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Abstract Meaningful engagement with stakeholders in research demands intentional approaches. This paper describes the development of a framework to guide stakeholder engagement as research partners in a pragmatic trial proposed to evaluate behavioral interventions for dysphagia in head and neck cancer patients. We highlight the core principles of stakeholder engagement including representation of all perspectives, meaningful participation, respectful partnership with stakeholders, and accountability to stakeholders; and describe how these principles were operationalized to engage relevant stakeholders throughout the course of a large clinical trial.

Summary: Background: Developing strategies to prevent breast cancer-related arm lymphoedema (BCRAL) is a critical unmet need because there are no effective interventions to eradicate it once it reaches a chronic state. Certain strategies such as prospective surveillance programs and prophylactic lymphatic reconstruction have been reported to be effective in clinical trials. However, a large variation exists in practice based on clinician preference, organizational standards, and local resources. Methods: A two-round international Delphi consensus process was performed from February 27, 2023 to May 25, 2023 to compile opinions of 55 experts involved in the care and research of breast cancer and lymphoedema on such interventions. Findings: Axillary lymph node dissection, use of post-operative radiotherapy, relative within-arm volume increase one month after surgery, greater number of lymph nodes dissected, and high body mass index were recommended as the most important risk factors to guide selection of patients for interventions to prevent BCRAL. The panel recommended that prospective surveillance programs should be implemented to screen for and reduce risks of BCRAL where feasible and resources allow. Prophylactic compression sleeves, axillary reverse mapping and prophylactic lymphatic reconstruction should be offered for patients who are at risk for developing BCRAL as options where expertise is available and resources allow. Recommendations on axillary management in clinical T1–2, node negative breast cancer patients with 1–2 positive sentinel lymph nodes were also provided by the expert panel. Routine axillary lymph node dissection should not be offered in these patients who receive breast conservation therapy. Axillary radiation instead of axillary lymph node dissection should be considered in the same group of patients undergoing mastectomy. Interpretation: An individualised approach based on patients' preferences, risk factors for BCRAL, availability of treatment options and expertise of the healthcare team is paramount to ensure patients at risk receive preventive interventions for BCRAL, regardless of where they are receiving care. Funding: This study was not supported by any funding. RJC received investigator grant support from the Australian National Health and Medical Research Council (APP1194051).

Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs’ experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist’s initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists.

Background and purpose: Over the past decade, patient engagement (PE) has emerged as an important way to help improve the relevance, quality, and impact of health research. However, there is limited consensus on how best to meaningfully engage patients in the research process. The goal of this article is to share our experiences and insights as members of a Patient Advisory Committee (PAC) on a large, multidisciplinary cancer research study that has spanned six years. We hope by sharing our reflections of the PAC experiences, we can highlight successes, challenges, and lessons learned to help guide PE in future health research. To the best of our knowledge, few publications describing PE experiences in health research teams have been written by patients, survivors, or family caregivers themselves. Methods: A qualitative approach was used to gather reflections from members of the Patient Advisory Committee regarding their experiences in participating in a research study over six years. Each member completed an online survey and engaged in a group discussion based on the emergent themes from the survey responses. Results: Our reflections about experiences as a PAC on a large, pan-Canadian research study include three overarching topics (1) what worked well; (2) areas for improvement; and (3) reflections on our overall contribution and impact. Overall, we found the experience positive and experienced personal satisfaction but there were areas where future improvements could be made. These areas include earlier engagement and training in the research process, more frequent communication between the patient committee and the research team, and on-going monitoring regarding the nature of the patient engagement. Conclusions: Engaging individuals who have experienced the types of events which are the focus of a research study can contribute to the overall relevance of the project. However, intentional efforts are necessary to ensure satisfactory involvement.

Previous research has identified communication and care coordination problems for patients with cancer. Healthcare providers (HCPs) have reported communication issues due to the incompatibility of electronic medical records (EMR) software and not being consistently copied on patient reports. We evaluated an asynchronous web-based communication system (“eOncoNote”) for primary care providers and cancer specialists to improve cancer care coordination. The objectives were to examine patients’ perceptions of the role of eOncoNote in their healthcare, and HCPs’ experiences of implementing eOncoNote. Qualitative interviews were conducted with patients with breast and prostate cancer, primary care providers, and cancer specialists. Eighteen patients and fourteen HCPs participated. Six themes were identified from the patient interviews focusing on HCP and patient roles related to care coordination and patient awareness of communication among their HCPs. Four themes were identified from HCP interviews related to the context of care coordination and experience with eOncoNote. Both patients and HCPs described the important role patients and caregivers play in care coordination. The results show that patients were often unaware of the communication between their HCPs and assumed they were communicating. HCPs encountered challenges incorporating eOncoNote into their workflow.

But de l’étude : Le projet consistait à concevoir, perfectionner et tester une approche de dépistage de la détresse auprès des survivants du cancer qui fréquentent des organismes communautaires de soutien aux personnes atteintes du cancer.Méthodologie : Le projet s’est décliné en plusieurs phases; on a notamment effectué une revue de la littérature récente et formé des groupes de discussion avec les survivants du cancer et le personnel d’organismes communautaires. Les données ont été collectées pour servir d’assise à la conception et à la mise en œuvre d’une nouvelle approche de dépistage adaptée aux organismes communautaires de soutien du cancer qui souhaitent identifier la détresse psychosociale de leurs membres.Résultats : Les questionnaires normalisés utilisés dans les approches de dépistage de la détresse en contexte clinique n’étaient pas considérés comme appropriés par les survivants du cancer qui cherchaient du soutien en milieu communautaire. Une nouvelle approche de dépistage a été conçue et mise en œuvre en tenant compte des commentaires des survivants du cancer et du personnel des organismes communautaires. L’outil utilisé dans l’approche de dépistage était axé autour des problèmes pertinents des personnes en milieu communautaire. Si des problèmes étaient identifiés, le personnel suivait une trajectoire de soins personnalisée pour les résoudre. Les patients comme les employés ont trouvé l’approche de dépistage utile pour repérer les problèmes et les solutions afférentes.Conclusions : Les approches de dépistage de la détresse peuvent être utiles dans un contexte de soutien communautaire aux survivants du cancer pour identifier les personnes très à risque de vivre des difficultés. Les données du dépistage peuvent servir aux organismes qui souhaitent faire état de l’efficacité de leurs services.

