The emotional boundary seesaw model to help cancer clinical nurse specialists work with patients who challenge them.

Receiving a diagnosis of cancer and receiving treatment can be physically and psychologically onerous for cancer patients. Alongside their nursing skills, cancer clinical nurse specialists (CCNSs) are trained to provide psychological support, assessment and intervention following a cancer diagnosis. Mental health specialists, usually clinical psychologists, provide clinical supervision to CCNSs to support them with this. One of the regular themes that comes up in clinical supervision with CCNSs is how to maintain a supportive and therapeutic relationship with 'challenging' patients. These patients may be considered challenging because they are inconsistent, demanding or ambivalent about their care, which puts a strain on the relationship with their CCNS. By using the emotional seesaw model to reflect on and attend to the emotional boundaries of the relationship, within clinical supervision, these challenging relationships can be understood and managed, and better outcomes for the patient can be achieved.

Integrative Nursing Interventions for Cancer-Related Symptoms in Oncology Inpatients: Results of a Descriptive Pilot Study.

BACKGROUND: Integrative nursing (IN) is an essential component of integrative medicine and integrative oncology. IN includes a range of external naturopathic, integrative nursing interventions, such as compresses, embrocation, and foot/hand baths, aimed at alleviating symptoms and side effects of conventional treatment. The project IMPLEMENT-UKU ("Implementation of IN at the University Hospital Ulm") was accompanied by a descriptive pilot study on the use of IN interventions on cancer-related symptoms in oncology inpatients, the characterization of these patients and the evaluation of the impact. METHODS: A single-arm study was conducted using a paper-based questionnaire administered before the IN interventions (t0) and 24 hours after the IN interventions (t1). Topics included sociodemographic data, symptoms, quality of life, health status, psychological burden, attitudes, and experience and satisfaction with the IN interventions. Analyses were descriptive using absolute and relative frequencies. RESULTS: During the 6-month study period out of 66 patients recommended for IN consultation by medical and nursing staff on 2 wards, 62 (93.9%) accepted the offer. Of those patients who received IN, 21 patients (33.9%) participated in the study. The number of IN interventions received per patient ranged from 1 to 3 during the 24-hour survey period. And a total of 36 IN interventions were performed: The most treated body region was the feet/legs (50.0%), followed by the back (25.0%), using oils such as solum oil (41.7%) and lavender oil (13.9%). Embrocation (77.8%) was the predominant type of IN intervention. For patients, the mean FACIT-F score was 29.2 ± 12.5. The mean PHQ-4 score was 3.0 ± 1.9. Regarding sleep quality in the last 4 weeks, 13 participants (61.9%) described it as rather or very poor. Satisfaction with the IN was high, with a large proportion of participants evaluating the IN interventions very positively. CONCLUSION: The study's findings suggest that there is a great need for IN among oncology inpatients. These patients are open to and interested in IN interventions and evaluate them positively. IN provides a promising opportunity to provide non-pharmacological support to inpatients. The integration of IN in conventional oncology care settings may enhance patient-centered care and contribute to improved patient wellbeing.

Identification of Nursing Outcomes and Quality Indicators for Home Health Care in Older Adults with End-Stage Cancer.

OBJECTIVE: This study aimed to identify nursing outcomes and quality indicators for older adults with end-stage cancer receiving home health care. METHODS: Nineteen experts and professional caregivers, including palliative doctors, nursing faculty, advanced practice nurses, and registered nurses, participated in the Delphi technique. Final medians and interquartile ranges were calculated. RESULT: Seven components with 43 nursing outcomes and quality indicators for older adults with end-stage cancer were developed, encompassing physical pain relief, symptom management, physical well-being, complication prevention, psychosocial support, caregiver and family roles in end-of-life care, and advance care planning. CONCLUSION: The caregiver and family's role in end-of-life care had the most indicators, reflecting the significance of family involvement in Thailand's cultural context. Consistent implementation of these indicators is crucial, and correlational analysis of indicator scores can enhance their validity.

