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Background: Approximately 82% of children with childhood cancer survive more than five years after diagnosis. Living as a cancer survivor elicits a new reality that can include psychosocial impacts. These psychosocial impacts interact collectively, especially regarding reassimilation, and are rarely explored. Objective: To explore the psychosocial impacts of surviving childhood cancer and reassimilation back into society in young adult survivors of childhood cancer. Methodology: Individual in-depth semi-structured interviews were conducted with childhood cancer survivors and explored psychosocial aspects associated with returning to work, school, and social environments after remission. Interpretive phenomenological analysis was conducted once interviews were manually transcribed. A group interview with survivors was held to discuss the study’s findings and interpretation. Results: Individual interviews and the group interview revealed three major themes: outlook on reassimilating, outlook on coping, and outlook on cancer. Conclusions: This work is a first step to understanding how survivors’ personal outlook on coping and healthcare system barriers play influential roles in reassimilation following cancer treatment. Survivors expressed the need for reliable survivorship information and improved communication with healthcare providers regarding what to expect, so they could feel prepared for life post-cancer. These aspects need to be explored more deeply through other qualitative studies.

Contexte : Environ 82 % des personnes atteintes d’un cancer pendant l’enfance survivent plus de 5 ans après le diagnostic. La survivance transforme leur quotidien et entraîne parfois des difficultés psycho­sociales. Les séquelles psychosociales – rarement étudiées – sont inter­reliées, surtout en ce qui concerne la réinsertion aux activités normales. Objectif : Examiner les effets psychosociaux de la survie au cancer pédiatrique et la réinsertion sociale des jeunes adultes. Méthodologie : Des entrevues individuelles semi-structurées détaillées ont été réalisées auprès de personnes ayant survécu à un cancer pédiatrique afin d’étudier les aspects psychologiques du retour au travail, à l’école et en société après la rémission. Après la transcription manuelle des entrevues, on a procédé à une analyse phénoménologique interprétative. Un groupe de discussion a été organisé pour permettre aux survivants de discuter des résultats de l’étude et de l’interprétation des données. Résultats : Les entrevues individuelles et le groupe de discussion ont fait ressortir trois grands thèmes : le regard porté sur la réinsertion, le regard porté sur l’adaptation et le regard porté sur le cancer. Conclusions : La présente recherche amorce une démarche visant à comprendre en quoi le regard que portent les survivants sur l’adaptation et les obstacles liés au système de santé influence la réintégration après le cancer. Les survivants ont exprimé le besoin d’obtenir des renseignements fiables sur la survivance au cancer et d’être mieux informés par leurs professionnels de la santé afin de se préparer à la vie après le cancer. Ces aspects devront faire l’objet d’autres études qualitatives détaillées.

In 2023, for the first time, CANO-ACIO awarded three nursing students the Nursing Research Student Award for their successful abstracts. The award gave them an opportunity to present their research work during the annual CANO/ACIO conference that took place in Niagara Falls, Ontario. This innovative award approach was of particular importance for these three nursing students, one of whom was in an undergraduate nursing program, one in a Master’s program, and one in a doctoral program. As is evident in the descriptions below, the award was important to them because it gave them an opportunity to share their work with a national audience, as well as begin to see the larger world of oncology nursing research and its potential to change practice. Each of the individual presentations was amazing and greatly appreciated by all attendees of the Board-sponsored research workshop. Based on the feedback and the desire to profile the opportunity for other students in the future, each nursing student was invited to contribute to this Research Reflections Column. They were asked to discuss their personal experience and its impact on them. The following paragraphs are a summary of the synopsis they provided about their experiences.

In recent years, equity issues have taken on great importance, particularly in the field of oncology. Indeed, Canada has faced significant challenges, including global migration, limited resources, and climate changes that have exerted undeniable impacts on equity in cancer care services. Furthermore, the COVID-19 pandemic was a significant milestone that exacerbated many pre-existing health inequities. Despite these challenges, oncology nurse researchers shoulder the responsibility to contribute to health and epistemic equity (i.e., creation, usage, and diffusion of knowledge). This responsibility transcends Canada’s official languages (French and English), reflecting Canada’s rich linguistic diversity, with more than 4.6 million individuals (12.7%) primarily using languages other than English or French at home, such as Mandarin, Yue, Cree languages, and many more (Statistics Canada, 2022). Numerous researchers, including those featured in this journal, have taken a proactive stance in raising awareness and advocating for improved oncology research on health and epistemic equity (Varcoe et al., 2015; Winkfield et al., 2020). Alongside scholars and researchers, numerous national and international organizations, including the American Society of Clinical Oncology and the Canadian Partnership Against Cancer, have also expressed a commitment to address this crucial issue.

