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Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

Objective To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. Design Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. Setting Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. Participants 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin’s disease, or non-Hodgkin’s lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. Intervention Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. Main outcome measures The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy—General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory—Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). Results For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference −0.15, 95% confidence interval −0.19 to −0.12; P Conclusions Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A “medium” Cohen’s effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients’ symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. Trial registration Clinicaltrials.gov NCT02356081 .

Purpose To synthesise existing qualitative evidence regarding the experiences of people living with cancer and their family caregivers using eHealth technology in their home setting. Method A narrative review using a systematic approach was utilised. Five databases (PubMed, CINAHL, EMBASE, PsycINFO and the Cochrane Library) were searched using a tailored search strategy to identify primary research articles published between January 2005 and May 2021. Studies were quality appraised using the Critical Appraisal Skills Programme's Qualitative Studies Checklist and the Mixed Method Appraisal Tool, where relevant. Identified studies were appraised by three reviewers and data were extracted for analysis. Key themes were identified and agreed upon by the authors. Results 28 empirical studies were included in the review. Five major themes emerged: (i) understanding of cancer and its care (ii) alignment and integration of eHealth technology into daily life (iii) connection and collaboration with healthcare professionals, family and peers (iii) reassurance and sense of safety (iv) and the psychosocial impact on the self during the cancer experience. Conclusions eHealth technology can have positive role in the lives of people with cancer and their family caregivers, beyond the intended health outcomes of the intervention. Individual preferences amongst people with cancer and their family caregivers using eHealth technology must be considered, especially regarding cancer information delivery, content and support methods. This review underlines a critical need for further in-depth evidence on the personal meaning and relationships people with cancer and their family caregivers develop with eHealth technology in an ambulatory care setting.

Purpose The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice. Methods Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites. Results After full-text screening, 27 publications were included. The majority (n = 14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n = 4), nausea/vomiting (n = 5), mucositis (n = 4), peripheral neuropathy (n = 3), diarrhoea (n = 2), constipation (n = 2), febrile neutropenia/infection (n = 7), palmar plantar erythrodysesthesia (PPE) (n = 1), and pain (n = 4). SM protocols were provided by >40% of the clinical sites. Conclusions A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.

Introduction (comprising background and problem statement): Clinical Practice Guidelines (CPGs) assist healthcare practitioners and patients in making decisions about evidence informed interventions to manage specific health related circumstances. They act as a mechanism for a systematic integrated delivery of care. Despite the existence of high quality international CPGs, their adoption and implementation in practice remains low. This is a real concern for healthcare policy makers and guideline developers. Adapting existing CPGs for local use using formal guideline adaptation frameworks has been advanced as an efficient method to foster better implementation. Guideline adaptation involves identifying standards and recommendations from existing quality CPGs and then contextualising them into an adapted guideline that is implementable within the practice setting intended. The importance of scientific methods to inform this process is critical. Description of policy context and objective: This paper provides a description of Guideline Adaptation methodology. The methodology described formed a study protocol that developed guidelines for the management of menopausal symptoms in breast cancer survivors within cancer services in North East Ireland. The methodology is underpinned by Implementation Science. Developed by the Canadian Partnership against Cancer, the CAN-IMPLEMENT programme © provides the overarching framework (1). The paper describes the methodology in three phases. The first phase focuses on the establishment of a participatory co-design model and involvement of patients, healthcare professionals and policy makers. The second phase describes the appraisal and evaluation of existing international clinical guidelines using the AGREE II instrument (2). The final phase focuses on guideline adaptation and implementation planning using the Consolidated Framework for Implementation Research (CFIR) (3) and Taxonomy of Implementation Strategies (4). Highlights (innovation, Impact and outcomes): This protocol provides an evidence informed guideline adaptation methodology using a collaborative model of co-design and co-production. The impact of the methodology is threefold in terms of outcomes. It enhances guideline development and implementation. It fosters networks and relationships where healthcare professionals and patients as equal partners address healthcare issues of concern. It promotes capacity building among healthcare stakeholders in guideline adaptation and implementation. Transferability: This protocol will inform other guideline groups in effective efficient methods for advancing the translation of CPGs into practice. This protocol could be applied to other settings as well as other clinical topics to strengthen the evidence on the adaption and implementation of CPGs. References: 1- Harrison MB, Graham ID, van den Hoek J, Dogherty EJ, Carley ME, Angus V. Guideline adaptation and implementation planning: a prospective observational study. Implementation Science. 2013;8(1):49. 2- Collaboration A. AGREE II Instrument and training resources. 2010. Available from: https://www.agreetrust.org/ 3- Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4. 4- Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10(1):21.

