Canadian Oncology Nursing Journal最新文献

Individuals who live in the north of Canada face many challenges when they are diagnosed with cancer. Accessing cancer care usually means having to travel to a cancer centre in southern facilities and stay in a city away from family, local community, language and culture. The Indigenous Cancer Program atThe Ottawa Hospital was established to assist these individuals in navigating a complex and unfamiliar system of care. The First Nations, Inuit, Métis Nurse Navigator role was designed to collaborate with these patients and develop interventions to meet their unique needs. Recently, a satellite oncology clinic was opened in the territory of Baffin Island Nunavut where patients can be assessed, receive cancer immunotherapy therapy treatment, if required, and be followed after their primary treatment is finished. Holding the clinic in the local setting reduces the travel and time away from home for cancer patients. It is hoped this type of care can be expanded in the remote areas of the country.

Several Canadian provincial cancer agencies have adopted a nurse-led model of patient navigation to decrease care fragmentation in the system. The scope of competencies of the oncology nurse navigator (ONN) in Canada has evolved over the years in response to emerging cancer care challenges. This integrative review aimed to outline the scope of competencies of the ONN role in Canada. Three databases were searched since its inception to identify Canadian studies or theoretical papers on the role of ONNs. The search yielded 62 articles of which 39 were included in the review. Three interdependent role domains were identified. The first domain of care coordinator highlighted the ONN as a coordinator of health and practical needs along the care journey. The second framed the ONN as a change agent, through increasing patients' health literacy, creating partnerships, and trusting relationships. ONNs were also described as a supporter of wellbeing, or a champion of emotional, multidimensional needs, and a transformer of the context of care. All domains were central to the navigator's success in addressing inequities in care and improving patient outcomes across care settings.

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.