Opioid Risk Mitigation Practices of Interprofessional Oncology Personnel: Results From a Cross-Sectional Survey.

BACKGROUND: This study explored the risk mitigation practices of multidisciplinary oncology health-care personnel for the nonmedical use of opioids in people with cancer. METHODS: An anonymous, cross-sectional descriptive survey was administered via email to eligible providers over 4 weeks at The Ohio State University's Arthur G. James Cancer Hospital. The survey asked about experiences and knowledge related to opioid use disorders. RESULTS: The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs consisted of advanced practice nurses, physician assistants, and pharmacists), and 518 registered nurses. Approximately 40% of participants responded feeling "not confident" in addressing medication diversion. The most frequent risk reduction measure was "Checking the prescription drug monitoring program" when prescribing controlled medications, reported by physicians (n = 29, 78.4%) and APPs (n = 164, 88.6%). CONCLUSION: People with cancer are not exempt from the opioid epidemic and may be at risk for nonmedical opioid use (NMOU) and substance use disorders. Implementing risk reduction strategies with every patient, with a harm reduction versus abstinence focus, minimizes harmful consequences and improves. This study highlights risk mitigation approaches for NMOU, representing an opportunity to improve awareness among oncology health-care providers. Multidisciplinary oncology teams are ideally positioned to navigate patients through complex oncology and health-care journeys.

Serious Illness Conversation Training for Inpatient Medical Oncology Advanced Practice Providers: A Quality Improvement Project.

Background: Hospitalized advanced cancer patients and their families are inadequately informed about their cancer diagnosis and prognosis, which limits educated and reasonable decision-making for their care and end-of-life planning. Objectives: The primary objective of this evidence-based project was to enhance serious illness conversations (SICs) with advanced cancer patients by providing advanced practice providers (APP) training and to increase the frequency of SIC documentation in the electronic medical record (EMR). Methods: SIC training included a 45-minute Zoom video recording and 30-minute discussion groups. Advanced practice providers' beliefs and self-efficacy were measured pre- and post-training via a survey. Prior training was queried in the pre-survey. Data from APP discussion groups were summarized and themes identified. Serious illness conversation documentation frequency was measured. Pre- and post-survey differences were assessed using Wilcoxon rank sum tests. Findings: 19 inpatient medical oncology nurse practitioners and 6 physician assistants participated. Many reported little formal training yet are engaging in SICs regularly. Scores on both the belief and self-efficacy survey sections were high prior to training and did not significantly change following training. Despite the high pre-survey scores, many of the APPs verbalized the need for more training to improve their confidence and to learn SIC communication skills. Training significantly improved the APP's ability to manage their own emotions and be present. This indicates a trend toward improved APP comfort with SICs. Accessible documentation in the EMR increased with training.

Nursing Government Affairs Advocacy Fellow: Introducing nurses to policy.

ABSTRACT: The Nursing Government Affairs Advocacy (NGAA) Fellowship is an interdisciplinary collaboration between the Department of Nursing and the Office of Government Affairs at a university in the Midwestern region of the US. This article discusses the history of the NGAA Fellowship, the Fellow accomplishments, and the future of the Fellowship.

EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center.

BACKGROUND: Implementation of evidence-based practice (EBP) in healthcare remains challenging. The influence of leadership has been recognized. However, few randomized trials have tested effects of an educational and skills building intervention for leaders in clinical settings. AIMS: Test effects of an EBP leadership immersion intervention on EBP attributes over time among two cohorts of leaders at a national comprehensive cancer center. METHODS: A stratified, randomized, wait-list group, controlled design was conducted. Participants received the evidence-based intervention one year apart (2020, n = 36; 2021, n = 30) with EBP knowledge, beliefs, competencies, implementation self-efficacy, implementation behaviors, and organizational readiness measured at pre- and post-intervention, and one- and two-year follow-ups. Participants applied learnings to a specific clinical or organization priority topic. RESULTS: Baseline outcomes variables and demographics did not differ between cohorts except for age and years of experience. Both cohorts demonstrated significant changes in EBP attributes (except organizational readiness) post-intervention. Mixed linear modeling revealed group by time effects at 3-months for all EBP attributes except implementation behaviors and organizational readiness after the first intervention, favoring cohort 2020, with retained effects for EBP beliefs and competencies at one year. Following Cohort 2021 intervention, at 12-weeks post-intervention, implementation behaviors were significantly higher for cohort 2021. LINKING EVIDENCE TO ACTION: An intensive EBP intervention can increase healthcare leaders' EBP knowledge and competencies. Aligning EBP projects with organizational priorities is strategic. Follow-up with participants to retain motivation, knowledge and competencies is essential. Future research must demonstrate effects on clinical outcomes.