Sobrecarga, afrontamiento y soporte social en progenitores de niños con cáncer / Caregiver burden, coping and social support in parents of children with cancer

Objetivo: Analizar la relación entre las estrategias de afrontamiento, el soporte social, las características de padres cuidadores migrantes y sus niños con cáncer en la sobrecarga del cuidador de dichos padres. Método: Participaron 82 cuidadores (67 madres y 15 padres) en condición de bajo recursos que residían en albergues para niños con cáncer y sus cuidadores, quienes migraron a la ciudad para recibir el tratamiento. Se utilizó la Escala de Sobrecarga de Zarit (Zarit et al., 1980), el Inventario de Afrontamiento COPE (Carver et al., 1989) y el Cuestionario MOS de apoyo social (Sherbourne y Stewart, 1991). Resultado: Se realizaron dos modelos de regresión para evaluar el impacto de las variables demográficas y psicológicas en la carga del cuidador, el primer modelo involucra la escala global de apoyo social (R2 ajustado=,43, F=9,73, p<,001) y el segundo las escalas específicas (R2 ajustado=,45, F=8,23, p<,001). Los resultados evidencian el rol predictivo de las estrategias de afrontamiento como la aceptación, la reinterpretación positiva y enfocar y liberar emociones; el soporte social global y de tipo afectivo; y características sociodemográficas como el nivel de instrucción del progenitor y la edad del hijo en la sobrecarga del cuidador. La mayoría de estas variables tienen una relación inversa con la sobrecarga. Conclusiones: Los resultados del estudio subrayan la importancia de investigar la sobrecarga del cuidador en situación de vulnerabilidad. Además, el estudio destaca la relevancia de factores como las estrategias de afrontamiento y el apoyo social, que desempeñan un papel clave en la sobrecarga del cuidador.(AU)

Aim: To analyze the relationship between coping strategies, social support, characteristics of migrant parent caregivers and their children with cancer on caregiver overload of such parents. Zarit Burden Interview (Zarit et al., 1980), the COPE Inventory (Carver et al., 1989) and the MOS Social Support Questionnaire (Sherbourne y Stewart, 1991) were used. Method: Eighty-two caregivers (67 mothers and 15 fathers) residing in shelters for children with cancer and their caregivers, who migrated to the city to receive treatment, participated in this study. Results: Two regression models were performed to evaluate the impact of demographic and psychological variables on caregiver burden, the first model involves the global social support scale (R2 adjusted=.43, F=9.73, p<.001) and the second the specific scales (R2 adjusted=.45, F=8.23, p<.001). Results: There is evidence the predictive role of coping strategies such as acceptance, positive reinterpretation and growth, focus and venting of emotions; global and affective social support; and sociodemographic characteristics such as parental level of education and child age in caregiver burden. Most of these variables have an inverse relationship with caregiver burden. Conclusions: The results of the study underline the crucial importance of investigating caregiver burden in the context of vulnerability. In addition, the study highlights the importance of factors such as coping strategies and social support, which play a key role in influencing caregiver burden.(AU)

Cancer Survivors' and Care Partners' Audio Diaries on Stress and Social Support Resources During the COVID-19 Pandemic.

