Education of the advanced practice nurse in oncology.

PURPOSE/OBJECTIVES: To review the education of the advanced practice nurse (APN) with a focus on curriculum and issues related to the oncology specialization. DATA SOURCES: The State-of-the-Knowledge Conference on Advanced Practice in Oncology Nursing, journal articles, monographs, and authors' personal experiences. DATA SYNTHESIS: APN education is a current issue in nursing, as well as in the specialty of oncology nursing. Current trends in the delivery of health care require reform of graduate education in nursing to better prepare APNs to shape and respond to the healthcare needs of the public along the entire cancer care continuum. CONCLUSIONS: APN education remains a dynamic, ever-evolving enterprise. The Oncology Nursing Society (ONS) and the American Cancer Society (ACS) have taken a proactive stand on APN education by revising master's curriculum guidelines and supporting the conference. IMPLICATIONS FOR NURSING PRACTICE: APN education in oncology will be an ongoing area of exploration for both ONS and ACS, as well as for leaders in oncology nursing. Development of graduate, postgraduate, and continuing education programs at the APN level of expertise will support high-quality advanced practice in oncology nursing. The feedback mechanisms among practice, education, and research will provide educational programs that will make a difference in the care of patients with cancer.

Determinants of home versus hospital terminal care for patients with gynecologic cancer.

BACKGROUND: This study reviewed all patients managed by the Gynecologic Oncology service of a tertiary care facility (n = 468) whose deaths occurred between 1980 and 1990 to ascertain the site of death and potential factors affecting whether patients died at home or in a hospital. METHODS: Gynecologic Oncology Tumor Registry data were analyzed for patient diagnosis, age at diagnosis, age at death, marital status, insurance coverage, and year of death in relation to location of death. RESULTS: This study found that 78% of patients died in the hospital, and 22% died at home. The mean terminal hospital stay was 15 days. The variables examined in this study could only accurately predict location of death in 59% of the cases. Examination of the variable year of death, however, demonstrated that the likelihood of death in the hospital generally increased from 1980 to 1990, despite introduction of diagnosis related groups and aggressive efforts by caregivers to facilitate and encourage death at home. CONCLUSIONS: Philosophical and economic considerations to the contrary, a significant majority of terminal patients with gynecologic cancers will die in a hospital, thus extensively utilizing our limited health resources.