NE Oncology Issue – November 2006

Dr. Wilkinson’s study on improving communica-tion skills in nurses was groundbreaking. When I was a novice nurse I used my intuition to help patients as best as I could. But most nurses would feel better equipped if they were taught to recognize and understand patient cues and the best way to communicate with them, especially with terminally ill patients. One of the most interesting aspects of Dr. Wilkinson’s study was that the participants developed their own agenda during the training program. The entire program was very well structured and individualized for the participant in that sense.

The PEPA model presented by Ms. Barrett was in a sense similar to Dr. Wilkinson’s training program since it focused on training healthcare professionals to be better communicators. Ontario has a similar program to PEPA called the Registered Nurses’ Association of Ontario (RNAO) fellowship that allows nurses to develop expertise in a particular field. The Advanced Clinical/Practice Fellowship (ACPF) offered by RNAO is a nurse mentoring experience aimed at developing and promoting nursing knowledge and expertise, and improving client care and outcomes in Ontario. At the University of Ontario, Oshawa, however, we are teaching communication skills at the undergraduate level. The students use self-assessment tools to improve communication skills and practise their skills on practice cases. This teaching tool is available on a CD. So in that sense, we are already training our nurses to be better communicators.

APNs play a key role in patient care. Hospitals need to be aware of all the issues in fully developing the APN role and giving them the education and training they need for helping patients obtain the best care.

The benefit of a supportive-care screening tool such as the one developed by Ms. Pigott and her colleagues is in allowing for patients to be referred to the appropriate healthcare professional earlier than they usually would have been. It is important for healthcare workers to ensure that the patient’s supportive care needs are being identified to ensure that they live a balanced life. For example, if a patient has no family nearby for support, this tool would help identify the kind of support the patient needs and the patient could be referred to a social worker. This is a kind of individualized assessment of patients’ supportive care needs even after the treatment has ended. In Canada, currently we have no such routine systematic screening and referral process and it would be interesting to test the validity and reliability of the Peter Mac SNST tool in other clinical settings.

Ms. Cusack’s presentation on the need for estimating patient to nurse ratio was very interesting. As she states, the diversity of patient load makes it very difficult to estimate patient care demands. For example, how can one predict the number of unexpected cases one gets in a day? A commonly used workload system to estimate this ratio in most hospitals is GRASP. However, the system cannot easily be customized to an individual hospital’s needs. In this regard, the development of an in-house system by Ms. Cusack’s group is particularly noteworthy.

(The GRASP Systems. Available at http://www.graspinc.com. Accessed October 11, 2006.).

The decision aid tool developed by Ms. Metcalfe and her colleagues for patients with breast cancer and BRCA1/2 mutations is quite remarkable. It will be interesting to see the results of clinical trials with the decision aid. A conference such as this opens one’s eyes, especially with regards to communicating with patients and getting relevant information out of them. Patients need to be provided the information and education they need for symptom management even after the treatment has ended. I believe an interdisciplinary approach to individualized treatment for symptom management and patient education is the key here. We have to work as a team so that we can provide patients with the support they need.

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Contributors

dr.lemonde
Manon Lemonde, MB
Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT
Dr. Manon Lemonde received her PhD in biomedical sciences from the Université of Montréal. She has many publications related to symptom management and social support. She has presented at oncology conferences and was also instrumental in developing workshops on fatigue in cancer. Dr. Lemonde’s oncology research interests are related to quality of life, human health resources planning in terms of recruitment and retention, and work environment.

dr-ellis
Peter Ellis, MBBS, MMed (Clin Epi), PhD, FRACP
Associate Professor in the Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University
Chair of the Juravinski Cancer Centre Lung Disease Site Team
Executive Member of the National Cancer Institute of Canada (NCIC) Clinical Trials Group Lung Disease Site Committee Dr. Peter Ellis is a staff medical oncologist at the Juravinski Cancer Centre (JCC). He is a member of Cancer Care Ontario’s Practice Guideline Initiative, Provincial Lung Disease Site Group. He is also an investigator on several NCIC and pharmaceutical industry-sponsored multi-centre phase III clinical trials in breast and lung cancer. Dr. Ellis has a research interest in the role of the consumer in decision making, and is an investigator in several studies in this area. He is also co-principal investigator in a systematic review examining diffusion and dissemination of cancer control interventions.

dr-clemons
Mark Clemons, MB, BSc, MRCP(UK), MD
Associate Professor of Medicine and Oncology, McGill University Division of Hematology, McGill University Health Centre Head of Breast Medical Oncology, Princess Margaret Hospital
Assistant Professor, Department of Medicine, University of Toronto
Dr. Mark Clemons is a staff oncologist at the Princess Margaret Hospital, Toronto. He has published widely on the management of breast cancer, and has a research program evaluating the mechanisms of resistance and sensitivity to treatment for bone metastases and locally advanced breast cancer.

dr-cole
Dana Cole, BScPharm, ACPR, PharmD
Clinical Pharmacist and Pharmacy Residency Coordinator, Prince George Regional Hospital
Head of Breast Medical Oncology, Princess Margaret Hospital
Assistant Professor, Department of Pharmacology, University of Northern British Columbia
Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
Dana Cole’s clinical interests are in supportive care, particularly anemia management, venous thromboembolism and palliative care. She has served as a reviewer for the professional development and assessment program, as a member of the advanced practitioner credentialing committee with the College of Pharmacists of BC, and as a member of the Canadian Association of Pharmacy in Oncology and the Canadian Society of Hospital Pharmacists.

dr-sehdev
Sandeep Sehdev, MD
Oncologist, William Osler Health Centre, Brampton
Dr. Sehdev is a community-focused medical oncologist at one of Canada’s largest community hospitals. He completed his fellowship at the Princess Margaret in Toronto in 1991, and his clinical practice treats most types of cancer. However, he has a keen interest in breast cancer, lung cancer, and patient education. Dr. Sehdev has been involved in breast cancer clinical trials through NCIC and BCIRG groups and has recently chaired several medical advisory board meetings on the role of hormonal therapy in breast cancer. In particular, Dr. Sehdev has been part of one of the largest and longest running breast cancer trials ever, the ATAC trial.