OBJECTIVES: To describe cancer survivors' and care partners' perceived stress and social support during the COVID-19 pandemic and assess the feasibility of audio diaries for assessing role-related needs and resources. METHODS: Participants (N = 51; n = 28 survivors, n = 23 care partners) recorded three monthly audio diaries reporting stress and support experiences. Diaries were transcribed and content-analyzed using a hybrid approach. Stress-related content was inductively coded, and social support content was deductively coded by type (instrumental, information, emotional, companionship, appraisal; κ = 0.75) then inductively coded. Descriptive statistics summarized sociodemographic data and compared coding frequencies by role. We developed narrative summaries of stress and support categories and selected quotes for contextual detail. RESULTS: Cancer-related stressors were most prevalent (28.8%), followed by work (26.8%), family (23.1%), social isolation (13.4%), and finances (8.0%). While no significant difference in reporting frequency was observed between roles, cancer-related stress was more prevalent for survivors while work-related stress was mentioned more by care partners. Emotional support was the most prevalent support type (32.1%), followed by companionship (25.3%), appraisal (17.9%), instrumental (16.67%), and informational support (8%). Survivors reported more appraisal support than care partners (χ2 = 6.48, df = 1, P = .011) and more support for self-care, while care partners expressed more other-oriented concerns and focused more on managing responsibilities and interactions outside the household. CONCLUSIONS: The pandemic complicated and intensified role-based stressors already present in the survivorship context. Our findings highlight the importance of informal social support networks, particularly when access to formal services is limited, and suggest that audio diaries can be an effective tool for assessing support needs and resources. IMPLICATIONS FOR NURSING PRACTICE: Nurses and healthcare providers should tailor social support assessments to address the distinct support needs and individual resources of cancer survivors and their care partners. This is especially critical in contexts that limit access to care and formal services.

Effectiveness of Occupation-Based Nursing Program on Chemotherapy-Related Symptoms and Satisfaction Among Pediatric Oncology Patients: A Randomized Controlled Trial.

OBJECTIVES: This study aimed to determine the effect of an occupation-based nursing program (OBaNuP) on chemotherapy-induced symptoms and satisfaction in pediatric oncology patients. DATA SOURCES: This study was a randomized controlled trial. The study sample consisted of 60 hospitalized children with cancer who were aged 7 to 12. Participants were randomly assigned to an OBaNuP (intervention group, n = 30) or clinical routine care only (control group, n = 30). The intervention group participated in an OBaNuP for an average of 30 minutes per day for 5 days. The Memorial Symptom Assessment Scale 7-12 and Psychosocial Symptoms in Hospitalized Children and Child Satisfaction Questionnaire were completed by participants at baseline, the first meeting immediately after intervention, and 7 days and 14 days after the intervention. CONCLUSION: The average scores of chemotherapy-related symptoms differed over time between the intervention and control groups (P < .05). The psychosocial symptom score averages of the children in the intervention group significantly decreased at all time points compared to the control group (P < .05). The satisfaction mean scores of the children in the intervention group increased significantly at all time points compared to the control group (P < .05). IMPLICATIONS FOR NURSING PRACTICE: The OBaNuP initiative supported the decrease of chemotherapy-related and psychosocial symptoms, while also promoting an increase in satisfaction among children undergoing cancer treatment at the hospital consistently over all observed time periods.

Oncology Nurse Navigation in Underserved Communities: Opportunities and Future Directions.

OBJECTIVES: Provide an overview of navigation in three disparate populations: rural, Native American/Alaska Native, and low- to middle-income countries. Discuss gaps in care and opportunities to improve cancer care. METHODS: A literature search was conducted in PubMed and on Google Scholar using search terms, nurse navigation, cancer, disparit*, low- to middle-income countries, Native American, American Indian, and rural. Peer-reviewed research studies, review articles, databases and websites of professional organizations, and historical books were reviewed to provide an overview of oncology nurse navigation in underserved communities. Experiences in working with these populations over the past 30 years were also provided to support current literature. RESULTS: Forty references were included in this overview of nurse navigation in underserved communities. Nurse navigation in these disparate areas is in its infancy. While some programs exist and outcomes have been positive, their dissemination is sparse. A need exists to expand nurse navigation into these areas to provide care for these underserved communities. CONCLUSION: Oncology nursing navigation for each of these underserved communities requires a culturally sensitive approach. Many of these approaches are universal to cultural competency and can be applied to most disparate populations. IMPLICATIONS FOR NURSING PRACTICE: Nurses comprise the largest workforce around the globe and are well-equipped to develop navigation programs in some of the most disparate communities around the world. To do so, it is important to use a foundation of building trust, embracing individual differences, providing culturally sensitive education and resources for growth, and good communication.