Background: Cancer care for Canadian cancer survivors remains fragmented. Little is known about the experience of Canadian oncology nurses providing cancer care for cancer survivors, as they transition from acute treatment to primary care. Objectives: This study aimed to (1) explore the experience of oncology nurses dealing with fragmented cancer care for cancer survivors in transition to survivorship; (2) identify oncology nurses’ perspectives about what promotes or inhibits their delivery of quality cancer care; and (3) obtain their suggestions to improve cancer care.Design: This study used a phenomenological design to explore the experience of oncology nurses in caring for cancer survivors during transition to survivorship and examine how the nurse participants describe their experience. Semi-structured interviews were used to collect data and an interpretative phenomenological analysis approach was used to develop themes from the data.Results: Three oncology nurses participated in this study. The following five themes emerged: (1) Under personal transition: nursing assessment, symptoms management, patient education, resources offered, refusing label of cancer survivors, promoting adjustment to a new normal life, promoting return to work, and recognizing meaning of survivorship; (2) Under cancer survivor’s care transition: promoting self-care management, communication, and maximal recovery of body functions; (3) Under nurse’s positive experience promoting delivery of quality cancer care: caring for cancer survivors, experience and knowledge, and advocate for cancer survivors; (4) Under barriers that negatively affected delivery of cancer care: low socioeconomic status (especially low income), cultures and languages barriers, and limited time providing nursing care; and (5) Suggestions to improve cancer care: establishing a new position – primary nurse, increasing the number of healthcare professionals, and improving knowledge, skills, and experience.Conclusion: Oncology nurses’ knowledge and experience provide a good foundation for quality cancer care and contribute to the health and wellbeing of cancer survivors.Keywords: oncology nurses, cancer care, treatment transition

Contexte : Au Canada, les soins offerts aux survivants du cancer demeurent fragmentés. On sait peu de choses de l’expérience des infirmières canadiennes en oncologie qui interviennent auprès des survivants du cancer pendant la transition du traitement actif vers les soins primaires.Objectifs de l’étude : 1) examiner l’expérience des infirmières en oncologie qui doivent composer avec les soins fragmentés que reçoivent les personnes en transition vers la phase de survivance; 2) comprendre les points de vue des infirmières en oncologie pour savoir ce qui facilite ou entrave la qualité des soins; 3) solliciter leurs suggestions pour améliorer les soins oncologiques.Devis : La présente étude utilise un devis phénoménologique pour consigner la description que font les infirmières en oncologie de leur expérience auprès des patients atteints de cancer en transition vers la phase de survivance afin de l’examiner en détail. Les données ont été recueillies dans le cadre d’entrevues semi-structurées; une analyse phénoménologique interprétative a ensuite permis d’en faire ressortir les thèmes.Résultats : Trois infirmières en oncologie ont pris part à l’étude, dont se dégagent les cinq thèmes suivants : 1) transition personnelle : évaluation infirmière, prise en charge des symptômes, enseignement au patient, ressources offertes, refus de l’étiquette de survivants, aide pour s’adapter à une nouvelle normalité et retourner au travail, reconnaissance de la signification de la phase de survivance; 2) transition des soins aux survivants du cancer : aide pour encourager les autosoins, la communication et le rétablissement optimal des fonctions corporelles; 3) expérience positive des infirmières favorisant la prestation de soins oncologiques de qualité : soins apportés aux survivants, expérience et connaissances, défense des intérêts des patients; 4) obstacles nuisant à la prestation des soins oncologiques : faible statut socio-économique (particulièrement le faible revenu), barrières de langues et de cultures, restriction du temps disponible pour les soins infirmiers; 5) suggestions pour améliorer les soins oncologiques : création d’un nouveau poste (infirmière primaire), augmentation du nombre de professionnels de la santé, amélioration des connaissances, des compétences et de l’expérience.Conclusion : Les connaissances et l’expérience des infirmières en oncologie forment la base de la qualité des soins prodigués aux personnes atteintes de cancer, et contribuent à la santé et au bien-être des survivants.Mots-clés : infirmières en oncologie, soins du cancer, transition post-traitement