Effective symptom management is a critical component of cancer treatment. Computational tools that predict the course and severity of these symptoms have the potential to assist oncology clinicians to personalize the patient’s treatment regimen more efficiently and provide more aggressive and timely interventions. Three common and inter-related symptoms in cancer patients are depression, anxiety, and sleep disturbance. In this paper, we elaborate on the efficiency of Support Vector Regression (SVR) and Non-linear Canonical Correlation Analysis by Neural Networks (n-CCA) to predict the severity of the aforementioned symptoms between two different time points during a cycle of chemotherapy (CTX). Our results demonstrate that these two methods produced equivalent results for all three symptoms. These types of predictive models can be used to identify high risk patients, educate patients about their symptom experience, and improve the timing of pre-emptive and personalized symptom management interventions.

Purpose The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer. Method This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis. Results The key themes to emerge from the date were ‘living in the here and now’ and ‘awareness of the Cancer Society’. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society. Conclusions Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies’ services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.

Background: There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods: There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results: The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions: Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries. ©Eileen Furlong, Andrew Darley, Patricia Fox, Alison Buick, Grigorios Kotronoulas, Morven Miller, Adrian Flowerday, Christine Miaskowski, Elisabeth Patiraki, Stylianos Katsaragakis, Emma Ream, Jo Armes, Alexander Gaiger, Geir Berg, Paul McCrone, Peter Donnan, Lisa McCann, Roma Maguire. Originally published in JMIR Cancer (http://cancer.jmir.org), 14.03.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)

BACKGROUND There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. OBJECTIVE This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. METHODS There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. RESULTS The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. CONCLUSIONS Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

Introduction While some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology (eSMART) study is designed to specifically address these weaknesses with an appropriately powered, repeated-measures, parallel-group stratified randomised controlled trial of oncology patients. Methods and analysis A total of 1108 patients scheduled to commence first-line chemotherapy (CTX) for breast, colorectal or haematological cancer will be recruited from multiple sites across five European countries. Patients will be randomised (1:1) to the ASyMS intervention (intervention group) or to standard care currently available at each site (control group). Patients in the control and intervention groups will complete a demographic and clinical questionnaire, as well as a set of valid and reliable electronic patient-reported outcome measures at enrolment, after each of their CTX cycles (up to a maximum of six cycles) and at 3, 6, 9 and 12 months after completion of their sixth cycle of CTX. Outcomes that will be assessed include symptom burden (primary outcome), quality of life, supportive care needs, anxiety, self-care self-efficacy, work limitations and cost effectiveness and, from a health professional perspective, changes in clinical practice (secondary outcomes). Ethics and dissemination Ethical approval will be obtained prior to the implementation of all major study amendments. Applications will be submitted to all of the ethics committees that granted initial approval. eSMART received approval from the relevant ethics committees at all of the clinical sites across the five participating countries. In collaboration with the European Cancer Patient Coalition (ECPC), the trial results will be disseminated through publications in scientific journals, presentations at international conferences, and postings on the eSMART website and other relevant clinician and consumer websites; establishment of an eSMART website (www.esmartproject.eu) with publicly accessible general information; creation of an eSMART Twitter Handle, and production of a toolkit for implementing/utilising the ASyMS technology in a variety of clinical practices and other transferable health care contexts. Trial registration number NCT02356081. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2016-015016 © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Background Children and adolescents with cancer are at risk of experiencing distress in relation to their cancer diagnosis, treatment and treatment-related procedures. Complementary therapies such as reflexology may be used to help alleviate distressing symptoms; however, there is a dearth of research regarding the experience of reflexology from the perspective of children/adolescents with cancer and/or the parents/guardians of those who have received these treatments. Objective: To ascertain the perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non-specific foot massage. Methods Children and adolescents aged between 7 and 18 years attending a national children’s hospital for cancer treatment were invited to participate in a randomised controlled trial using a Mixed Between Group Repeated Measures design following receipt of ethical approval from the hospital’s Research Ethics Committee. In total, 75 children/adolescents either consented or assented to take part in the study. Of these, 39 were randomized to the intervention group (reflexology) and 36 to the control group (non-specific foot massage). Semi-structured interviews were undertaken with parents/guardians using an interview guide. Interviews were analysed using Braun and Clarke’s (2006) thematic analysis. Results The overarching theme which emerged across the interviews was participants’ perceptions of the foot treatments in general as a means of supporting the child during treatment for cancer. This central theme is discussed under a number of subthemes, namely psychological wellbeing, perceived physiological impact, time and space, a safe relationship and service development. Conclusions The parents/guardians views regarding the foot treatments in general were consistently positive. The implications of the study findings and the future delivery of the complementary therapy service will be discussed. Legal entity responsible for the study UCD. Funding Childhood Cancer Foundation. Disclosure All authors have declared no conflicts of interest.