Oncology Nurses' Experiences of Using Health Information Systems in the Delivery of Cancer Care in a Range of Care Settings: A Systematic Integrative Review.

OBJECTIVES: This systematic review aimed to identify oncology nurses' experiences of using health information systems (HIS) in the delivery of cancer care. DATA SOURCES: The electronic databases searched included CINAHL, MEDLINE (EBSCO host), SCOPUS, Web of Science Core Collection, Google Scholar, OVID, and ProQuest Central (using advanced search strategy) and hand searching of reference lists of the included articles and relevant systematic reviews. Studies published in English language were examined. CONCLUSION: Twenty-six studies were included. Three themes emerged: (1) the transparency and application of the nursing process within HIS, (2) HIS enhancing and facilitating communication between nurses and patients, and (3) the impact of HIS on the elements of person-centered care. Nurses' experiences with HIS were overall positive. However, digital systems do not fully capture all elements of the nursing processes; this was confirmed in this review, through the nurses' lens. Most studies used HIS for symptom reporting and monitoring within non-inpatient settings and largely biomedical and lack insight into the person-centeredness and overall holistic care. IMPLICATIONS FOR NURSING PRACTICE: There are evidently varied views of HIS adoption across the globe. HIS can improve health-related quality of life and symptom burden, including self-reporting of symptoms among patients. However, there is a need for ongoing high-quality research, and clearer reporting than is evident in the current 26 studies, to fully understand the impact of HIS within the nursing processes and patient outcomes across all specialty cancer fields.

Navigating Through Disaster: Application of Oncology Nurse Navigator Competencies to Climate Disaster Preparation and Response.

OBJECTIVES: The role of the oncology nurse navigator (ONN) before, during, and after a climate disaster is critical to ensuring that individuals with cancer continue to receive the necessary care and support. The objective of this article is to provide an overview of the essential role of the ONN by highlighting the application of core competencies to climate disasters. METHODS: Competencies available for ONNs from the Oncology Nursing Society include coordination of care, communication, education, professional role, and expertise. International Council of Nurses (ICN) core competencies for disaster nursing include eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. These competencies are explored for application to climate disaster preparation, mitigation, and response. RESULTS: The ONN competencies and the domains of the ICN disaster nursing competencies were integrated to outline the role of the ONN in disaster preparedness and response. CONCLUSION: The ONN is pivotal in maintaining the continuity of cancer care. The ONN's expertise is critical for navigating the difficulties presented by hurricanes, floods, wildfires, and other extreme climate events as well as existing barriers to cancer care. The ONN's adeptness at coordinating care, communicating effectively, and tapping into community resources will transfer to a climate disaster, ensuring minimal treatment interruptions and access to necessary care. IMPLICATIONS FOR NURSING PRACTICE: The ONN is integral to the cancer care team in preparing and responding to climate disasters. The ONN ensures ongoing access to cancer care and advocates for the specialized care that people with cancer need. The ONS ONN Core Competencies and the ICN Disaster Competencies are applicable for developing processes and procedures to address climate disasters in clinical practice.

Cancer Patient Navigation in Canada: Directions From the North.