The COVID-19 pandemic and health services impacts related to physical distancing posed many challenges for older adults with cancer. The goal of this study was to examine the impact of the pandemic on cancer treatment plans and cancer treatment experiences of older adults (ie, aged 65 years and older) and their caregiver' experiences of caring for older adults during the pandemic to highlight gaps in care experienced. In this multi-centre qualitative study guided by an interpretive descriptive research approach we interviewed older adults diagnosed with cancer and caregivers caring for them. Participants were recruited via cancer treatment centres in the provinces of British Columbia and Ontario (Vancouver and Toronto), Canada, and through an online ad sent out through patient advocacy organization newsletters. Interviews were recorded and transcribed verbatim and data were analyzed using an interpretive thematic analysis approach. A total of 27 individuals (17 older adults, 52.9% female; 10 caregivers, 90% female) participated in interviews lasting on average 45 minutes. Older adults with cancer described many impacts and pressures created by the pandemic on their cancer experiences, though they generally felt that the pandemic did not impact treatment decisions made and access to care. We grouped our findings into two main themes with their accompanying sub-themes, related to: (1) alterations in the individual and dyadic cancer experience; and (2) navigating health and cancer systems during the pandemic. The additional stressors the pandemic placed on older adults during their treatment and decision-making process and their caregivers expose the need to create or avail additional supports for future disruptions in care.

BackgroundAdherence to diet and medical therapies are key to improving heart failure (HF) outcomes; however, nonadherence is common. While mobile apps may be a promising way to support patients with adherence via education and monitoring, HF patient perspectives regarding the use of apps for HF management in unknown. This data is critical for these tools to be successfully developed, implemented, and adopted to optimize adherence and improve HF outcomes.ObjectiveTo determine patients' needs, motivations, and challenges on the use of mobile apps to support HF management.MethodsA qualitative descriptive study using focus groups (n = 4,60 minutes) was conducted among HF patients from outpatient HF clinics in Toronto, Canada. The Diffusion of Innovation theory informed a ten-question interview guide. Interview transcripts were independently coded by two researchers and analyzed using content analysis.ResultsNineteen HF patients (65 ± 10 yrs, 12 men) identified a total of four key themes related to the use of mobile apps. The theme 'Factors impacting technology use by patients' identified motivations and challenges to app use, including access to credible information, easy and accessible user-interface. Three themes described patients' needs on the use of mobile apps to support HF management: 1) 'Providing patient support through access to information and self-monitoring', apps could provide education on HF-related content (e.g., diet, medication, symptoms); 2) 'Facilitating connection and communication', through information sharing with healthcare providers and connecting with other patients; 3) 'Patient preferences', app features such as reminders for medication, and visuals to show changes in HF symptoms were favoured.ConclusionsHF patients perceive several benefits and challenges to app use for HF self-management. Capitalizing on the benefits and addressing the challenges during the app development process may maximize adoption of such tools in this patient population.

Introduction: We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. Methods: We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. Results: Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). Conclusion: The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients’ access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).

BackgroundNonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs’ perspectives on the use of mobile apps to support HF management. ObjectiveThe aim of this study is to determine HCPs’ perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. MethodsA qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. ResultsThe 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption—these include patient age, technology savviness, technology access, and ease of use; improved delivery of care—apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care—apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education—apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients—HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). ConclusionsHCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.

The COVID-19 pandemic required oncology nursing researchers to immediately and drastically adjust their research activities. During the 33rd Annual CANO/ACIO Conference Roundtable Workshop October 2021 – Moving Research Forward During COVID-19, oncology nurses gathered to share and discuss strategies they will continue, conclude, and commence when leading research during and beyond the pandemic. Workshop participants identified the use of low technology, such as telephone and virtual calls without video, as a valuable data collection strategy they will continue for individual interviews. In contrast, attendees expressed their desire to stop conducting virtual focus groups when public health measures are lifted. Oncology nurses indicated an interest in beginning to use a hybrid in-person/virtual data collection approach and incorporate some technological features, such as QR codes, for recruiting participants. Workshop attendees also reflected on the impact of COVID‑19 on oncology nursing practice and education, highlighting future research priorities and considerations.

