, PhD, RN,
AOCN
®
, Cancer Institute of New Jersey, New Brunswick, NJ; Diane Otte,
RN, MS, OCN
®
, Mayo Clinic, La Crosse, WI; and Linda Jones, DNS, RN,
AOCN
®
, Memorial Health System, Springfield, IL.
Content:
Advanced practice nurses (APn) in oncology care have the
potential to impact outcomes for patients, families, and institutions.
The measurement of outcomes in APn practice requires identifying the
outcomes most influenced by a specific APn role or area of specializa-
tion. careful consideration of the current outcome measures and ease
of measurement is imperative. There are many outcomes that can be
used to evaluate the impact of APn care, but no one set of measures is
appropriate for all APn settings.
AbstrAct 2550
title:
CLINICAL PRACTICE REVIEW: UTILIZING EVIDENCE-BASED
PRACTICE TO DEVELOP STANDARDS OF CARE FOR CANCER PATIENTS
ACROSS THE SPECTRUM
Focus Area:
Clinical/Evidence Based Practice
Author:
Christine Rimkus, RN, MSN, AOCN
®
, Barnes-Jewish Hospital,
St. Louis, MO.
Content:
Ensuring that care is consistent throughout the healthcare
continuum can be challenging in a large cancer center. At one large com-
prehensive cancer center, inconsistencies in care of immune-suppressed
patients existed among care settings. Patients expressed confusion and
frustration over the inconsistencies. in an attempt to standardize practice
across the care continuum, the clinical nurse specialist (cns) initiated
a meeting among the 5 inpatient oncology nursing units, the discharge
coordinators, the infection control liaison the outpatient infusion center,
and the outpatient nurse coordinators.
The purpose is to ensure that care is consistent across the spectrum of
a large comprehensive cancer center.
The cns reviewed the evidence-based literature on care of the
immune-suppressed BmT patient in various care settings as well as
reviewed the national comprehensive cancer network (nccn) and
centers for Disease control (cDc) guidelines for infection control
in BmT patients. The group looked at the evidence and discussed the
specific issues each care setting encountered. consistent guidelines
that are evidenced based were adopted. The staff in each care setting
was educated using sample scripting. Printed patient education mate-
rial was also reviewed to ensure that it reflected the newly established
guidelines. The group then identified the need to review the new
evidence on immunizing BmT patients set by the European group
for Blood and marrow Transplantation (EBmT). new immunization
recommendations were presented to the physician group and adopted
as well. The group was energized by the accomplishments and opted
to continue meeting bimonthly to review all practice standards that
cross the care continuum.
This meeting not only accomplished the desired endpoint to incorporate
evidenced-based practice across care settings, but it also brought the
group together collegially to discuss other practice issues.
The group has now taken on the PEP cards as task to develop standards
of care in oncology. mucositis and skin care standards are the first to be
completed based on evidence-based guidelines.
OncOlOgy nursing FOrum – vOl 34, nO 6, 2007
1247
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Poster Session Author Index
Appling
Bell
Bowe
Cai
Crabbe
Dulko
Eaby
Fuson
Gobel
Heater
Houchin
Hollis
Kline
Madsen
Moore
Narus
Ponto
Ponto
Purdy
Rimkus
Rimkus
Roethke
Shoen
Storey
Tiffen
Towler
2510
2529
2519
2499
2528
2550
2536
2521
2497
2516
2547
2532
2522
2480
2488
2501
2548
2549
2530
2551
2531
2539
2542
2507
2506
2490
Improving Persistent Fatigue in Breast Cancer Survivors Using a Holistic Group-Based Mind-Body Intervention
Protocol to Manage Vasomotor Symptoms of Women with Ductal Carcinoma in Situ Receiving Tamoxifen
Leptomeningeal Disease
Proton Therapy as a Cancer Treatment Option
It Takes a Village: Development of a Multidisciplinary Head and Neck Supportive Care Program
Using Common Data Elements to Describe Oncology Practic Outcomes
Managing Erlotinib-Induced Rash in NSCLC Patients; A Practical Assessment of a Proposed Algorithm
An Analysis of the Advanced Practice Nurse Work Environment
Evidence Based Practice: Development of a Plan for the Early Detection and Intervention for Delirium in Patient
With Cancer
Development of a Clinical Treatment Pathway for a Unique Tobacco Cessation Program Within a Comprehensive
Cancer Center
Tools for Learning for Our Oncology Nursing Assistants
“Tell Me Your Story.” Use of an Explanatory Model in Nursing Education
A Model of Care Delivery to Reduce Falls in a Major Cancer Center
Developing a Multidisciplinary Prostate Cancer Clinic for the Newly Diagnosed Prostate Cancer Population—
Defining the Role of an Oncology APN
Supporting Evidence-Based Practice via an Interactive Website for Nurses Caring for Patients with Colorectal
Cancer
Getting to the Point: Penile Rehabilitation With Intracavernosal Injection Therapy Post-Prostatectomy
Advanced Practice Oncology Certification: Role Specific Examinations
Developing Oncology CNS and NP Competencies
High Risk Breast Cancer Screening: The APN Role
Clinical Practice Review: Utilizing Evidence-Based Practice to Develop Standards of Care for Cancer Patients
Across the Spectrum
Breaking Up the Monotony: Protocol Specific Patient Education Pathways
Safety Considerations for Temsirolimus (Torisel™), a Novel Inhibitor of Mammalian Target of Rapamycin, in
the Treatment of Patients with Advanced Renal Cell Carcinoma
Kidney Cancer Survivors: A Clinical Model for Follow-up Care
Evidence Based Practice: Measurement of Knowledge, Attitude, Skills & Habits of Participants Before and After
a Formal EBP Program
Implementation of a Hospital-Based End-of-Life Nursing Continuing Education Program
So You Found a Breast Mass
OncOlOgy nursing FOrum – vOl 34, nO 6, 2007
1248