Introduction: In Ireland, the risk of a women developing breast cancer is 1 in 9. For hormone responsive breast cancer, the risk of re-occurrence is reduced by anti-hormone therapy. However, the treatment induces menopausal symptoms that are often severe and adversely impact on quality of life and treatment adherence. This project adopts a guideline adaptation approach to develop clinical guidelines for the management of menopausal symptoms in breast cancer survivors in North East Ireland. Guideline adaptation involves identifying standards from existing clinical practice guidelines and contextualising them into an adapted guideline for local context. Guideline adaptation frameworks offer a systematic way of approaching adaptation to improve transparency, methodological rigor, and the quality of the adapted guideline (1). This paper provides a process evaluation on the value and utility of the guideline adaptation framework CAN-IMPLEMENT © (2, 3). Methods: This case study design utilised a collaborative participatory model within the CAN-IMPLEMENT © Framework.. Stakeholder engagement included patients, policymakers, researchers and healthcare professionals from medical oncology, cancer nursing, pharmacy and community. An evaluation was conducted with the Guideline Development Group. Data collection included documentary meeting notes, individual interviews and a validation evaluation forum. Findings: CAN-IMPLEMENT was evaluated as a rigorous, systematic method that provided novice guideline developers with methodological and practice assistance in both guideline adaptation and implementation planning. The AGREE II tool for appraisal and evaluation of existing international clinical guidelines was evaluated as a positive feature of the framework. The framework was limited in providing tools to support implementation planning. The facilitating strategies for multidisciplinary collaboration embedded within CAN-IMPLEMENT was considered a favourable feature of the framework as it facilitated strong stakeholder engagement to facilitate the complex multi-faceted process of guideline adaptation. Conclusions: CAN-IMPLEMENT provides transparency and methodological rigor for the development of a quality adapted guideline. The collaborative approach fosters engagement and empowerment of patients and healthcare communities to become equal partners in care. Discussions: A guideline adaptation framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs and implementation into account. Stakeholder engagement is a potent mechanism to develop capacity building among the local healthcare community. Lessons learned: Developing a guideline without adequate consideration of local context implementation hinders the uptake and adoption of existing high quality guidelines. CAN-IMPLEMENT is a valuable framework to address this challenge and has application potential across any healthcare environ. Limitations: This process evaluation was a single case study representing a cancer health service region in Ireland. The evaluation was based on self-reports rather than a formal framework evaluation tool. Suggestions for future research: This evaluation could be augmented by other evaluation studies of CAN-IMPLEMENT. References: 1- Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implementation Science. 2018;13(1):72. 2- Harrison MB, Graham ID, van den Hoek J, Dogherty EJ, Carley ME, Angus V. Guideline adaptation and implementation planning: a prospective observational study. Implementation Science. 2013;8(1):49. 3- Cancer CPA. Canadian Partnership Against Cancer Toronto CAN-IMPLEMENT]. Available from: https://www.partnershipagainstcancer.ca/can-implement/