Purpose: This project was designed to develop, refine and field-test a distress screening approach with survivors accessing community-based cancer support agencies.Methods: The project was conducted in phases including a literature review and focus groups with cancer survivors and community agency staff. Data were gathered to lay the foundation for building a subsequent development and implementation of a new screening approach suitable for community-based cancer support agencies to use in identifying psychosocial distress in their clients.Results: Standardized questionnaires used for distress screening approaches in clinical settings were not seen by cancer survivors as appropriate for community-based cancer support settings. A new screening approach was designed and implemented based on input from cancer survivors and staff in community-based agencies. The tool used in the distress screening approach focused on problems relevant to individuals in the community setting. If problems were identified, staff followed tailored care pathways to resolve them. Both patients and staff found the screening approach useful for quickly pinpointing problems and avenues for dealing with the issues.Conclusions: Screening for distress approaches can be useful in a community-based cancer support setting to identify individuals who are at greater risk for experiencing difficulties. Data from screening can be useful for agencies to report on their service effectiveness.

Introduction: Breast cancer in Rwanda is a major concern for women’s health, as most breast cancer diagnoses are made at an advanced stage. Yet, diagnosis can be done early with breast cancer screening practices. Aim: To assess factors influencing breast cancer screening practices among women of reproductive age in South Kayonza District of Rwanda.Methodology: A quantitative survey was conducted with 246 women between 16 and 49 years of age from four health centres in South Kayonza District. A structured, pretested, and self-administered questionnaire was used to assess the influence of knowledge, health facilities, and socioeconomic and cultural factors on breast screening practices among women in South Kayonza. Result: Among all respondents, 55.5% had moderate knowledge about breast cancer risk factors and 60.2% also had moderate knowledge on the influence of breast cancer screening. While 28% were knowledgeable about Breast Self-Examination (BSE), 16.4% were knowledgeable about Clinical Breast Examination (CBE) and breast ultrasound. Responses about the practice of breast screening in the last two years showed 72% of respondents had never practiced BSE and 81.3% had not used CBE or breast ultrasound scan. The main source of information about breast cancer screening was the radio, used by 30.4% of respondents. Significant relationships were found between age and marital status with breast cancer screening practices. Conclusion: This study revealed low levels of knowledge about breast cancer, breast cancer screening, and practice regarding breast cancer screening. There is a need to promote awareness of breast cancer and create a program, which can influence breast cancer screening knowledge and practice to ultimately improve health among women in south Kayonza.

Introduction : Au Rwanda, le cancer du sein est une grande préoccupation pour la santé des femmes puisque la plupart des diagnostics sont faits à un stade avancé de la maladie. On sait pourtant que les pratiques de dépistage du cancer du sein permettent d’accélérer le diagnostic.Objectif : Évaluer les facteurs qui influencent les pratiques de dépistage du cancer du sein chez les femmes en âge de procréer habitant le district de Kayonza, au Rwanda.Méthodologie : Une étude quantitative a été menée dans quatre centres de santé au sud du district de Kayonza auprès de 246 femmes de 16 à 49 ans. Un questionnaire structuré, prétesté et autoadministré a été utilisé pour évaluer l’influence des connaissances, des centres de santé et des facteurs socioéconomiques et culturels sur les pratiques de dépistage du cancer du sein chez les femmes dans le sud de Kayonza.Résultats : Parmi les répondantes, 55,5 % avaient une connaissance moyenne des facteurs de risque du cancer du sein, et 60,2 % sur l’incidence du dépistage du cancer du sein. On a constaté que 28 % étaient familiarisées avec l’auto-examen des seins (AES) et 16,4 % avec l’examen clinique des seins (ECS) et l’échographie mammaire. Au cours des deux années précédentes, les réponses entourant les pratiques de dépistage du sein ont révélé que 72 % des répondantes n’avaient jamais réalisé d’AES et que 81,3 % n’avaient jamais passé d’ECS ou d’échographie mammaire. Pour 30,4 % des répondantes, l’information sur le dépistage du cancer du sein provenait principalement de la radio. Des relations significatives avec les pratiques de dépistage du cancer du sein sont ressorties pour l’âge et l’état matrimonial.Conclusion : L’étude témoigne du peu de connaissances sur le cancer du sein, le dépistage et les pratiques relatives au dépistage de cette maladie. Il est donc nécessaire de promouvoir la sensibilisation au cancer du sein et de créer un programme qui puisse améliorer les connaissances et les pratiques en matière de dépistage afin d’améliorer la santé des femmes du sud de Kayonza.

