Journal of the Advanced Practitioner in Oncology最新文献

Background: Across the United States, an incremental need for cancer care continues to emerge. Specialty nurse practitioners and physician assistant teams have helped in meeting this demand. However, there is a need for evidence-based recommendations to inform appropriate provider-patient staffing ratios that encompass complex cancer treatments and ensure optimal care.

Methods: A literature review identified a gap in existing research with regard to recommended inpatient provider-patient ratios for hematology and oncology services. The conceptual framework of ICU nursing workload was utilized to ensure a comprehensive understanding of an inpatient specialty cancer provider's duties.

Results: Within the unit, job, patient, and situation workload levels, there were multiple interventions implemented to streamline systems and improve workplace conditions for providers, as measured by the work-related quality of life (WRQoL) scale. Patient satisfaction scores improved an average of 4% across multiple criteria and exceeded benchmark rankings by 10.7% surrounding communication with nurses and physicians (a 6.3% increase). Discharge efficiency improved, with 6.1% more discharges occurring by 11:00 am, and length of stay was noted to be 8.8 days fewer than teaching services treating the same cancer diagnosis. Finally, additional shift pay was greatly reduced and turnover decreased by 17%.

Conclusion: Application of the conceptual framework of ICU nursing workload provided a scientific assessment of specialty inpatient cancer services within one institution. Interventions resulted in improved working conditions, patient satisfaction, discharge efficiency, and reduced turnover, ultimately ensuring the provision of high-quality cancer care.

Background: Nurse practitioners (NPs) have assumed a greater role in the management of pain related to cancer. Several studies have associated adequate management of cancer pain with improved survival. Opioids are an essential treatment for cancer pain management and thus it is important to understand influences on prescribing these substances. However, due to a lack of previous studies on this topic, little is known about the influences on NP prescription of opioids for patients with pain due to cancer.

Purpose: Competent decision-making is highly correlated with dominant personality characteristics and dominant decision-making styles in everyday life. The rational approach to decision-making has demonstrated superior performance with different daily tasks, including career-related tasks. However, it is unknown whether dominant personality and/or decision-making style impacts the decisions of medical professionals. Using the Diffusion of Innovations theoretical framework, this study evaluated whether dominant personality, dominant decision style, advanced specialty certification, and/or demographic factors influenced oncology NP opioid prescribing proficiency (termed opioid decision score, or ODS) according to the National Comprehensive Cancer Network (NCCN) Guidelines. Other advanced practice providers (APPs) were excluded from the study due to controlled substance prescribing limitations.

Methods: An internet-based descriptive comparative study was performed evaluating the dominant personality characteristic and dominant decision-making style as a predictor of opioid prescribing among NPs working in oncology. Participants were recruited using lists from the Oncology Nursing Society (ONS) and American Association of Nurse Practitioners (AANP). A nationwide convenience sample of NPs working with adult oncology patients was evaluated for opioid prescribing according to recommendations in the NCCN Cancer Pain Guidelines.

Results: Univariate linear regression revealed a statistically significant increase in the ODS as the Big Five Inventory (BFI) Openness scale score increased (estimate = 0.36, standard error [SE] = 0.17, 95% confidence interval [CI] = 0.03-0.69). Nurse practitioners reporting advanced specialty certification in oncology and/or hospice or palliative care scored significantly higher on the ODS compared with those with no advanced specialty certification (n = 81, M = 2.86, 2.34, t = -2.75, df = 178, p = .0065).

Conclusion: This study provides preliminary findings regarding the decision-making of NPs working with oncology patients and prescribing opioids for cancer pain. Nurse practitioners with a dominant personality characteristic of openness and those reporting an advanced specialty certification in oncology and/or hospice or palliative care were more likely to prescribe opioids f

Indeterminate thyroid nodules can present a confounding scenario for both provider and patient. Once a diagnosis of an indeterminate thyroid nodule is made, appropriate management can range from conservative observation to surgical resection. A thorough evaluation, including a dedicated history and physical examination, biochemical profile, pathologic information from a seasoned pathologist, and thyroid ultrasound by an experienced radiologist can help point health-care providers in the right direction. However, the ultimate diagnosis cannot be rendered unless surgical excision is performed. Provider and patient must agree on a personalized risk vs. benefit profile for the indeterminate thyroid nodule.

