-
Canadian Oncology Nursing Journal =... 2023Patients with severe mental illness often present with more advanced cancer at diagnosis, experience poorer quality of care, receive fewer medical treatments, have...
Patients with severe mental illness often present with more advanced cancer at diagnosis, experience poorer quality of care, receive fewer medical treatments, have higher overall disease mortality, and are less likely to access timely palliative care when compared to patients without severe mental illness. Research findings have shown that early involvement of specialized palliative care services for patients with advanced cancer improves quality of life, increases satisfaction with care, and mitigates depression. This case study will highlight the spectrum of challenges in caring for patients with a severe mental illness and advanced cancer from the perspective of an inpatient palliative care consult team.
PubMed: 38919897
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2023Having advanced care planning conversations with patients and/or their substitute decision maker has been shown to lead to many benefits, including aligning a patient's...
Having advanced care planning conversations with patients and/or their substitute decision maker has been shown to lead to many benefits, including aligning a patient's priorities and health expectations with his or her wishes. Typically, these conversations have been held with physicians, but have evolved over time to also be incorporated into the roles of other healthcare professionals. Advanced practice nurses who are trained to use a framework or an approach when having such conversations has been shown to have merit. As a result, advanced practice nurses are well positioned to be leaders in facilitating such conversations. In this project, the documentation notes of one advanced practice nurse on an in-patient palliative care team were examined, using the , to evaluate the Advanced Practice Nurse's contribution to the process of holding advanced planning conversations with patients.
PubMed: 38919894
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2022With the number of cancer diagnoses and cancer-related deaths on the rise, palliative care is becoming a more important consideration for helping to improve the quality...
With the number of cancer diagnoses and cancer-related deaths on the rise, palliative care is becoming a more important consideration for helping to improve the quality of life of patients and families and the support they receive during their healthcare journey. Accordingly, the early integration of palliative care into standard oncology care would appear to be an underutilized and novel approach that could be used to address the specific needs of palliative oncology patients. Oncology nurses play a central role in this process, delivering care throughout the health continuum, including palliative care. The purpose of this rapid review is to outline the benefits of early palliative care interventions and describe their characteristics. A literature search on CINAHL and PubMed returned five randomized trials conducted between 2010 and 2018. An analysis of these papers showed that the majority of the selected studies concluded that the early integration of palliative care into standard oncology care, which includes such treatments as chemotherapy and radiation therapy, can lead to improvements in quality of life, symptoms of anxiety and depression, and overall survival rate.
PubMed: 38919785
DOI: 10.5737/23688076324505 -
Canadian Oncology Nursing Journal =... 2022Hospital administrators have a great interest in obtaining a valid and reliable nursing workload measurement to help determine the hours of care needed per patient; one...
Hospital administrators have a great interest in obtaining a valid and reliable nursing workload measurement to help determine the hours of care needed per patient; one such method available is the GRASP Workload Measurement System. At Sunnybrook Health Sciences Centre, nurses' GRASP compliance and accuracy varies and often does not meet the target of 90%. The target assists the organization in estimating ongoing nursing workload and patients' care needs, while ensuring the provision of safe and appropriate care that is fiscally responsible. The objective of the quality initiative reported in this paper was to identify the facilitators and barriers that influence nurses' completion of GRASP. The quality improvement project was conducted using a mixed-method design with a sample of 28 nurses working in oncology acute care and palliative care inpatient units. The Theoretical Domain Framework (TDF), often used in behaviour change studies, was used in designing the questionnaire survey and interview questions that listed pertinent and measurable factors that may influence nurses' GRASP completion. Facilitators included: nurses' knowledge about the role GRASP has in funding and staffing levels, job responsibility, and perception of GRASP as a potential tool to organize work. Barriers identified by nurses included insufficient GRASP knowledge, limited access to workstations and computers, GRASP tool elements not capturing the complexity of the nursing work, time constraints, increased patients' acuity, and care demands. In addition to the Theoretical Domain Framework, the Normalization Process Theory was used to guide the implementation and evaluation of the recommendations to enhance nurses' GRASP compliance and adherence practice.
PubMed: 38919784
DOI: 10.5737/23688076324463 -
Canadian Oncology Nursing Journal =... 2022Despite the availability of healthcare and community services dedicated to cancer survivors, these remain underutilized by young adults living with cancer (YAC; aged...
BACKGROUND AND OBJECTIVES
Despite the availability of healthcare and community services dedicated to cancer survivors, these remain underutilized by young adults living with cancer (YAC; aged 18-39). A workshop was organized in Montréal, Canada, to identify the needs of YAC during their post-treatment transition period and explore existing services dedicated to YAC.
METHODS
We recruited seventeen stakeholders (N = 17), including seven YAC, to participate in a one-day workshop to consult about best approaches and practices to meet the needs of YAC, post-treatment. All discussions were transcribed, and a thematic qualitative analysis was performed.
RESULTS
Two main findings were identified: differences and similarities among stakeholders about perceptions of post-treatment needs; and suggestions to meet YAC needs following treatment.
CONCLUSIONS
Results demonstrate the importance of collaboration among multiple stakeholders, including YAC, when designing services for YAC. Results include suggestions to improve services available through community or healthcare centres.
PubMed: 38919780
DOI: 10.5737/23688076324484 -
Canadian Oncology Nursing Journal =... 2023Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and...
Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and genomics. In spite of this, cancer remains the leading cause of death in Canada, with an estimated two in five Canadians expected to be diagnosed with cancer and one in four Canadians expected to die of cancer in their lifetime. Although Canada has a publicly funded, universal healthcare system, profound inequities exist across the country. Such inequities are often due to a multitude of intersecting factors. The focus of this paper is to review the impact of rurality on cancer care. People residing in rural and remote regions are known to have reduced access to and availability of cancer care, from prevention through diagnosis, treatment, follow-up, and palliative care. Potential strategies to mitigate the challenges associated with rurality will be discussed, including an overview of the role that nurses can play in addressing the needs of patients in rural regions. Oncology nurses are well suited to help support patients, their loved ones, and healthcare colleagues in rural settings with a view to helping improve equity in access to care, quality of care, and outcomes of care for all Canadians.
PubMed: 38919591
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2023Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline,...
BACKGROUND
Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline, and a low survival rate.
OBJECTIVE
To determine whether deceased Glioblastoma Multiforme patients had received follow-up service from the palliative care team before their death, whether invasive measures had been reduced, and whether the last antineoplastic treatment was given within 14-30 days before death.
METHOD
A retrospective study utilizing chart data from January 2020 to March 2022 from an institutional project. Data were gathered to reflect selected indicators of quality of care for palliative care patients.
RESULTS
Of the 30 hospitalized patients with Glioblastoma Multiforme who had died while in hospital, 50% had received support from the palliative care team. Two patients (6.7%) had undergone antineoplastic treatment in the last 14 days of life and 13 (43.3%) had an order limiting invasive measures defined in the last two weeks of life.
CONCLUSION
In half of the patients monitored by a palliative care team, antineoplastic treatment and limitation of invasive measures occurred in the last 14 days of life. This may be associated with increased suffering of patients, family members, and professionals. Discussions about end-of-life care-related choices and goals of care need to be respected.
PubMed: 38919587
DOI: 10.5737/23688076334436 -
Canadian Oncology Nursing Journal =... 2023To explore the impact of implementation of a symptom screening and supportive/palliative care referral pathway in patients newly referred to a Canadian gastrointestinal...
PURPOSE
To explore the impact of implementation of a symptom screening and supportive/palliative care referral pathway in patients newly referred to a Canadian gastrointestinal medical oncology clinic.
METHODS
Eighty-eight subjects were recruited in each study arm. Intervention subjects were assessed by a member of the supportive/palliative care team if they had a severity score of >3/10 on the Edmonton Symptom Assessment System. Controls received normal care, including discretionary referral. Symptom severity was assessed over the subsequent five months. Data on survival, care setting of death (home, hospice or hospital) and long-term resource use were also collected.
RESULTS
Screening led to 141 specialist supportive/palliative care visits in the intervention arm versus only nine in the control arm. There were, however, no subsequent significant differences in symptom severity or the long-term outcomes measured. Many patients identified by the >3/10 severity threshold did not need/want specialist supportive/palliative care referral, and those with severe distress were either identified by the oncology team already or were too unwell or overwhelmed to participate in the study. The specialist service was not overwhelmed. Important considerations on timing and mode of administration of screening tools were revealed.
CONCLUSION
Routine symptom screening can be burdensome for oncology patients and needs to be as simple as possible. Triaging positive screens is an important role for oncology nurses. Investment in training oncology teams to manage uncomplicated distress in the oncology clinic allows for optimal use of scarce supportive/palliative care specialist resources for patients with complex needs.
PubMed: 38919584
DOI: 10.5737/23688076334452 -
Frontiers in Endocrinology 2024Medullary thyroid carcinoma (MTC) accounts for only 3% of all thyroid carcinomas: 75% as sporadic MTC (sMTC) and 25% as hereditary MTC (hMTC) in the context of multiple... (Review)
Review
Medullary thyroid carcinoma (MTC) accounts for only 3% of all thyroid carcinomas: 75% as sporadic MTC (sMTC) and 25% as hereditary MTC (hMTC) in the context of multiple endocrine neoplasia type 2 (MEN2). Early diagnosis is possible by determining the tumour marker calcitonin (Ctn) when clarifying nodular goitre and by detecting the mutation in the proto-oncogene RET in the MEN2 families. If the Ctn level is only slightly elevated, up to 30 pg/ml in women and up to 60 pg/ml in men, follow-up checks are advisable. At higher levels, surgery should be considered; at a level of > 100 pg/ml, surgery is always advisable. The treatment of choice is total thyroidectomy, possibly with central lymphadenectomy. In the early stage, cure is possible with adequate surgery; in the late stage, treatment with tyrosine kinase inhibitors is an option. RET A mutation analysis should be performed on all patients with MTC. During follow-up, a biochemical distinction is made between: healed (Ctn not measurably low), biochemically incomplete (Ctn increased without tumour detection) and structural tumour detection (metastases on imaging). After MTC surgery, the following results should be available for classification in follow-up care: (i) histology, Ctn immunohistology if necessary, (ii) classification according to the pTNM scheme, (iii) the result of the RET analysis for categorisation into the hereditary or sporadic variant and (iiii) the postoperative Ctn value. Tumour progression is determined by assessing the Ctn doubling time and the RECIST criteria on imaging. In most cases, "active surveillance" is possible. In the case of progression and symptoms, the following applies: local (palliative surgery, radiotherapy) before systemic (tyrosine kinase inhibitors).
Topics: Humans; Thyroid Neoplasms; Proto-Oncogene Mas; Carcinoma, Medullary; Multiple Endocrine Neoplasia Type 2a; Proto-Oncogene Proteins c-ret; Thyroidectomy; Mutation; Calcitonin; Biomarkers, Tumor; Carcinoma, Neuroendocrine
PubMed: 38919477
DOI: 10.3389/fendo.2024.1412942 -
Canadian Oncology Nursing Journal =... 2021
PubMed: 38919455
DOI: No ID Found