Contexte : Dans le monde, le cancer du col utérin arrive au troisième rang des cancers les plus fréquents chez les femmes, mais il passe au deuxième rang en Afrique orientale, où se trouve le Rwanda. Le dépistage périodique est un moyen de prévention efficace. Malgré cela, en Afrique, on estime que le taux de dépistage de ce cancer se situe entre 10 et 70 %. Plusieurs facteurs entravent le dépistage, surtout en Afrique subsaharienne. Au Rwanda, on recense peu d’écrits sur l’utilisation des services de dépistage et les facteurs nuisant au dépistage du cancer du col utérin.Objectif : Évaluer les connaissances sur le dépistage du cancer du col utérin qu’ont les femmes fréquentant les hôpitaux de district de Kigali (au Rwanda), recenser l’utilisation de ce service et déterminer les obstacles qui empêchent d’y recourir.Méthodologie : Une étude transversale descriptive a été menée, et les données ont été collectées au moyen d’un questionnaire structuré. Des questions nominales de type « oui ou non » ont mis en lumière les connaissances des femmes sur le cancer du col utérin et l’utilisation des services de dépistage. Pour cerner les obstacles au dépistage, nous avons utilisé des questions de type « échelle de Likert ». Ces données ont ensuite fait l’objet d’une analyse statistique descriptive et déductive. La sélection des répondantes s’est faite par échantillonnage aléatoire systématique depuis la base de données des patientes fréquentant les services gynécologiques de trois hôpitaux de district de Kigali (Rwanda).Résultats : Au total, 329 femmes ont répondu au sondage. La moitié d’entre elles (n = 165) connaissaient bien le dépistage du cancer du col utérin. Le pourcentage de dépistage se situe à 28,3 %. Nous avons décelé un lien entre l’utilisation du dépistage et une bonne connaissance du sujet (P = 0,000, r = -0,392) ainsi que certains facteurs démographiques (P = 0,000). Parmi les obstacles qui concourent à restreindre l’accès au dépistage, nous avons relevé des obstacles individuels (méconnaissance de l’existence des services de dépistage), géographiques (milieu rural) et liés au système de santé et aux prestataires de soins (campagnes de sensibilisation déficientes, attitudes négatives des prestataires de soins envers les patientes et longs délais d’attente).Conclusion : Dans les hôpitaux de district étudiés de Kigali (Rwanda), on constate un faible pourcentage de dépistage du cancer du col utérin causé par plusieurs obstacles. Il est donc fortement recommandé d’engager une campagne d’information permanente sur ce cancer et son dépistage. Enfin, il est crucial que les prestataires de soins qualifiés encouragent les femmes à se soumettre au dépistage, et qu’ils s’efforcent de réduire les obstacles qui s’y rattachent.

Background: Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening.Objective: To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda.Methods: A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal ‘yes’ or ‘no’ questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda.Results: Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion: A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.

The Canadian Association of Nurses in Oncology/Association Canadienne des Infirmières en Oncologie (CANO/ACIO) is committed to being an influencing force globally. Its role in international work has been an important aspect of the Strategic Plan over the past five years. Beginning in 2015, following an environmental scan, literature review, and member input, the “Framework for International Engagement, Exchange, Influence and Partnerships” was articulated. This article focuses on experiences and exemplars of work in international settings that focus on symptom management, supportive care, education, and the integration of the CANO standards and competencies into other settings. Exemplars from East Africa (Rwanda and Kenya) and Central America (Costa Rica) in which CANO/ACIO members were involved will be highlighted.

ÉNONCÉ DE POSITION DE L’ACIO/CANOSommaireLe vieillissement de la population constitue une nouvelle réalité pour les infirmières en oncologie du Canada. La variété et l’éventuelle complexité des besoins des patients âgés et des proches exigent une approche intégrative, globale et personnalisée.Pour prodiguer des soins de qualité aux adultes âgés atteints de cancer et bien accompagner les proches, les infirmières canadiennes en oncologie souhaitent miser sur les forces, favoriser l’accessibilité, optimiser les communications (en personne et en mode virtuel), soutenir la prise de décision quant au traitement, évaluer et prendre en compte diligemment les enjeux liés à l’âge, en plus d’assurer un travail d’équipe interprofessionnel et interdisciplinaire efficace, ainsi qu’une collaboration dynamique entre les professionnels de la santé offrant des soins de proximité et les prestataires de soins en oncologie.La pratique infirmière en oncologie est une composante clé de la qualité des soins. Au Canada, les infirmières en oncologie sont à l’écoute des préoccupations des patients et de leurs proches et défendent leur cause dans les équipes de soins et au-delà; elles optimisent également les soins en gérant les besoins liés à l’âge, en coordonnant les soins et en facilitant l’orientation des patients vers les bons services.Pour contribuer pleinement à la qualité des soins que reçoivent les adultes âgés, les infirmières canadiennes en oncologie ont besoin de soutien et de ressources dans les domaines de la pratique clinique, du leadership, de la formation, des politiques et de la recherche.

CANO/ACIO POSITION STATEMENTPosition SummaryThe aging population presents a new reality for Canadian oncology nursing care. The variation and potential complexity of the needs of older adults with cancer and their families requires integrative, comprehensive, and tailored approaches to care.Canadian oncology nurses envision quality care for older adults with cancer and their families that honors strengths, promotes accessibility of care and optimal communication (in-person and virtually), supports treatment decision making processes, proactively assesses and addresses age-related concerns, involves effective interprofessional and interdisciplinary teamwork, and ensures active collaboration among community and cancer care providers. Oncology nursing practice is key to this quality care. Canadian oncology nurses notice patient and family concerns; advocate for the patient and family within and beyond health care teams; and act to optimize care by managing age-related needs, facilitating referrals, and coordinating care.To contribute fully to quality of care for older adults with cancer, Canadian oncology nurses require support and resources in clinical practice, leadership, education, policy, and research.

In my various readings this past week, I was introduced to an idea that was new to me, although linked to ones with which I am familiar. It clearly has implications for oncology nursing and, therefore, is an idea I thought you might be interested in learning about.