Treatment options are limited for patients with anemia associated with lower-risk myelodysplastic syndromes (LR-MDS). The recent approval of luspatercept for the treatment of anemia associated with very low-to intermediate-risk MDS with ring sideroblasts (RS) or with myelodysplastic/myeloproliferative neoplasm with RS and thrombocytosis has provided adult patients and practitioners with a much-needed new therapeutic option. Luspatercept is a first-in-class erythroid maturation agent that exerts its effects on later stages of erythropoiesis. In the phase III MEDALIST trial of patients with LR-MDS with RS, luspatercept (starting dose 1 mg/kg) demonstrated substantial clinical benefit (38% of patients treated with luspatercept vs. 13% of those treated with placebo [p < .001] achieved transfusion independence for ≥ 8 weeks during the first 24 weeks of treatment) and a favorable safety profile. The most common adverse events (AEs), including fatigue, asthenia, dizziness, and diarrhea, were more frequent during the first 4 treatment cycles and subsequently declined. This review provides a comprehensive overview of luspatercept treatment administration, including the mechanism of action, efficacy and safety data, management of dosing, and AEs associated with luspatercept treatment of patients with LR-MDS.

In recent years, chimeric antigen receptor (CAR) T-cell therapy has emerged as an effective and potentially paradigm-shifting therapy for patients with refractory lymphoma and myeloma. This novel therapy involves engineering T cells to recognize specific antigens on the surface of cancer cells. Several CAR T-cell products are approved by the US Food and Drug Administration as a result of numerous clinical trials. Due to the complexity of these studies and the high level of care required for CAR T-cell therapy patients, the role of the research advanced practice provider (APP) has become increasingly central to the success of CAR T-cell trials. This review article explores the vital role of the research APP in CAR T-cell clinical trials.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma in the US. For nearly 2 decades, standard front-line treatment has consisted of chemoimmunotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Numerous trials have unsuccessfully attempted to achieve better outcomes in these patients. Recently, the results of the phase III POLARIX trial were published. This study randomized newly diagnosed DLBCL patients to receive polatuzumab vedotin in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) or standard-of-care R-CHOP. The POLARIX trial demonstrated 2-year progression-free survival of 76.7% for pola-R-CHP compared with 70.2% for R-CHOP with comparable safety profiles between the two arms. Based on these results, a new standard of care may be emerging in patients with DLBCL. This article provides a practical approach to managing a newly diagnosed patient with DLBCL.

The lack of diversity in cancer trials is a multifaceted, decades-old problem that has remained persistent despite efforts to increase the number of participants from underrepresented racial and ethnic backgrounds. This lack of meaningful improvement is a problem that continues to perpetuate inequities in cancer care. For optimal generalizability of clinical trial results, populations that are likely to be treated must be adequately represented. Beyond consensus statements, policy enactments, and federal mandates, strategic collaboration with at-risk underrepresented communities is critically necessary to improve the accrual of minorities to cancer clinical trials. As such, the clarion call is for advanced practitioners in oncology to take a keen interest in this issue and seek to develop population-specific strategies to bridge and eliminate the disparity gap and improve outcomes in these groups.

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

Background and purpose: Clinical guidelines suggest that prophylactic antiepileptic drugs (AEDs) should be given to newly diagnosed seizure-naive brain tumor patients for up to 1 week after craniotomy. Yet, data suggest that prophylactic AEDs are used up to 12 months after surgery. A quality improvement project was implemented to improve adherence to evidence-based prophylactic AED guidelines.

Methods: A quasi-experimental, pre- and post-test intervention design was used to assess the effect of a multiphase intervention on guideline adherence and prophylactic anticonvulsant prescription rates. The 16-week intervention consisted of provider education sessions, provider alerts, documentation templates, and a weekly audit and feedback. Participants included four providers and newly diagnosed seizure-naive brain tumor patients. Measures included guideline adherence rates and AED prescription rates extracted from chart review, and a provider attitude and knowledge survey. Analyses included descriptive statistics, Wilcoxon signed-rank tests, and Chi-square tests.

Results: Guideline adherence increased significantly (p < .01) from 4 months before implementation (15.8%) to 1 year before implementation (27.8%) and then to 93.3% after implementation. Provider knowledge showed clinically meaningful decreases in the likelihood to prescribe prophylactic AEDs (-.5 point) and increased understanding of prophylactic AED side effects (+0.5 point), although these were not statistically significant (p = .083). Finally, prophylactic AED prescription rates decreased by 2.2% (p = .119) compared with 4 months and 1 year before implementation (2.6%; p = .072).

Conclusion: This project highlights the important role of provider education, provider alerts, a documentation template, and audit and feedback in improving guideline adherence rate. Findings suggest that the combination intervention and weekly audit and feedback strategy can improve guideline adherence to prophylactic anticonvulsant use in seizure-naive newly diagnosed brain tumor patients.

Implications: By following prophylactic AED guideline recommendations, clinicians can avoid the potential side effects of anticonvulsant-induced cognitive, behavioral, and psychiatric issues that can impair patients' quality of life.