The COVID-19 pandemic has led to major shifts in the healthcare environment, including the conduct of health research. Oncology practice has been significantly affected by abrupt measures to minimize COVID-19 exposure to cancer patients, family caregivers, and healthcare providers, such as social distancing, shifts to telehealth, redeployment and staffing changes, implementation of visitor restrictions, and round-the-clock use of personal protective equipment (Duncan et al., 2021). Efforts to minimize the risk of COVID-19 transmission also resulted in significant reductions in enrolling cancer patients in clinical trials in the early stages of the pandemic, especially for non-interventional studies (Tolaney et al., 2020; Waterhouse et al., 2020).

The rapid development of metastatic melanoma treatment options has significantly improved overall survival, but paralleled patient educational and supportive care resources have fallen behind. Particularly, the need for grassroots programs targeting environments outside urban centers has grown. Accordingly, an environmental scan of the Durham region in Ontario, Canada, showed the lack of melanoma-specific resources for outpatients. The goal of this study was to identify the needs of metastatic melanoma patients and survivors attending a large outpatient clinic in Durham, and then develop a patient-reviewed intervention plan. Needs were assessed in 5 domains through a melanoma-specific supportive care needs assessment survey. Among 75 surveyed melanoma patients and survivors, high-level needs were identified in 3 domains: psychological, health system information, and melanoma-specific information. Furthermore, domain-specific needs were heightened in specific sociodemographic groups. Based on these survey results, a multifaceted intervention plan was developed to mitigate future needs. The intervention plan was patient-reviewed in focus groups prior to implementation, refining the developed intervention plan.

Obtaining adequate survey response rates from registered nurses can at times seem like an uphill battle. Even students enrolled in undergraduate nursing programs are often inundated with requests to participate in surveys, to which they may stop responding altogether (Nulty, 2008). Ignoring or not responding to survey requests does not bode well for the researcher who is trying to collect data to complete a post-graduate degree, or a researcher attempting to publish what could prove to be an important study.

Il peut parfois s’avérer laborieux d’obtenir des taux de réponse satisfaisants aux sondages effectués auprès des infirmières. Même les étudiants inscrits à des programmes de premier cycle en sciences infirmières sont souvent submergés par des demandes de participation à des sondages, ce qui peut les empêcher de répondre (Nulty, 2008). Or, les faibles taux de réponse sont défavorables au chercheur qui collecte des données en vue d’obtenir un diplôme d’études supérieures ou qui mène une recherche possiblement capitale.

But : Le but de cette étude était d’explorer les rôles joués par les infirmières pivots en oncologie (IPO) pour accroître la responsabilisation des adultes atteints d’un cancer du poumon durant la phase diagnostique des soins oncologiques. Devis : Une étude descriptive qualitative a été utilisée. Les données proviennent d’entrevues individuelles avec des patients et d’un groupe de discussion formé d’IPO.Résultats : Huit personnes ont participé : quatre (4) adultes atteints d’un cancer du poumon et quatre (4) infirmières pivots en oncologie. Les thèmes liés aux fonctions cliniques des rôles joués par l’IPO pour accroître la responsabilisation des patients identifiés ont été : la représentation du patient (s’en faire le porte-parole), le soutien éducationnel, la gestion personnalisée des symptômes, et l’intervention pivot.Conclusion : Les IPO occupent un poste clé leur permettant d’adapter leur pratique aux besoins émotionnels et aux soins de soutien requis pour promouvoir la responsabilisation des patients et de leur famille.Mots-clés : infirmières pivots, responsabilisation des patients, cancer, phase diagnostique

Objective: The objective of this study was to explore the role of oncology nurse navigators (ONN) in enhancing patient empowerment for adult patients with lung cancer during the diagnostic phase of cancer care. Design: A qualitative descriptive design was used. Data were gathered through individual patient interviews and a focus group with the ONNs. Results: Eight individuals participated: four adult patients with lung cancer and four oncology nurse navigators. Themes regarding the clinical functions of the ONN role in enhancing patient empowerment were identified: patient advocate, educational support, personalized symptom management, and resource navigation.Conclusion: ONNs are in a key position to adapt their practice to the emotional and supportive care needs required to promote patient and family empowerment.Key words: nurse navigators, patient empowerment, cancer, diagnostic phase