Active surveillance (AS) has gained acceptance as a primary management approach for patients diagnosed with low-risk prostate cancer (PC). In this qualitative study, we compared perspectives between patients and health care professionals (HCP) to identify what may contribute to patient–provider discordance, influence patient decision-making, and interfere with the uptake of AS. We performed a systematic comparison of perspectives about AS reported from focus groups with men eligible for AS (7 groups, N = 52) and HCP (5 groups, N = 48) who engaged in conversations about AS with patient. We used conventional content analysis to scrutinize separately focus group transcripts and reached a consensus on similar or divergent viewpoints between them. Patients and clinicians agreed that AS was appropriate for low grade PC and understood the low-risk nature of the disease. They shared the perspective that disease status was a critical factor to pursue or discontinue AS. However, men expressed a greater emphasis on quality of life in their decisions related to AS. Patients and clinicians differed in their perspectives on the clarity, availability, and volume of information needed and offered; clinicians acknowledged variations between HCP when presenting AS, while patients were often compelled to seek additional information beyond what was provided by physicians and experienced difficulty in finding or interpreting information applicable to their situation. A greater understanding of discordant perspectives about AS between patients and HCP can help improve patient engagement and education, inform development of knowledge-based tools or aids for decision-making, and identify areas that require standardization across the clinical practice.

Abstract Background Over the last decade, active surveillance has proven to be a safe approach for patients with low-risk prostate cancer. Although active surveillance presents several advantages for both patients and the health care system, all eligible patients do not adopt this approach. Our goal was to evaluate the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods Focus groups (n = 5) were held with physicians who provided care for men with low-risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of health care professionals (HCPs) was captured to understand their decisions in proposing active surveillance and to reveal the barriers and facilitators that affect the adherence to this approach. A content analysis was performed on the verbatim transcripts from the sessions. Results Although physicians agreed that active surveillance is a suitable approach for low-risk prostate cancer patients, they were concerned about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for additional tools to appropriately identify proper patients for whom active surveillance is the best option. Urologists and radiation-oncologists were keen to collaborate with each other, but the role of general practitioner remained controversial once patients were referred to a specialist. Conclusions Integration of more reliable tools and/or markers in addition to more specific guidelines for patient follow-up would increase the confidence of both patients and physicians in the choice of active surveillance.

Abstract Background In prostate cancer, men diagnosed with low risk disease may be monitored through an active surveillance. This research explored the perspectives of men with prostate cancer regarding their decision-making process for active surveillance to identify factors that influence their decision and assist health professionals in having conversations about this option. Methods Focus group interviews (n = 7) were held in several Canadian cities with men (N = 52) diagnosed with prostate cancer and eligible for active surveillance. The men’s viewpoints were captured regarding their understanding of active surveillance, the factors that influenced their decision, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the sessions. Results Patients described their concerns of living with their disease without intervention, but were reassured by the close monitoring under AS while avoiding harmful side effects associated with treatments. Conversations with their doctor and how AS was described were cited as key influences in their decision, in addition to availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.

A year ago I wrote an editorial entitled, “The power of the narrative” (CONJ, Vol. 29, No. 1). I was inspired then by the digital stories that had been developed by the Canadian Cancer Society (CCS). These were stories told by cancer survivors about their experiences being diagnosed, treated, and living afterward. We saw the digital stories for the first time at the CANO/ACIO Annual Conference in Prince Edward Island.

Patients have reported that nausea and vomiting are their first concern when receiving chemotherapy. The consequences of inadequately controlled nausea and vomiting range from minor discomfort to dose-limiting toxicity. Nurses have a key role to play in helping patients and families manage the distress associated with treatment side effects. Astute assessment, collaborative planning and developing a partnership with the patient are key aspects of the nurse's role. The relationship the nurse develops with the patient is the avenue for understanding the patient's perspective and ensuring treatment goals are mutually agreeable.

Research has a role in generating sound information and in helping cancer nurses make good practice decisions. Frequently, cancer nurses have not had the opportunity to learn about research. This article describes an approach for introducing research to cancer nurses. The approach was selected primarily to help cancer nurses see a relevancy in research. It also helped th e nurses see a use for the data gathered through research methods and experience a sense of investment in data collection activities. Four projects are highlighted to illustrate how nurses identified questions in their clinical practice and used systematic data collection to generate information (data) to help in their practice decision-making. The projects focus on information needs of women experiencing colposcopy, use of an information sheet for women with breast cancer after radiation, introduction of a new health assessment tool and identifying the needs of palliative care patients on an inpatient service.

Before developing interventions for stomatitis, nurses require a simple, valid and reliable approach to staging severity. The eight-item WCCNR was previously validated for chemotherapy-induced stomatitis. In this study, the validity and reliability of the WCCNRR, a shorter three-item tool for staging stomatitis caused by chemotherapy, radiotherapy, or both, was assessed. Pairs of data collectors evaluated 207 patients from 10 Canadian cancer centres. The WCCNRR correlated well with the MacDibbs Mouth Assessment (r=0.44, p=0.0002 to r=0.54, pR is a valid and reasonably reliable tool for staging stomatitis due to cancer therapy.

Avant de développer des interventions pour la stomatite, les infirmières ont besoin d’une approche de classification de la sévérité qui soit simple, valide et fidèle. Le Western Consortium for Cancer Nursing Research (WCCNR) à 8 items avait été validé pour la stomatite causée par la chimiothérapie. Cette étude avait pour but d’évaluer la validité et la fidélité du WCCNRR, un outil plus concis de seulement 3 items permettant d’établir la sévérité de la stomatite provoquée par la chimiothérapie, par la radiothérapie ou par ces deux traitements combinés. Les infirmières responsables de la collecte de données ont travaillé deux par deux à l’évaluation de 207 patients dans 10 centres de cancérologie canadiens. On a constaté une bonne corrélation entre le WCCNRR et la MacDibbs Mouth Assessment (l’évaluation de la santé buccale MacDibbs) (r=0,44, p=0,0002 à r=0,54, pR constitue un outil valide et raisonnablement fidèle de classification des stades de la stomatite causée par un traitement anticancéreux.