OBJECTIVES: Cancer is a complex disease that is experienced by those affected by cancer and their loved ones differently. The importance of cancer patient navigation is quintessential to support those affected through the healthcare system and to supportive resources. Canadian cancer statistics advise of the continued increase of cancer and impacts on health care. With Canada being a large geographical area, large portions of the population live in rural and remote areas with decreased access to health services. In Canada, cancer navigation is different across the country; each province's or territory's health authority creates their own cancer navigation program based on the needs of their patients. This report aims to provide an overview of cancer in Canada, along with the different navigation programs available nationally. Additionally, it will review the role the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) plays in creating a community of practice to support cancer patient navigators across the country. METHODS: The information on various provincial and territorial navigation programs was obtained through discussion with the CANO/ACIO Navigation Special Interest Group (SIG). All provinces and territories were interviewed with the exception of Quebec, Prince Edward Island, Nunavut, and Yukon. RESULTS: While the vast majority of navigation has a similar core intent, there are many differences between the provinces and territories in the navigation programs. These differences are based on geographical need and the individual health authorities. CONCLUSIONS: The Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) provides a community for cancer navigators to connect through a Special Interest Group (SIG), meeting virtually monthly to support each other across Canada to collaborate, identify issues, trends, and challenges. IMPLICATIONS FOR NURSING PRACTICE: Cancer patient navigation is a valuable resource for all individuals with cancer and their loved ones, particularly when faced with difficulties accessing care in rural and remote areas. Cancer patient navigators' scope is similar in intent, despite potential differences in programs. By connecting with other navigators through the CANO/ACIO navigation SIG, navigators across the country can provide a connection to discuss program similarities and barriers and opportunities for cancer navigation programs to work together to support each other and evolve their programs to meet the needs of their provincial and territorial residents.

Evaluating the Oncology-Related Education Needs of Emergency Nurses.

INTRODUCTION: Treatment for patients with cancer in the emergency department ranges from treating life-threatening emergencies to symptom management or issues unrelated to their cancer, but for which cancer and its treatment may be complicating factors. Nurses are expected to manage the care of this population and be aware of risk factors for complications that may be unique to cancer patients. To date, education for emergency nurses regarding oncologic emergencies and the care for patients with cancer has been limited. METHODS: We conducted a cross-sectional needs assessment to establish emergency nurses' educational needs (knowledge, skills, and attitudes) related to the care of patients with cancer and to evaluate if there are different educational needs for emergency nurses associated with the care of the cancer patient by practice setting type. RESULTS: Of 237 nurses surveyed, only 28% of nurse respondents indicated receiving any cancer-specific education or training. Overall, scores on a knowledge assessment were relatively low (mean 53%; range 9.5-85.7%; SD 13%). Nurses reported variable confidence and skills, with the weakest areas being in the triage of complications and oncologic emergencies, assessment of complications related to cancer treatment, and end-of-life conversations. Nearly all of the respondents (97%) indicated a need for oncologic education for emergency nurses with moderate-high priority in relation to other educational needs. DISCUSSION: Our findings suggest that emergency nurses need a stronger foundation of the knowledge and skills required to care for patients with cancer. Results from this study can inform future curriculum development efforts.

Level of Family centered care and associated factors among parents of children with cancer at tertiary level hospital, Ethiopia.

OBJECTIVE: To determining level and factors affecting Family Centered Care (FCC) in pediatric oncology unit of Tikur Anbessa Specialized hospital (TASH), Ethiopia. METHOD: A cross sectional study was conducted from June to December 2022. Three hundred ninety-three parents of children with cancer were consecutively interviewed using Measure of Processes of Care (MPOC-20). Multivariable linear regression was used to identify independent predictors of FCC. RESULT: The total MPOC 20 means was 3.71(SD = 1.04). The mean score for respectful and supportive care, coordinated and comprehensive care, enabling and partnership, providing specific information and providing general information were found to be 4.8, 4.6, 3.7, 2.3 and 2.6, respectively. Family employment (-0.33(95% CI = -0.63, -0.03; P = .029)), low family education (-0.40 (95% CI = -0.70, -0.11; P = .008)), referral cases (-0.37(95% CI = -0.59, -0.14; P = .001)), shorter time spent in hospital (-0.49(95% CI = -0.85, -0.12; P = .010)) and psychological distress (-0.01(95% CI = -0.026, -0.001; P = .028)) were associated with lower mean score of FCC. CONCLUSION: The total FCC mean score was found to be low. From the five FCC components providing general and specific information scored the lowest mean level. PRACTICE IMPLICATIONS: Mechanism to improve information delivery that address parents from different background and referred from other health facility should be in place in order to improve FCC level. In addition, the FCC should be designed to address parents of children with different lengths of stay.