Background: In recent years, the shift in cancer services from traditional tertiary care to care delivered within communities has increased the need for patients to engage in self-care activities in order to prevent or reduce the severity of numerous and complex-side effects (McCorkle et al., 2011) and make important health decisions when at home in the absence of clinicians (Butow et al., 2012). The actual degree of engagement in self-management may be dependent on patients’ perceived competence or self-efficacy to perform such activities (Fenlon et al., 2015). Self-efficacy has been defined as “a person’s belief to execute courses of action required to deal with a prospective situation” (Bandura, 1977, 2001). One’s beliefs in their capability to successfully manage tasks and consequently influence situations that impact their lives constitutes a central part of human agency, and can be influenced by performance accomplishments (Bandura, 1989, 2001). Whilst self-efficacy can enable engagement in self-management, actual participation in self-management activities can further increase one’s perceived ability to undertake such activities; it is thus obvious that a bi-directional association between self-management and self-efficacy exists. Supporting a shift in clinical practice with innovative technological systems affords a solution to the increasing demands placed on acute care by enabling the delivery of care in the home and community setting (Basch et al., 2011; Carpenter et al., 2008). Such remote monitoring systems facilitate the provision of clear lines of real-time communication between patients and their health care providers (Basch et al., 2011), and can deliver organised self-management advice tailored to the individual’s clinical characteristics and severity/distress of symptoms of anti-cancer treatment. Aim(s): Funded by the European Union (FP7 programme), a multi-centre European project (the eSMART study) has been designed to investigate the effects of an electronic patient-reported outcomes (ePRO) system, the Advanced Symptom Management System (ASyMS), on patient outcomes including improvement in self-efficacy, symptom management, supportive care needs, psychological status, work presenteeism, and well-being; health system costs; and the current clinical practice. The primary aim of eSMART is to evaluate the short and long term impact of the ASyMS technology on patient reported outcomes in people with breast cancer, colorectal cancer or haematological malignancies receiving first-line chemotherapy. In addition, eSMART will evaluate the cost-benefit of remote patient-monitoring and changes in clinical practice as a result of the application of the ASyMS intervention in different European healthcare settings. The study is currently recruiting patients, thus no data will be available for presentation. This presentation will nonetheless aim to present and discuss the hypothesis that provision of symptom self-management advice may be an important mechanism to improve patient self-efficacy, which may establish a self-sustained cycle where self-care advice provision enables patient self-efficacy and this in turn further increases patient involvement in self-management that can ultimately lead to improved patient outcomes. Method(s)/Results: The current study has been informed by the Medical Research Council Complex Interventions Framework (Anderson, 2008; Craig and Petticrew, 2012; Mackenzie et al., 2010), and the Holistic Framework to improve the Uptake and Impact of e-Health Technologies (van Gemert-Pijnen et al., 2011). The eSMART programme of work comprises two parts that will take place over a period of five years. The first part consists of preparatory work to refine the ASyMS intervention for use in a multi-national context, and concludes with a feasibility testing period to establish the technological readiness of the system prior to its use in the second part. The second part will employ a repeated-measures, parallel-group, stratified randomised controlled trial methodology to demonstrate the effects of the ASyMS intervention in supporting patients who receive chemotherapy treatment through individualised symptom management. The second part will test the short- (i.e. during the treatment phase) and long-term effects (i.e. at one-year follow-up) of the ASyMS intervention versus standard care across the participating countries (Austria, Greece, Ireland, Norway and the UK). The ASyMS intervention comprises use of a mobile phone (i.e. ASyMS patient handset) and a tympanic thermometer. The patient handset will enable participants on the intervention group to enter symptom/temperature data on a dedicated, electronic symptom questionnaire daily and whenever they feel unwell. Upon successful submission of their data, patients will immediately receive automated, evidence-based self-care advice based on their symptom reports. Patients will also have access to a self-care library, symptom graphs (detailing trends in individual symptoms experienced) and contact numbers of care teams and patient support organisations in their country, available within the ASyMS patient handset. Via dedicated tablet PCs, all participants will complete an electronic version of the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer) (Wolf et al., 2005) at baseline; after each CTx; and 3, 6, 9 and 12 months post-chemotherapy treatment. The CASE-Cancer is a validated, 12-item measure that yields scores on three factors: understanding and participating in care, maintaining a positive attitude, and seeking and obtaining information. In accordance with latest recommendations for pragmatic research in healthcare (Oakley et al., 2006; Treweek and Zwarenstein, 2009), the longitudinal nature of the trial will aid to establish sustainability of intervention effects and further stress its benefits when compared to standard care. Conclusions: This anticipatory model of care supports symptom management within the patient’s home, where the early toxicities of chemotherapy can be managed, utilising self-care and local community services. This model is also expected to contribute to the health literacy of patients with cancer in relation to early identification, report and self-management of their most common symptoms. As part of the project’s objectives, we will aim to show improved self-efficacy (as shown by statistically significantly higher self-efficacy scores) during active chemotherapy for breast cancer, colorectal cancer, or haematological malignancies, and/or at one-year follow-up. It is hoped that an enhanced self-efficacy (evidenced by patients’ greater understanding and participation in care, positive attitude, and engagement in seeking health-related information) will in turn enable a smoother rehabilitation process for patients in the post-treatment survivorship period and beyond. EU FP7 Programme Grant agreement No. 602289. Trial registration identifier (clinicaltrials.gov) NCT02356081.