Ovarian cancer is the fourth leading cause of cancer-related deaths in women. Ovarian cancer, and its treatment, has a considerable effect on the quality of life of women diagnosed with the disease. Young women diagnosed with ovarian cancer must confront life-threatening illness at a time when many are in the midst of raising children, maintaining a household, and actively engaging in work and career activities. Very little has been reported about the perspectives of young women regarding their experiences with ovarian cancer.This article reports data from 39 women 45 years of age or less concerning the impact of ovarian cancer and its treatment as well as the availability of support. At the time of the study, the women were, on average, 38 years of age and approximately two-thirds were married and had children. About half of the women were working.The most frequently identified problems included side effects (n=25), fear of recurrence (n=25), and difficulty sleeping (n=25). On average, women reported experiencing 10.4 problems since diagnosis. Of those who experienced problems, less than 50% perceived they had received adequate help. Approximately two-thirds of these women experienced a lifestyle change. Quality of life was rated significantly lower following their experience with ovarian cancer. Implications for oncology nurses emerge in areas of assessment, referral, and patient teaching.

Art therapy is a healing art intended to integrate physical, emotional, and spiritual care by facilitating creative ways for patients to respond to their cancer experience. A new art therapy program was designed to provide cancer patients with opportunities to learn about the McMichael Canadian Art Collection and the explore personal feelings about their cancer experience through combined gallery and studio components. The role of the facilitator was to assist in the interpretation of a participant's drawing in order to reveal meaning in the art.This paper presents the patients' perspectives about the new art therapy program. Content analysis of participant feedback provided information about the structure, process, and outcomes of the program. Evaluation of the art therapy/museum education program demonstrated many benefits for cancer patients including support, psychological strength, and new insights about their cancer experience.

L'art-thérapie est une démarche de guérison qui intègre les soins physiques et le soutien affectif et spirituel et qui permet aux patients de faire appel à la créativité pour faire face à leur vécu du cancer. Un nouveau programme d'art-thérapie a été conçu pour fournir à des patients atteints de cancer diverses possibilités d'explorer la Collection McMichael d'art canadien et d'examiner leurs propres émotions face à leur vécu du cancer et ce, en combinant des activités dans la galerie proprement dite et dans un studio. Le rôle de l'animatrice consistait à faciliter l'interprétation des dessins des participants en vue d'en révéler la signification.Cet article présente les perspectives des patients relatives à ce nouveau programme d'art-thérapie. L'analyse de contenu de la rétroaction des participants a fourni des renseignements sur la structure, le processus et les résultats du programme. L'évaluation de ce programme d'art-thérapie et d'éducation muséale indique qu'il offre de nombreux avantages aux patients atteints de cancer, notamment en matière de soutien, de force psychologique et de compréhension intime du vécu du cancer.

Cet article décrit l'application qui est faite de l'art-thérapie pour aider les patients atteints de cancer à exprimer visuellement leur vécu de la maladie aux niveaux physique, psychosocial et spirituel. Ce programme d'art-thérapie et d'éducation muséale a été conçu en 1996 par la Collection McMichael d'art canadien en collaboration avec le Centre régional de cancérologie de Toronto-Sunnybrook et le Bayview Support Network. Jusqu'à présent, le programme a connu trois séries de 16 séances. Ces trois séries ont eu comme animatrice une art-thérapeute qualifiée.Le programme fournissait à un musée d'art une occasion en ou de se mettre au service de la collectivité dans son ensemble en lui offrant un exutoire artistique dans le calme d'un cadre rural contrastant avec l'environnement stérile des hôpitaux. L'article décrit les buts particuliers du programme et les bénéfices thérapeutiques généraux de l'art-thérapie.On explore également l'efficacité d'une démarche existentielle et phénoménologique qui apporte un soutien aux patients atteints de cancer et qui rapproche aussi deux disciplines foncièrement différentes—soit l'art-thérapie et l'éducation muséale. Il est suggéré qu'une démarche thérapeutique d'ordre existentiel favorise la confrontation à la mort et son acceptation, un pas qu'il faut franchir si on veur menet une vie plus fructueuse. En outre, une démarche phénoménologique met l'accent sur l'action de « regarder », un élément essentiel du développement de l'objectivité et du passage à la conscience de pensées jusque là inconscientes.On souligne l'importance du soutien affectif et social qui vient compléter les soins médicaux par le biais de l'art-thérapie. Grâce à cette dernière, les patients atteints de cancer sont invités à découvrir diverses manières de faire face à la douleur et au malheur et de faire place à la créativité dans leur « art de vivre ».

Barriers to prevention and early detection of cancer among the socioeconomically disadvantaged are important areas for public health focus. A community coalition was established in North York, Ontario, to identify a suitable primary prevention initiative, cervical screening among young women of lower economic status. Two pilot communities were selected for the project. Community members, key informants and service providers participated in a series of individual and focus group meetings to identify barriers that impede cervical screening. The benefits and challenges of such a project will be of importance to practitioners eager to work collaboratively on primary prevention initiatives. This article will be of interest to nurses wanting to foster a community coalition approach to program design, planning, implementation and evaluation. It will also assist nurses with utilizing needs-based assessment in their work. Although the findings relate to a population of women in a large urban centre, the results will be useful for nurses and other health professionals planning to engage in work related to cervical screening.

On said peu de choses au sujet des connaissances, attitudes et comportement sanitaires des aînés (personnes de plus de 55 ans) en matière de cancer et au sujet de l'élaboration d'interventions répondant à leurs besoins en éducation.

The Supportive Care Framework for Cancer Care was originally formulated in 1994 (Fitch, 1994). The framework was designed as a tool for cancer care professionals and program managers to conceptualize what type of help cancer patients might require and how planning for service delivery might be approached. The framework has been presented in various arenas and utilized in program and the number of requests has been growing for a wider distribution of a full description of the framework.The purpose of this article is to share the Supportive Care Framework for Cancer Care with the cancer nursing community. As a conceptual framework, it may be a useful tool for service or program planning, a basis to organize educational approaches in cancer care, or as a model underpinning research projects.