Objective: The objective of this study was to explore the role of oncology nurse navigators (ONN) in facilitating continuity of care for adult lung cancer patients during the diagnostic phase of cancer care. Design: A phenomenological approach was used and involved semi-structured patient interviews and an oncology nurse navigators’ focus group. Results: Eight individuals participated, including four adult patients with lung cancer and four oncology nurse navigators. Themes regarding the organizational functions of the ONN role in facilitating continuity of care were identified: patient-focused care, needs assessments, shared decision-making, accessibility, and eliminating barriers.Conclusion: Awareness of the organizational functions of the ONN role could be used to create core areas of practice within nursing training modules to provide consistent and patient-centred continuity of care. Key words: nurse navigators, continuity of care, cancer, diagnostic phase

But : Le but de cette étude était d’explorer le rôle joué par les infirmières pivots en oncologie (IPO) pour soutenir la continuité des soins offerts aux adultes atteints d’un cancer du poumon pendant la phase diagnostique du cancer.Devis de l’étude : On a eu recours à une approche phénoménologique, à des entrevues semi-structurées auprès de patients et à un groupe de discussion formé d’infirmières pivots en oncologie.Résultats : Huit personnes ont participé : quatre patients adultes atteints du cancer du poumon et quatre infirmières pivots en oncologie. Les thèmes suivants ont été dégagés relativement aux fonctions organisationnelles jouées par l’IPO en vue de soutenir la continuité des soins : soins centrés sur le patient, évaluation des besoins, prise de décision partagée, accessibilité et élimination des obstacles.Conclusion : La prise de conscience des fonctions organisationnelles associées au rôle d’IPO pourrait permettre la création de domaines d’exercices dans les modules de formation en soins infirmiers, et ainsi assurer la dispensation de soins continus, uniformes et centrés sur le patient.Mots clés : infirmières pivots, continuité des soins, cancer, phase diagnostique

Les normes de soins de l’Association canadienne des infirmières en oncologie (ACIO/CANO, 2001) fournissent un cadre définitoire aux rôles et responsabilités de l’infirmière en oncologie. Cette étude vise à explorer comment l’infirmière en oncologie perçoit son rôle et ses responsabilités par rapport aux normes de soins de l’ACIO. Six groupes ont été formés et 21 infirmières autorisées (inf. aut.) venant d’un hôpital communautaire ont participé à l’étude. La transcription des conversations a été effectuée de manière inductive et qualitative. Trois thèmes ont été dégagés : 1) L’infirmière en oncologie perçoit une disparité entre la définition de son rôle et la réalité de sa pratique quotidienne parce que les soins prodigués aux personnes atteintes de cancer sont de plus en plus complexes et parce qu’elles doivent prodiguer des soins spécialisés à davantage de patients même si le système de santé ne s’adapte pas à la même vitesse de manière à les soutenir en assurant, par exemple une stabilité du personnel; 2) L’infirmière en oncologie, à titre de spécialiste, a besoin de perfectionnement professionnel et doit occuper un rôle de leadership; 3) L’infirmière en oncologie s’engage à fournir des soins continus et sert de point de référence pour l’équipe de soins de santé en favorisant la collaboration interdisciplinaire et en aidant le patient à naviguer dans le système. Le soutien organisationnel apporté par un engagement à assurer une bonne dotation en personnel et à cibler un champ d’exercice correspondant aux besoins du patient contribuera à maximiser la santé et le bien-être de l’infirmière, la prestation de soins de qualité et le rendement organisationnel.

The Canadian Association of Nurses in Oncology (CANO) Standards of Care (2001) provides a framework that delineates oncology nursing roles and responsibilities. The purpose of this study was to explore how oncology nurses perceive their roles and responsibilities compared to the CANO Standards of Care. Six focus groups were conducted and 21 registered nurses (RNs) from a community-based hospital participated in this study. Transcripts were analyzed using qualitative inductive content analysis. Three themes were identified: 1) Oncology nurses perceive a gap between their defined roles and the reality of daily practice, as cancer care becomes more complex and as they provide advanced oncology care to more patients while there is no parallel adaptation to the health care system to support them, such as safe staffing; 2) Oncology nursing, as a specialty, requires sustained professional development and leadership roles; and 3) Oncology nurses are committed to providing continuous care as a reference point in the health care team by fostering interdisciplinary collaboration and facilitating patient’s navigation through the system. Organizational support through commitment to appropriate staffing and matching scope of practice to patient needs may lead to maximize the health and well-being of nurses, quality of patient care and organizational performance.