While co-design methods are becoming more popular in healthcare, there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed.

Summary This paper discusses oncology nursing students’ views of an objective structured clinical examination (OSCE). The OSCE has been used as a form of assessment in medical education since the 1970s. It has subsequently been used by nursing faculties as one of a number of approaches to assessment of clinical skills. As a form of assessment it has been lauded as being more objective than traditional clinical examinations. The information in this study was collected through annual evaluations since 1998, when the OSCE was first employed to assess the students on a post-graduate oncology nursing programme. The sample comprised 185 students, and the principle areas addressed were students’ perceptions regarding their degree of preparation for the examination, the overall efficacy and relevance of the OSCE in testing clinical skills and their views on stress and anxiety associated with this form of assessment. The results indicate that while students acknowledge the OSCE was stressful, they felt they were well prepared and appreciated the efficacy and relevance of this assessment method.

The oncology nursing development project was implemented to facilitate the teaching of cancer care to nurses at the pre-registration level. Since the project involved the implementation of change, an action research design was employed. As a first step an assessment of the cancer content of pre-registration nurse education programmes in every general and sick children's training hospital in Ireland was undertaken. This demonstrated that those involved in teaching the cancer content of pre-registration nurse education programmes wanted to be updated in various different aspects of cancer care. As a result of these findings, a directory of cancer-related educational resources was developed and distributed to all schools of nursing. In addition, a learning needs assessment was undertaken to determine which aspects of cancer care should be addressed in a ‘Training the Trainers’ programme. This assessment was used as a basis to develop such a programme, which was implemented and subsequently evaluated. The majority of the participants indicated that they found the programme helpful and requested further education in the area of cancer care. The major strength of this project was that it was implemented nationally, which means that potentially all newly registered nurses in Ireland will be better prepared to care for cancer patients.

Some oncology outpatients experience a higher number of and more severe symptoms during chemotherapy (CTX). However, little is known about whether this high risk phenotype persists over time. Latent transition analysis (LTA) was used to examine the probability that patients remained in the same symptom class when assessed prior to the administration of and following their next dose of CTX. For the patients whose class membership remained consistent, differences in demographic and clinical characteristics, and quality of life (QOL) were evaluated. The Memorial Symptom Assessment Scale (MSAS) was used to evaluate symptom burden. LTA was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of the MSAS symptoms. Of the 906 patients evaluated, 83.9% were classified in the same symptom occurrence class at both assessments. Of these 760 patients, 25.0% were classified as Low-Low, 44.1% as Moderate-Moderate and 30.9% as High-High. Compared to the Low-Low class, the other two classes were younger, more likely to be women and to report child care responsibilities, and had a lower functional status and a higher comorbidity scores. The two higher classes reported lower QOL scores. The use of LTA could assist clinicians to identify higher risk patients and initiate more aggressive interventions.

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.