Health care restructuring has resulted in significant changes in the workload and work environment for oncology nurses. While recent studies describe the impact of these changes on the general nursing workforce in several countries, there have been no published studies that have focused on worklife issues of Canadian oncology nurses. Therefore, a qualitative study was conducted to gain insight about how oncology nursing has changed over the past decade and how Canadian oncology nurses are managing these changes. Analysis of telephone interviews with 51 practising oncology nurses employed across Canada revealed three major themes. The first theme, “health care milieu”, portrayed a picture of the cancer care environment and patient and professional changes that occurred over the past decade. The second theme, “conflicting demands”, reflects how the elements of change and social forces have challenged professional oncology nursing practice. The third theme, “finding the way”, describes the patterns of behaviour that nurses used to manage the changing health care environment and make meaning out of nurses’ work in cancer care. Overall, the findings portray a picture of Canadian oncology nurses in “survival mode”. They face many workplace challenges, but are able to keep going “for now” because they find ways to balance their responsibilities on a daily basis and because they know and believe that their specialized nursing knowledge and skills make a difference in patient care.

La restructuration des soins de santé a entraîné des changements importants sur le plan de la charge et du milieu de travail pour les infirmières en oncologie. De récentes études décrivent l’impact de ces changements sur l’ensemble de la main-d’oeuvre infirmière de plusieurs pays, mais aucune étude publiée n’a porté sur les questions de la vie au travail chez les infirmières en oncologie du Canada. C’est pour cette raison que nous avons mené une étude qualitative afin de bien saisir la manière dont les soins infirmiers en oncologie ont changé au cours de la dernière décennie et la manière dont les infirmières en oncologie du Canada gèrent ces changements. L’analyse des entrevues téléphoniques réalisées auprès de 51 infirmières en oncologie qui exercent actuellement au pays a permis de dégager trois thèmes principaux. Le premier « Le milieu des soins de santé » dessinait une image du milieu et du système des soins aux personnes atteintes de cancer ainsi que des changements qui avaient marqué la pratique infirmière et les populations de patients durant la décennie précédente. Le deuxième thème intitulé « Des intérêts contradictoires » se rapporte aux défis que les composantes du changement et les forces sociales ont présentés pour la pratique professionnelle des soins infirmiers en oncologie. Quant au troisième thème, « Trouver le moyen », il décrit les types de comportement utilisés par les infirmières en oncologie pour gérer l’évolution des soins de santé et pour trouver un sens dans leur travail. Dans l’ensemble, le portrait des infirmières en oncologie canadiennes ébauché à l’aide de nos résultats, révèle qu’elles fonctionnent en mode survie. Elles font face à de nombreux défis dans leur lieu de travail et sont capables de continuer pour l’instant parce qu’elles trouvent jour après jour le moyen d’équilibrer leurs responsabilités et parce qu’elles croient et savent que leurs compétences et connaissances infirmières spécialisées leur permettent de faire la différence sur le plan des soins aux patients.

CANO/ACIO’s vision is to be “a driving force nationally and an influencing force internationally in advancing excellence in cancer nursing across the cancer control spectrum.” We want to see “Canadians across the cancer spectrum have timely access to high quality nursing” (CANO/ACIO, p. 8). With this end in view, a panel of experts came together to explore health inequities in cancer care from a variety of national and international perspectives at the 25th Annual CANO/ACIO conference, held in Vancouver in October 2013. Represented on the panel were experts in health disparities research (Dr. Colleen Varcoe and Dr. Christina Sinding), past presidents of the Oncology Nursing Society (ONS) (Dr. Mary Gullatte) and the International Society of Nurses in Cancer Care (ISNCC) (Dr. Greta Cummings), and leadership from the Canadian Partnership Against Cancer (CPAC) (Dr. Margaret Fitch). Oncology nurses are uniquely positioned to positively influence health equity in cancer care at national and international levels. What follows are summaries of the panelists’ presentations.

Selon sa vision, l’ACIO/CANO « joue un rôle de premier plan au niveau national et exerce une influence internationale quant à la promotion de l’excellence des soins infirmiers dans tous les domaines de la lutte contre le cancer ». Toujours selon elle, « les Canadiens, peu importe où ils en sont dans le continuum du cancer, accèdent en temps opportun à des soins infirmiers de haute qualité » (ACIO/CANO, p. 8*). C’est dans cette optique qu’un groupe d’experts représentant toute une gamme de perspectives nationales et internationales a été formé en vue d’explorer les iniquités en matière de santé dans le domaine de la cancérologie lors de la 25e conférence annuelle de l’ACIO/CANO tenue à Vancouver en octobre 2013. Le groupe se composait des experts suivants en recherche sur les disparités en matière de santé (Colleen Varcoe et Christina Sinding), anciennes présidentes de l’Oncology Nursing Society (ONS) (Mary Gullatte) et de l’International Society of Nurses in Cancer Care (ISNCC) (Greta Cummings) et, une experte du Partenariat canadien contre le cancer (Margaret Fitch). Les infirmières et infirmiers en oncologie sont exceptionnellement bien placés pour exercer une influence positive sur l’équité dans les soins de santé en cancérologie et ce, aux niveaux national et international. Les présentations des membres du groupe sont résumées ci-dessous.

Il me semble qu’avril serait meilleur que janvier pour prendre des résolutions. Après avoir festoyé et décroché pendant les Fêtes, le retour à la routine est déjà ardu en soi, mais on vient ajouter par-dessus le marché des résolutions pour s’améliorer et adopter de nouvelles habitudes!... Avec ses journées qui rallongent, la météo qui se fait plus clémente et le printemps qui nous insuffle un sentiment de renouveau, ne croyez-vous pas que le mois d’avril serait plus propice pour opérer ces changements?

I wonder if April is a better month to follow through on New Year’s Resolutions than in January. After the holidays, with all the celebrating and relaxing, getting back into a routine is difficult enough without adding new behaviours and expectations about improving oneself based on resolutions. I think April would be easier to accomplish this change. After all, the weather is improving, the daylight hours are longer, and there is a sense of renewal in the air, as spring arrives.

