Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden

OBJECTIVES: To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects. 
. SAMPLE & SETTING: 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES: Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered. 
. RESULTS: Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance. 
. IMPLICATIONS FOR NURSING: An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.

The 2014-2018 Oncology Nursing Society Research Agenda.

PURPOSE/OBJECTIVES: To identify priority areas of research for the Oncology Nursing Society (ONS) Research Agenda for 2014-2018, consistent with ONS's mission to promote excellence in oncology nursing and quality cancer care
. DATA SOURCES: Review of the literature, 2013 ONS Research Priorities Survey, National Institute of Nursing Research, and the National Cancer Institute research foci
. DATA SYNTHESIS: Multimethod consensus-building approach by content leaders and content experts of the ONS Research Agenda Project Team
. CONCLUSIONS: The 2014-2018 Research Agenda Project Team identified eight high-priority research areas: symptoms, late effects of cancer treatment and survivorship care, palliative and end-of-life care, self-management, aging, family and caregivers, improving healthcare systems, and risk reduction. In addition, four cross-cutting themes were identified: biomarkers, bioinformatics, comparative effectiveness research, and dissemination and implementation science. IMPLICATIONS FOR NURSING: The Research Agenda is a synthesis of the state of the science in cancer and identifies gaps and directions for the conduct and dissemination of research. Oncology nurses can use the agenda to inform clinical practice, develop research proposals, inform policy makers, support interdisciplinary research efforts, and promote scientist and clinician collaborations in targeted patient-centered research
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Nursing knowledge, practice patterns, and learning preferences regarding chemotherapy-induced peripheral neuropathy.

PURPOSE/OBJECTIVES: To explore nurses' practice patterns, knowledge, and barriers related to chemotherapy-induced peripheral neuropathy (CIPN). DESIGN: Descriptive, cross-sectional. SETTING: The United States. SAMPLE: 408 oncology nurses. METHODS: A team of eight experts met and developed the CIPN nurse knowledge and preferences survey, which was electronically sent to randomly selected nurses. MAIN RESEARCH VARIABLES: The survey assessed nurses' knowledge and practice patterns regarding assessment strategies and barriers, evidence-based interventions, preferences for education, and perceived gaps in scientific knowledge. FINDINGS: Nurses in the survey lacked knowledge regarding neurotoxicity of specific agents and evidence-based treatments. CIPN-focused physical examinations and standardized measurement tools were infrequently used during assessment. The most frequently reported barriers to CIPN assessment included lack of access to measurement tools, lack of specialized skills needed for assessment, lack of confidence, and lack of time. Recommendations for future research included CIPN prevention research, exploration of CIPN-related effects on quality of life, and alternative treatments of CIPN. The majority of participants preferred online educational opportunities. CONCLUSIONS: Nurses do not consistently integrate evaluation and management of CIPN in their practices. IMPLICATIONS FOR NURSING: Educational offerings should incorporate web-based CIPN assessment and management content.

Setting the bar: developing quality measures and education programs to define evidence-based, patient-centered, high-quality care.

In 2008, the Oncology Nursing Society (ONS) initiated a multi-year project to develop and test quality measures in areas judged by oncology nurses as high-priority opportunities to improve quality of life for patients across the cancer continuum, and to provide education to oncology nurses on how to achieve high-quality care. Supported through a grant to the ONS Foundation by the Breast Cancer Fund of the National Philanthropic Trust, two teams of expert nurses convened to review the literature and draft potential measures that are considered important to providers and patients, are high-volume, high-impact issues, and are supported by strong clinical evidence linking high-quality care processes to improved outcomes. The ONS Foundation contracted with the Joint Commission's Department of Quality Measurement to combine its measure-development experience with ONS's ambulatory oncology perspective to create a reproducible testing process. A third project team designed and implemented a series of 10 regional education workshops illustrating the use and benefits of quality measurement in clinical care.

Priorities for oncology nursing research: the 2013 national survey.

PURPOSE/OBJECTIVES: To advance the goals of evidence-based care and prioritize the knowledge generation that addresses contemporary challenges in oncology nursing. Results are used to inform the development of the Oncology Nursing Society (ONS) Research Agenda and by the ONS Foundation to develop strategic research initiatives. DESIGN: Descriptive, cross-sectional survey. SETTING: Web-based survey. SAMPLE: 8,554 ONS members from all levels of education. All doctorally prepared members were invited to participate. A random stratified sample was obtained from the remainder of the membership. METHODS: The ONS Research Priorities Survey project team created the survey and analyzed and interpreted the results. Members received an email invitation and follow-up reminders for survey completion. MAIN RESEARCH VARIABLES: Oncology nursing research and evidence-based practice topic questions. FINDINGS: The response rate was 11%, which is comparable to previous surveys. Topics ranked included descriptive research on patient adherence; intervention studies to optimize adherence, achieve concordance with cancer screening guidelines in minority populations, manage neurologic and cardiovascular late effects, and manage symptoms and symptom clusters; and studies to identify optimal delivery models for survivorship care. These findings have direct implications for translating existing evidence into practice and underscore the need for intervention research focused on improving patient-centered outcomes. CONCLUSIONS: Results provide a broad assessment of member views regarding oncology research priorities. Given the response rate, additional strategies to encourage member participation will be considered. IMPLICATIONS FOR NURSING: The results, together with the updates of the ONS Research Agenda, can guide ONS and ONS Foundation research and evidence-based practice initiatives.

Professional nursing societies and evidence-based practice: strategies to cross the quality chasm.

The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

Oncology nursing society putting evidence into practice resources: where are we now and what is next?