Relationship and Attachment to Digital Health Technology During Cancer Treatment.

OBJECTIVE: The aim of this study is to explore the relationship that people with cancer and their family caregivers develop with symptom management technology during chemotherapy. DATA SOURCES: A longitudinal and multi-perspective interpretative phenomenological approach was adopted. Data were collected using one-to-one in-depth interviews with people with colorectal cancer using supportive digital health symptom management technology (n=3) and their family caregivers (n=4) at two time points during chemotherapy treatment. Data were analyzed using interpretative phenomenological analysis and followed COREQ guidelines. CONCLUSION: People with cancer and their family caregivers can develop emotional bonds with supportive symptom management technology during cancer treatment. Digital health technology can be experienced as a person guiding them during their cancer treatment. Participants felt vulnerable after the technology was returned to the research team. Participants recognized that it was not the technology that successfully facilitated them through their initial chemotherapy cycles; rather, the technology helped them learn to manage their symptoms and promoted their self-efficacy, as well as how to emotionally respond. IMPLICATIONS FOR NURSING PRACTICE: The relationship and psychological bonds people with cancer and their family caregivers develop with technology during treatment may be critically important for oncology nurses to be aware of should digital health be prescribed within the outpatient model of cancer care. This study indicates that technology may not be needed for a full treatment experience, as digital health can promote confidence and self-efficacy regarding symptom management and prepare people with cancer to be independent after the digital health technology is returned to the research team. However, further research is needed regarding individual preferences for digital health provision.

Utilizing the 2022 Oncology Navigation Standards of Practice to Revise a Mixed Oncology Navigation Practice Model.

OBJECTIVES: The 2022 Oncology Nursing Society Oncology Navigation Standards of Professional Practice offer a framework for role delineation in oncology navigation. The goal of completing a job task analysis using the standards with four independent navigation teams was to identify a core map of work which would align skills, experience and knowledge with clinical nurse navigators, social work navigators, and patient navigators. Role delineation reduces suboptimal use of resources and inconsistent navigation services. METHODS: An independent job task analysis was conducted with each of the four oncology navigation teams. Patient navigators and clinical nurse navigators were asked to report on each requested task over a 2-week period. The team discussed and determined alignment or misalignment with the standards. This discussion included the request and skill level of each navigator. RESULTS: Sixty percent of the tasks identified in the job task analysis were in alignment with the standards for role and level of care. Thirty percent of the tasks aligned for role, but not for level of care, with nurse navigators performing a high number of non-nursing/clerical tasks. Ten percent were outside the scope of navigation. CONCLUSIONS: Four enterprise opportunities were identified: (1) formalize standards for Tumor Board management, (2) create a core model for essential metrics, (3) establish standardized process for medical record retrieval for new oncology patients, and (4) explore alternative staffing models. IMPLICATIONS FOR NURSING PRACTICE: Using a job task analysis allows time for meaningful exploration of roles and scope of work completed by the team. High work volume for navigation teams often leads to a "this is the way we've always done it" mentality. A job task analysis provides a structured approach with dedicated time and a safe space for navigators to "think critically" about their daily work, identify opportunities for change, and progress using this framework.

Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study.

OBJECTIVES: The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES: This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS: As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.

Navigating Transitions in Oncology Care: From Emergency Department to Outpatient Clinic.