Interprofessional Oncology Providers' Experiences and Knowledge of Opioid Use Disorders in Patients With Cancer.

OBJECTIVES: To determine oncology providers' experiences and knowledge of opioid use disorders (OUDs) in patients with cancer. SAMPLE & SETTING: The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs), and 518 nurses at a large comprehensive cancer center. METHODS & VARIABLES: This study used a cross-sectional descriptive survey to describe providers' experiences and knowledge of OUDs. RESULTS: Nurses and APPs reported personal experiences with addiction and encountering issues with OUDs in patients more often compared to physicians. Knowledge deficits were identified regarding addiction, including evidence-based treatment for OUDs. Overall, OUDs are a topic of concern that the majority of oncology providers are interested in learning more about. IMPLICATIONS FOR NURSING: The opioid epidemic presents an opportunity to improve the knowledge of interprofessional oncology providers addressing OUDs. Nurses and APPs are ideally positioned for the prevention and early recognition of patients with an OUD and cancer.

De-escalation Training as Part of a Workplace Violence Prevention Program.

Workplace violence, including verbal and physical abuse, is escalating nationwide. As healthcare workers try to enforce COVID-19 prevention policies and practices, this phenomenon is exacerbated. De-escalation training is a method to prepare nurses through increased situational awareness, leading to early recognition and improved coping and confidence in dealing with aggression. Outcomes are presented, suggesting education of nurses may have a positive influence on the number of security calls and incident reports.

Supporting Advanced Practice Providers' Professional Advancement: The Implementation of a Professional Advancement Model at an Academic Medical Center.

Organizational commitment to a structured professional advancement model (PAM) is critical for advanced practice provider (APP) development in order to promote and reward excellence, enhance job satisfaction and improve retention and recruitment. A PAM may also serve as a motivational tool for personal and professional growth by developing and promoting a professional, evidence-based collaborative practice environment. A voluntary PAM was implemented at a large Midwestern academic medical center to recognize experienced APPs including certified nurse practitioners, certified nurse-midwives and physician assistants. This manuscript describes the case for creating a PAM, implementation and evaluation.

Oncology Nurses' Attitudes and Engagement in Nursing Research.

OBJECTIVES: To assess nurses' attitudes and perceptions about research. SAMPLE & SETTING: 623 RNs at a National Cancer Institute-designated comprehensive cancer center in the midwestern United States. METHODS & VARIABLES: This study used a cross-sectional, descriptive survey to describe nurses' attitudes toward nursing research, perceptions of the research environment, and research involvement. RESULTS: Nurses' attitudes toward research were generally more positive than negative. Results suggested that the biggest obstacle to nurses participating in research is time. IMPLICATIONS FOR NURSING: Understanding oncology nurses' attitudes toward research and the research environment is vital for the future of patient outcomes research. Results from this study inform strategic goals for increasing nursing research capacity, including the use of research teams and access to research mentors and resources, as well as nursing research fellowship programs.

Delayed administration of filgrastim (G-CSF) following autologous peripheral blood stem cell transplantation (APBSCT) in pediatric patients does not change time to neutrophil engraftment and reduces use of G-CSF.

