Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 5 Articles
Rationale.Many cancer patients and survivors do not meet nutritional and physical\nactivity guidelines, thus healthier eating and greater levels of physical activity could\nhave considerable benefits for these individuals.While research has investigated cancer\nsurvivors� perspective on their challenges in meeting the nutrition and physical\nguidelines, little research has examined how health professionals may assist their\npatients meet these guidelines. Cancer nurses are ideally placed to promote healthy\nbehaviours to their patients, especially if access to dieticians or dietary resources is\nlimited.However, little is known about cancer nurses� healthy eating promotion practices\nto their patients. The primary aim of this study was to examine current healthy\neating promotion practices, beliefs and barriers of cancer nurses in Australia andNew\nZealand. A secondary aim was to gain insight into whether these practices, beliefs and\nbarriers were influenced by the nurses� hospital or years of work experience.\nPatients and Methods. An online questionnaire was used to obtain data. Sub-group\ncancer nurse comparisons were performed on hospital location (metropolitan vs\nregional and rural) and years of experience (<25 or�25 years) using ANOVA and chi\nsquare analysis for continuous and categorical data respectively.\nResults. A total of 123 Australasian cancer nurses responded to the survey. Cancer\nnurses believed they were often the major provider of nutritional advice to their\ncancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially\nhigher than oncologists (3.3%). The majority promoted healthy eating\nprior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses\nfelt that healthy eating had positive effects on the cancer patients� quality of life\n(85.4%), weight management (82.9%), mental health (80.5%), activities of daily\nliving (79.7%) and risk of other chronic diseases (79.7%), although only 75.5%\nagreed or strongly agreed that this is due to a strong evidence base. Lack of time\n(25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited\nby the cancer nurses as the most common barriers to promoting healthy eating to\ntheir patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses� healthy eating\npromotion practices, beliefs and barriers were largely unaffected by hospital location\nor years of experience.\nConclusion. Australasian cancer nurses have favourable attitudes towards promoting\nhealthy eating to their cancer patients across multiple treatment stages and believe\nthat healthy eating has many benefits for their patients. Unfortunately, several\nbarriers to healthy eating promotion were reported. If these barriers can be overcome,\nnurses may be able to work more effectively with dieticians to improve the outcomes\nfor cancer patients....
Background: With the widespread use of orally administered anticancer agents, self-management by cancer\npatients is inevitable, and adherence to medication is becoming the centre of interest in oncology.\nMethods/Design: This mixed-method study is a two-phased approach with a combined quantitative and\nqualitative design. In the first phase, we will conduct a prospective randomised controlled study to assess the\neffects of a nurse-led medication self-management programme for patients receiving oral anticancer treatment.\nPatients with metastatic breast cancer, who have been newly prescribed an oral chemotherapy or a targeted\ntherapy agent will be enrolled in the study. The participants will be randomly assigned to either the medication\nself-management support programme group (intervention group) or the conventional care group (control group).\nThis will be an open-label study; therefore, neither the patients nor the nurses will be blinded. Nurses will provide\npatients in the intervention group with information by using the teach-back method, help patients set a goal based\non their preferences, and solve problems through follow-up counselling. The primary outcome measure is\nadherence to medication, to be measured on the basis of the medication possession ratio (MPR), which is the ratio\nof the number of days of medication supply to the total days at a specified time interval. We hypothesize that the\nintervention group will have an MPR of �90 % that is significantly higher than that of the control group. Secondary\noutcome measures include self-efficacy, quality of life, psychological distress, severity and interference of symptoms,\npatient satisfaction, emergency department visits, and hospital admissions. In the second phase, we will conduct\nfocus-group interviews with intervention nurses, and perform a content analysis to understand their role and\nchallenges these nurses will face in the programme while improving patients� medication adherence.\nDiscussion: The present study will be the first Japanese study to evaluate the effects of medication\nself-management support provided by nurses to patients with metastatic breast cancer who are receiving\noral anticancer treatment. The study is characterised by a unique patient-centred approach aiming to help\npatients manage their medication based on their needs and preferences, with both quantitative and\nqualitative evaluations. The findings will contribute to the facilitation of medication management in cancer\npatients....