OBJECTIVE: This quality improvement project was a collaborative effort with Penn Medicine's emergency department (ED) and oncology nurse navigators (ONNs). The goal of the project was to streamline patient transitions from the ED to the outpatient oncology clinic by developing a standardized referral process. The main objectives were to simplify and automate the referral process using the electronic medical record, improve multidisciplinary communication across the care continuum, ensure timely follow-up, and address barriers to oncology care. METHODS: The ED providers placed a consult to ONNs. The ONNs reached out to the patient within 48 hours of the consult. They maintained a database of patient referrals and collected information such as patient demographics, reason for referral, insurance, and patient outcomes. RESULTS: The ED providers referred 204 patients to the ONNs from April 2022 to September 2023. The development of a standardized referral process from the ED to the outpatient oncology clinic proved successful. Of the patients referred, the ONNs facilitated 98 cancer diagnoses and 80 of those patients are receiving oncology care at Penn Medicine. The median time to the patient's first appointments was seven days, diagnosis was 15 days, and treatment initiation occurred within 32 days. CONCLUSION: The project team achieved their goal of facilitating timely access to oncology care, ensuring continuity, and addressing patient-specific barriers. IMPLICATIONS FOR NURSING PRACTICE: This quality improvement initiative highlights the ONNs' role in enhancing access and equity in cancer care delivery. The success of the project underscores the ONN's expertise and leadership in addressing healthcare disparities in oncology care. Collaboratively, the teams created a new referral workflow improving care transitions from the ED to the outpatient oncology clinic. The project sets a precedent for optimizing patient care transitions, demonstrating the positive impact of ONNs as key members of the multidisciplinary healthcare team.

Screening for Frailty Using the FRAIL Scale in Older Cancer Survivors: A Cross-sectional Comparison With the Fried Phenotype.

OBJECTIVES: To examine the diagnostic performance of the FRAIL Scale for frailty screening with reference to the Fried phenotype and investigate its association with health outcomes in older cancer survivors. DATA SOURCE: In this cross-sectional quantitative study, participants were post-treatment cancer survivors aged 65 or above. Measurements included the FRAIL Scale, Fried phenotype, Geriatric Depression Scale-15 item, Modified Barthel Inventory, and EORTC Core Quality of Life Questionnaire. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the FRAIL Scale with reference to the Fried phenotype. Health outcomes associated with being frail as estimated by the FRAIL Scale and Fried phenotype were also examined using regressions. RESULTS: Based on 293 older cancer survivors, the area under curve (AUC) of the FRAIL Scale was 0.79, and the optimal cut-off of 1 yielded a sensitivity of 92% and specificity of 41%. According to regression results, the FRAIL Scale was modified by adding an item on time since cancer treatment completion (AUC = 0.81), and using a cut-off of 2 for older cancer survivors, which yielded a sensitivity of 74% and specificity of 67%. The modified FRAIL Scale was associated with depressive symptoms, functional independence, fatigue, dyspnea, physical functioning, and role functioning. CONCLUSIONS: The modified FRAIL Scale is proposed for use in older cancer survivors, and a cut-off of 2 should be used. IMPLICATIONS FOR NURSING PRACTICE: The modified FRAIL Scale can serve as a brief screening tool for identifying frailty among older cancer survivors in practice.

Defining the Role and Responsibilities of the Oral Anticancer Medication Nurse Navigator.

OBJECTIVES: The goal of this article is to define the role and responsibilities of the oral anticancer medication nurse navigator. METHODS: This article combines findings from a review of scientific literature including research studies, quality improvement projects, case studies, standards, and guidelines combined with the experience and professional insights of the authors in the role creation and function of the oral anticancer medication nurse navigator. RESULTS: The role of the oral anticancer medication nurse navigator includes coordination of patient care, pre-treatment assessment of barriers to adherence, patient and caregiver education, planned follow-up and coaching, and symptom management. Professionally, the role includes the development of interdisciplinary workflows, coordination of care with internal and external stakeholders, clinical staff education, the application of technology, and advocacy. CONCLUSION: The oral anticancer medication nurse navigator uses the nursing process to coordinate care of the individual taking these medications. The role optimizes patient outcomes and benefits the healthcare organization through reduced healthcare costs and the ability to meet accreditation needs. IMPLICATIONS FOR NURSING PRACTICE: The role of the oral anticancer medication nurse navigator provides value to patients taking oral anticancer medications and to the healthcare team.