BACKGROUND: Delayed initiation of granulocyte colony stimulating factor (G-CSF) after high-dose chemotherapy and autologous bone marrow or peripheral blood stem cell (APBSCT) in adult patients does not affect time to neutrophil or platelet engraftment, duration of fever, incidence of bacteremia, duration of non-prophylactic antibiotic therapy, and length of hospitalization when compared to early initiation. This study compares the effect of delayed (day +6) versus early (day +1) administration of G-CSF in pediatric patients on time to neutrophil engraftment (TNE), duration and cost of G-CSF therapy, incidence of blood stream infections, duration of febrile-neutropenia, duration of non-prophylactic antibiotic therapy, and duration of hospitalization due to febrile-neutropenia. METHODS: This is a retrospective review of 65 patients who engrafted after receiving APBSCT and G-CSF between 1993 and 2006. They were divided into the delayed group (day +6) (n = 46) and the early group (day +1) (n = 19). RESULTS: The median ages were 4.7 and 5.3 years in the early and delayed groups, respectively. There was no significant difference in TNE (P = 0.06) between the two groups. The duration of G-CSF administration was significantly less in the delayed group (P = 0.003). No significant differences were observed in the duration of neutropenia, time to platelet engraftment, the incidence of blood stream infections, and duration of fevers. Duration of hospitalization due to febrile-neutropenia was significantly lower in the delayed group (P = 0.01). Significant cost savings were observed by delaying G-CSF administration. CONCLUSION: Delayed administration of G-CSF after APBSCT in children has no adverse effect on TNE or other clinical outcomes when compared to early administration and may incur substantial cost savings.

Prevalence of abnormal bone density of pediatric patients prior to blood or marrow transplant.

Osteoporosis and osteopenia are long-term side effects of bone marrow transplant (BMT). The purpose of this study was to determine the prevalence of bone mineral density (BMD) abnormalities in pediatric patients prior to BMT. Forty-four pediatric patients were evaluated with DEXA scans. The average Z-score was -0.37. Thirty-six percent had abnormal BMD. Sixty-seven percent of ALL patients had abnormal BMD. Patients with non-malignant diseases were significantly more likely to have abnormal BMD. Patients with ALL had more defects than solid tumor patients. Females had more defects than males. These results demonstrate BMD defects are common in children prior to BMT, especially in patients with ALL.

Mobilization of PML-RARA negative blood stem cells and salvage with autologous peripheral blood stem cell transplantation in children with relapsed acute promyelocytic leukemia.

BACKGROUND: Relapsed acute promyleocytic leukemia (APL) is treated with re-induction chemotherapy, commonly arsenic trioxide, and stem cell transplantation (SCT). The effect of arsenic trioxide on autologous peripheral blood stem cell collection is unknown. PROCEDURE: Five pediatric patients with relapsed APL had PML-RARA negative peripheral blood stem cells mobilized (four after arsenic trioxide) and underwent autologous SCT after cyclophosphamide (60 mg/kg x 2) and total body irradiation (TBI-fractionated 1,200 cGy) conditioning. RESULTS: All five patients remain in molecular remission a median of 20 months post-transplant. CONCLUSION: Autologous SCT performed during molecular remission is a treatment option for pediatric patients with relapsed APL and may provide durable leukemia-free survival without the complications of allogeneic transplantation.

Autologous hematopoietic stem cell transplant with melphalan and thiotepa is safe and feasible in pediatric patients with low normalized glomerular filtration rate.

Normalized glomerular filtration rate (nGFR) <60 mL/min/1.73 m(2) often precludes hematopoietic stem cell transplant (HSCT) in pediatric patients. Three patients with nGFR < 60 mL/min/1.73 m(2) enrolled on an institutional phase I trial of HSCT preparative therapy for advanced and recurrent solid tumors with escalating melphalan, ranging from 135 to 180 mg/m(2), thiotepa (600 mg/m(2)), and vincristine (2 mg/m(2)). An additional patient with low nGFR was treated with the same preparative therapy. None of the patients developed acute renal failure, excess toxicities during HSCT or delayed engraftment. These cases demonstrate that it is feasible and safe to perform HSCT in pediatric patients with low nGFR using melphalan- and thiotepa-based preparative therapy.