Evidence-based practice can be hard to implement in the "real world" of clinical care. A set of reference cards with outcome-specific intervention options can make that practice possible. The Oncology Nursing Society Putting Evidence Into Practice (ONS PEP) resources cover 16 topics to improve care for patients with cancer and their families. A survey evaluated awareness of the tools and the need for further research on their adoption. The survey also elicited target topics for future ONS PEP resources. Awareness of the resources varies among different nursing roles. Increased awareness among clinicians can guide and support improved patient care.

2008 ONS research priorities survey.

PURPOSE/OBJECTIVES: To determine the priorities of oncology nursing research, including the effect of evidence-based practice resources as identified by the Oncology Nursing Society (ONS) membership in June 2008. DESIGN: Descriptive, cross-sectional. SETTING: A Web-based survey of ONS members. SAMPLE: Stratified into three groups: a representative random sample of the general membership (n = 4,460, 421 responded), an over-sampled random sample of advanced practice nurses (n = 980, 149 responded), and all ONS members who were doctorally prepared (n = 589, 143 responded); 713 responded overall. METHODS: The 2004 survey was revised and the new 2008 survey was beta tested. The invitation to complete the survey was sent via e-mail with a link to the survey Web site. A follow-up reminder was sent one week after the initial invitation. MAIN RESEARCH VARIABLES: 70 oncology nursing research topic questions, divided into five categories, and two additional categories regarding ONS Putting Evidence Into Practice resources. FINDINGS: Quality of life and pain were the two highest rated topics, consistent with 2000 and 2004 research priority survey findings. Eleven topics were new to the top 20 ranked priority topics in 2008. Differences in rankings were apparent between member groups. CONCLUSIONS: The respondents represented the broad spectrum of ONS membership. Changes in topic rankings indicate that oncology nursing research priorities have shifted since the 2004 survey. The lag in research result dissemination to clinical practice may account for differences in topic rating between groups. IMPLICATIONS FOR NURSING: The survey results will be used to develop the 2009-2013 ONS Research Agenda. The results also will assist the ONS Foundation and other funding agencies in setting priorities.

Symptom clusters in adults with chronic health problems and cancer as a comorbidity.

PURPOSE/OBJECTIVES: To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. DESIGN: Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. SETTING: School of Nursing at the University of Pittsburgh. SAMPLE: The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. METHODS: Analysis of existing comorbidity and symptom data collected from both studies. MAIN RESEARCH VARIABLES: Symptom clusters, chronic disease, and cancer as a comorbidity. FINDINGS: Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. CONCLUSIONS: The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. IMPLICATIONS FOR NURSING: Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.

Sleep wake disturbances in people with cancer and their caregivers: state of the science.

PURPOSE/OBJECTIVES: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES: Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.

Oncology Nursing Society year 2004 research priorities survey.

PURPOSE/OBJECTIVES: To determine the Oncology Nursing Society (ONS) research priorities for 2005-2008 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, survivorship, and palliative care. DESIGN: Descriptive, cross-sectional survey. SAMPLE: Stratified into two groups: random sample of general membership (N = 2,205; responses = 287, or 13%) and all ONS active members in the United States with doctoral degrees (N = 627, responses = 144, or 23%); overall response rate was 15%. METHODS: The 2000 survey was revised and updated. Postcards were mailed to the original sample (N = 1,605) prior to the launch of the online survey, inviting participation via an online or paper-and-pencil survey. An e-mail announcement of the survey was launched one week later, followed by reminders the following week. Because of low response rates, a second sample (N = 600) was selected and contacted. MAIN RESEARCH VARIABLES: 117 topic questions divided into seven categories. Several items were new or reworded. FINDINGS: The top 20 research priorities included 12 of the top 20 items found in the 2000 survey; 8 topics were new to the top 20. Priority topics were distributed across six of seven categories. When general membership results were compared to the doctoral sample, 10 topics were among the top 20 for both groups. Nine topics were top priorities in the 2000 (researcher) and 2004 (doctorally prepared) surveys. CONCLUSIONS: Response rates to the electronic survey were lower than for previous paper-and-pencil surveys, but an adequate response was obtained. Rank order of mean importance ratings was determined by narrow differences in scores. The general membership and doctorally prepared samples showed similarities as well as differences in results. IMPLICATIONS FOR NURSING: The 2004 survey results will inform the 2005 research agenda and assist the ONS Foundation and other funding organizations in distributing research funds.

Year 2000 Oncology Nursing Society Research Priorities Survey.

PURPOSE/OBJECTIVES: To determine the Oncology Nursing Society's (ONS's) research priorities for 2001-2005 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, and palliative care. DESIGN: A cross-sectional, mailed survey. SAMPLE: Stratified by the general member group (i.e., a random sample of 1,850 ONS members) and researcher group (i.e., census of 150 ONS researchers). 788 responded for an overall response rate of 39%. MAIN RESARCH VARIABLES: 113 topics that were identified from the 1994 ONS Research Priority Survey questionnaire and earlier ONS Research Priority Surveys, with the addition of 20 new items to existing questionnaire categories and one new category area: health services research. FINDINGS: Top 20 research priorities were distributed across six of eight questionnaire categories, and the number of top 20 priorities within categories differs. Compared to the 1994 survey, 9 topics were common to both top 20 lists; 8 were new to the top 20, and 11 dropped out of the top 20. When the researcher group and adjusted total sample group top 20 priority ratings were compared, nine topics were common to both groups. CONCLUSIONS: Examining research priorities affords different perspectives to guide practice, education, research, management, and administration. IMPLICATIONS FOR NURSING: ONS Research Priority Survey results provide an important foundation for developing future research across the entire scope of oncology nursing.