Background: Automated dispensing cabinets (ADCs) were introduced in 2010 and 2012 at the Heart Hospital (HH)\nand National Center for Cancer Care and Research (NCCCR), both run by Hamad Medical Corporation in Qatar.\nThese medication distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at\nthe point of care in patient care units. The purpose of this study was to assess nursesââ?¬â?¢ perceptions of and\nsatisfaction with the use of ADCs at HH and NCCCR.\nMethods: A cross-sectional study was conducted in the two institutions in May and November 2012 using a\npiloted, validated, online, and anonymous questionnaire. The questionnaire consisted of four parts: nursesââ?¬â?¢\nsociodemographic and practice characteristics, 21 questions about their perceptions, one question about their\noverall satisfaction, and one about the systemââ?¬â?¢s ease of use. The self-administered survey was distributed to 503\nnurses working at HH and NCCCR over three weeks using Survey MonkeyÃ?®.\nResults: The survey response rate was 80 % (n = 403). No significant difference was found in perception scores\nbetween the two institutions (p = 0.06). Ninety-four percent (n = 378) of nurses agreed that the medication delivery\nsystem allowed them to do their job more safely, and 90 % (n = 363) nurses agreed that they now spent less time\nwaiting for medication from the pharmacy than they did before the ADC system was introduced. Eighty seven\npercent (n = 349) nurses agreed that they were able to administer medication more efficiently with the ADC\nsystem. The overall satisfaction rate (either ââ?¬Å?very satisfiedââ?¬Â or ââ?¬Å?satisfiedââ?¬Â) for the two hospitals was 91 %.\nConclusions: The nursesââ?¬â?¢ perceptions of and levels of satisfaction with the ADC system were very good over the\n6 months after complete implementation and integration at HH and NCCCR. ADCs appear to increase efficiency in\nthe medication process and should therefore improve the quality of care....
Background: Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities\nfrequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis,\nconstipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes,\ndecrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in\nreal-time, is regarded as the ââ?¬Ë?gold-standardââ?¬â?¢ to allow rapid clinical decision-making/intervention. This paper presents the\nprotocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for\nremote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients.\nMethods/Design: Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria\ninclude: diagnosis of chronic lymphocytic leukaemia/Hodgkinââ?¬â?¢s/non-Hodgkinââ?¬â?¢s lymphoma; agedââ?°Â¥ 18 years; receiving\nââ?°Â¥ 2 cycles chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with stratification by\ndiagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated\nto the control arm will receive ââ?¬Ë?Usual Careââ?¬â?¢ whilst those allocated to the intervention will receive the intervention in\naddition to ââ?¬Ë?Usual Careââ?¬â?¢. Intervention patients will be provided with a computer tablet and software prompting\ntwice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed\npre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and\ncontact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed\nto educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of\ncycles) via pen-and-paper self-report alongside review of the patient medical record. The primary outcome is burden\ndue to nausea, mucositis, constipation and fatigue. Secondary outcomes include: burden due to vomiting and\ndiarrhoea; psychological distress; ability to self-manage health; level of cancer information/support needs and;\nutilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is planned.\nDiscussion: This trial is the first in the world to test a remote monitoring/management intervention for adult\nhaematological cancer patients receiving chemotherapy. Future use of such interventions have the potential to\nimprove patient outcomes/safety and decrease health care costs by enabling early detection/clinical intervention....
Background: Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities\nfrequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis,\nconstipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes,\ndecrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in\nreal-time, is regarded as the ââ?¬Ë?gold-standardââ?¬â?¢ to allow rapid clinical decision-making/intervention. This paper presents the\nprotocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for\nremote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients.\nMethods/Design: Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria\ninclude: diagnosis of chronic lymphocytic leukaemia/Hodgkinââ?¬â?¢s/non-Hodgkinââ?¬â?¢s lymphoma; agedââ?°Â¥ 18 years; receiving\nââ?°Â¥ 2 cycles chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with stratification by\ndiagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated\nto the control arm will receive ââ?¬Ë?Usual Careââ?¬â?¢ whilst those allocated to the intervention will receive the intervention in\naddition to ââ?¬Ë?Usual Careââ?¬â?¢. Intervention patients will be provided with a computer tablet and software prompting\ntwice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed\npre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and\ncontact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed\nto educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of\ncycles) via pen-and-paper self-report alongside review of the patient medical record. The primary outcome is burden\ndue to nausea, mucositis, constipation and fatigue. Secondary outcomes include: burden due to vomiting and\ndiarrhoea; psychological distress; ability to self-manage health; level of cancer information/support needs and;\nutilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is planned. Discussion: This trial is the first in the world to test a remote monitoring/management intervention for adult\nhaematological cancer patients receiving chemotherapy. Future use of such interventions have the potential to\nimprove patient outcomes/safety and decrease health care costs by enabling early detection/clinical intervention....
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