The paper describes the application of art therapy in assisting cancer patients to visually express their cancer experience on several levels - physically, psychosocially, and spiritually. The art therapy/museum education program was developed in 1996 at the McMichael Canadian Art Collection in partnership with Toronto-Sunnybrook Regional Cancer Centre-Bayview Support Network. To date, the program has run for three rounds with 16 sessions in each round. The facilitator for all three rounds was a trained art therapist.The program provided an unique opportunity for an arts institution to serve the community at large by offering an artistic outlet in a peaceful, rural setting in contrast to a sterile hospital environment. The specific goals of the program and the general therapeutic benefits of art therapy are described.In addition, the effectiveness of an existential/phenomenological approach in not only serving the cancer population, but also bridging the two diverse disciplines - art therapy and museum education - is explored. It is suggested that an existential therapeutic approach promotes the confrontation and acceptance of death that is necessary in order to lead a more meaningful life. Moreover, a phenomenological approach promotes the act of "seeing" as an essential ingredient in gaining objectivity and bringing unconscious thoughts into consciousness.The importance of social and emotional support in the way of art therapy in addition to medical care is emphasised. Through art therapy, cancer patients are encouraged to discover ways to face pain and misfortune and be creative in their "art of living."

Little is known about the cancer-related knowledge, attitudes and health behaviours of older adults (>55 years), or about designing health promotion and early detection interventions responsive to their learning needs. A collagorative project was established with the intent of designing an appropriate program for older adults. The initial work included a community needs assesment using focus groups, one-on-one interviews and self-report surveys. The use of key community contacts was effective in locating older adult subjects (>55 years) through pre-established linkages with agencies. Various ethnocultural groups, low income communities and isolated individuals, as well as other pro-established groups, were included in this study. The needs assessment found that: age is not perceived as a cancer risk factor; transportation is a barrier to screening; family and peers are the main source of support, ethnospecific groups have different information needs; and finally, that lifestyle suggestions can reduce the risk of cancer. The findings indicated that community health promotion programs for older adults will require multiple approaches with a combination of strategies in order to meet their learning needs.

Dans cette étude, nous avons mis à l’épreuve un modèle d’équations structurelles en vue d’examiner les facteurs associés au milieu de travail en relation avec les changements touchant la satisfaction professionnelle des infirmières en oncologie entre 2004 et 2006. Le leadership relationnel et une bonne relation médecin-infirmière influençaient constamment les perceptions quant à la présence d’un nombre suffisant d’infirmières pour fournir des soins de qualité et quant à la liberté de prendre des décisions à propos des soins des patients, ce qui influençait directement à son tour la satisfaction professionnelle des infirmières au fil du temps. Le soutien des superviseurs en matière de résolution de conflits et la capacité à influencer les résultats pour le patient constituaient des influences significatives sur la satisfaction professionnelle en 2004, tandis qu’en 2006, une philosophie claire des soins infirmiers revêtait une plus grande importance. Plusieurs facteurs exerçant une influence sur la satisfaction professionnelle des infirmières en oncologie du Canada ont évolué au fil du temps, ce qui peut refléter des changements sur le plan des milieux de travail et de la vie au travail. Ces résultats proposent des pistes pour la modification des conditions de travail qui pourraient rehausser la satisfaction professionnelle et la vie au travail des infirmières.Mots clés : satisfaction professionnelle, soins infirmiers en oncologie, relation médecin-infirmière, modélisation par équation structurelle

In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses’ job satisfactionover time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses’ job satisfaction and work life.Key words: job satisfaction, oncology nursing, physician-nurse relationships, structural equation modelling

On développe, à mesure que grandit le nombre de survivants du cancer, un bassin toujours plus grand d’information sur l’incidence à long terme du cancer et de son traitement. Cancer de l’ovaire Canada (COC) a abordé les besoins cernés des femmes ayant reçu un traitement pour le cancer de l’ovaire et a mis au point un programme d’ateliers destiné aux survivantes et intitulé Picking Up the Pieces [Recoller les morceaux]. Cet article décrit l’évaluation de l’atelier tel qu’il a été offert à 170 survivantes dans le cadre de huit séances données à l’échelle du Canada. Les sondages imprimés et les entrevues détaillées révélaient que les participantes avaient trouvé l’atelier d’une très grande utilité concernant la validation de leurs expériences en matière d’adaptation à titre de survivantes, les liens qu’il leur permettait d’établir avec d’autres survivantes et un réseau de soutien ainsi que les outils pratiques qu’il leur fournissait afin de les aider à aller de l’avant et à vivre la vie qu’elles envisageaient pour ellesmêmes. Les infirmières en oncologie occupent une position idéale pour encourager les femmes à assister aux ateliers conçus pour les survivantes. En outre, ce programme pourrait servir de modèle et être adapté pour d’autres populations de patients atteints de cancer.

New evidence has emerged concerning the persistent presence of a combination of symptoms that can be indicative of ovarian cancer. Professionals need to be aware of this evidence and incorporate it into their practice. Ovarian Cancer Canada (OCC) has implemented an innovative program in selected Canadian universities, as a method to educate undergraduate medical and nursing students about ovarian cancer. Survivors Teaching Students has been offered to 3,620 undergraduate students. This article presents the evaluation of the program using pre and post session surveys. Overall, students reported a change in knowledge related to the progression of ovarian cancer, symptoms of ovarian cancer, risk factors for the disease, and perspectives about what a woman with ovarian cancer might feel on being diagnosed. Having survivors provide the classroom session brought “a face and a voice” to the issue of ovarian cancer for the students.

