Developing a Provincial Cancer Patient Navigation Program Utilizing a Quality Improvement Approach. Part Three: Evaluation and Outcomes.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement (QI) project to develop, implement, and evaluate a provincial Cancer Patient Navigation (CPN) program spanning 15 sites across over 600,000 square kilometres. This project was selected for two years of funding (April 2012-March 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process (ACF, 2015). A series of articles has been created to capture the essence of this quality improvement (QI) project, the processes that were undertaken, the standards developed, the education framework that guided the orientation of new navigator staff, and the outcomes that were measured. The first article in this series focused on establishing the knowledge base that guided the development of this provincial navigation program and described the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites. The second article delved into the education framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into cancer patient navigator roles and how this framework evolved to support navigators from novices to experts. This third and final article explores the evaluation approach used and outcomes achieved through this QI project, culminating with a discussion section, which highlights key learnings, and subsequent steps that have been taken to broaden the scope and impact of the provincial navigation program.

Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part one: Designing and implementing.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement project to develop, implement, and evaluate a provincial navigation program spanning 15 sites across over 600,000 square kilometres. This project was selected for two years of funding (April, 2012-March 31, 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process. A series of articles has been created to capture the essence of this quality improvement project, the processes that were undertaken, the standards developed, the educational framework that guided the orientation of new navigator staff, and the outcomes that were measured. This first article in the series focuses on establishing the knowledge base that guided the development of this provincial navigation program and describing the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites. The second article in this series will delve into the educational framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into the newly developed cancer patient navigator roles. The third and final article will explore the outcomes that were achieved through this quality improvement project culminating with a discussion section highlighting key learnings, adaptations made, and next steps underway to broaden the scope and impact of the provincial navigation program.

Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part two: Developing a Navigation Education Framework.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement project to develop, implement, and evaluate a provincial cancer navigation program spanning 15 sites across more than 600,000 square kilometres. This project was selected for two years of funding (April 2012-March 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process (ACF, 2015). A series of articles has been created to capture the essence of this quality improvement (QI) project, the processes that were undertaken, the standards developed, the education framework that guided the orientation of new navigator staff, and the outcomes that were measured. The first article in this series focused on establishing the knowledge base that guided the development of this provincial navigation program and described the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites (Anderson et al., 2016). This article, the second in the series, delves into the education framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into cancer patient navigator roles and how this framework has evolved to support navigators, as they move from novice to expert practice. The third and final article will explore the outcomes that were achieved through this quality improvement project culminating with a discussion section highlighting key learnings, adaptations made, and next steps underway to broaden the scope and impact of the provincial navigation program.

Designing and implementing an ambulatory oncology nursing peer preceptorship program: using grounded theory research to guide program development.

Having enough staff to provide high-quality care to cancer patients will become a growing issue across Canada over the next decades. Statistical predictions indicate that both the number of new diagnoses and the prevalence of cancer will increase dramatically in the next two decades. When combining these trends with the simultaneous trend toward health human resource shortage in Canada, the urgency of assuring we have adequate staff to deliver cancer care becomes clear. This research study focuses directly on oncology nurses. Guided by the grounded theory methodology, this research study aims to formulate a strategic, proactive peer preceptorship program through a four-phased research process. The goal of this research is to develop a program that will support experienced staff members to fully implement their role as a preceptor to new staff, to facilitate effective knowledge transfer between experienced staff to the new staff members, and to assure new staff members are carefully transitioned and integrated into the complex ambulatory cancer care workplaces. In this article, the data from the first phase of the research project will be explored specifically as it relates to establishing the foundation for the development of a provincial ambulatory oncology nursing peer preceptorship program.

Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of Stage 0, I, and II breast cancer.

PURPOSE: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. METHODS: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. RESULTS: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. CONCLUSIONS: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using antiperspirants during their treatment, and the decision to use an antiperspirant or not in this setting should be left to the discretion of the patient.