De nouvelles données probantes révèlent la présence persistante d’une combinaison de symptômes pouvant indiquer l’existence d’un cancer de l’ovaire. Les professionnels de la santé doivent être au courant de ces données probantes et les incorporer dans leur pratique. L’organisme Cancer de l’ovaire Canada (COC) a mis en oeuvre un programme novateur dans diverses universités canadiennes en tant que méthode visant à instruire les étudiants de premier cycle en médecine et en sciences infirmières sur le cancer de l’ovaire. Le programme Survivors Teaching Students a été dispensé à 3620 étudiants de premier cycle. Le présent article présente l’évaluation du programme réalisée au moyen de sondages menés avant et après les séances. Dans l’ensemble, les étudiants ont fait état d’une amélioration de leurs connaissances sur l’évolution du cancer de l’ovaire, les symptômes de ce type de cancer, les facteurs de risques afférents et aussi de leurs perspectives sur ce qu’une femme atteinte d’un cancer de l’ovaire pouvait bien ressentir à l’annonce du diagnostic. En demandant à des survivantes de présenter l’exposé en classe, les étudiants ont pu mettre « un visage et une voix » sur l’enjeu qu’est le cancer de l’ovaire.

L’International Society of Nurses in Cancer Nursing [Société internationale des infirmières en oncologie] (ISNCC) compte parmi les buts stipulés dans son mandat celui de promouvoir la croissance des soins infirmiers en oncologie dans des régions du monde où les soins aux personnes atteintes de cancer ne sont pas perçus comme une spécialité. Le concept de jumelage de pays riches en ressources avec des nations dont les ressources vont de moyennes à faibles a été proposé au conseil d’administration de l’ISNCC à titre de stratégie permettant d’atteindre ce but. La Division des soins infirmiers du Centre de cancérologie Odette, lequel fait partie du Centre des sciences de la santé Sunnybrook, s’est portée volontaire pour établir un « cas type » pour ce nouveau programme de jumelage ou de partenariat. Après plusieurs conversations entre M. Fitch lorsqu’elle occupait le poste de présidente de l’ISNCC et D. Makumi, Hôpital universitaire Aga Khan situé à Nairobi, au Kenya, une entente de collaboration a été conclue. Une proposition a été élaborée à des fins de soumission à l’Union internationale contre le cancer (UICC) en vue d’organiser, à Nairobi, un atelier de soins infirmiers en oncologie sur l’administration de la chimiothérapie. Cela constituait la première étape de notre expérience de jumelage. Cet article décrit l’expérience de quatre infirmières du Centre de cancérologie Odette (lesquelles ont élaboré et donné le programme) et celle des infirmières du Kenya (lesquelles ont aidé à planifier le programme et y ont participé) tandis qu’elles collaboraient en tant que « jumelles ».

The International Society of Nurses in Cancer Care (ISNCC) has, as part of its mission, the goal of fostering the growth of oncology nursing in parts of the world where cancer nursing is not perceived as a specialty. The idea of “twinning” high-resource countries with middle/low-resource countries was proposed, as a potential strategy to the ISNCC Board for achieving this goal. The Odette Cancer Centre Nursing Division from Sunnybrook Health Sciences Centre stepped forward and indicated it would be a “test case” for this new twinning or partnership program. Based on several conversations between M. Fitch when she was President of ISNCC and D. Makumi, Aga Khan University Hospital in Nairobi, Kenya, an agreement was reached to work together. A proposal was then developed for submission to the International Union Against Cancer (UICC) to hold an oncology nursing workshop on chemotherapy administration in Nairobi. This was a first step in our twinning experience. This article describes the experiences of the four nurses from Odette Cancer Centre (who prepared and offered the program) and the nurses in Kenya (who helped to plan and participated in the program) in working collaboratively as “twins.”

The cadre of individuals who are living after a diagnosis of cancer is growing steadily. In developed countries, as many as 78% of pediatric patients are alive five years following diagnosis, as are 60% of adult patients (Curtiss & Haylock, 2006). At present in Canada, about one million individuals are living as cancer survivors (Canadian Cancer Society, 2008). With the anticipated increase in the incidence of cancer around the world and the success of treatment approaches, it is anticipated this cadre will continue to grow. Unfortunately, cancer survivorship does not come without cost. It is becoming increasingly evident there are late and long-term effects cancer survivors experience, both physical and psychosocial, that can compromise quality of life and increase the burden of suffering. Compared to matched population controls, cancer survivors have significantly lower outcomes on many burden of illness measures and experience difficulties accessing appropriate health care for a broad range of chronic medical conditions (Yabroff, Lawrence, Clauser, Davis, & Brown, 2004; Earle & Neville, 2004). A history of cancer may shift attention from important health problems unrelated to cancer and the roles of primary care providers and specialists in cancer care of survivors are not yet clear. As well, quality of life issues are different for survivors than for individuals at the point of diagnosis and treatment. Cancer survivors face a range of physical and psychosocial challenges. Up to 75% of survivors have health deficits related to their treatments (Aziz & Rowland, 2003), more than 50% live with chronic pain (Lance Armstrong Foundation, 2004), 70% have experienced depression (Lance Armstrong Foundation, 2004), and between 18% and 43% have reported emotional distress (Vachon, 2006). Regardless of tumour type, there are commonly reported challenges: living with fear and uncertainty; changes in family roles; alterations in self image and self esteem; changes in comfort, physiological functioning and mobility; alterations in cognitive functioning; changes in employment and recreation; altered fertility and sexuality (Aziz & Rowland, 2003; Denmark-Wahnefried, Aziz, Rowland, & Pinto, 2005; Ganz, 2001; Lance Armstrong Foundation, 2005). Clearly, cancer survivors are a vulnerable population. New approaches are needed to overcome the barriers cancer survivors experience and ensure they receive appropriate care.

The Supportive Care Framework for Cancer Care was originally formulated in 1994 (Fitch, 1994). The framework was designed as a tool for cancer care professionals and program managers to conceptualize what type of help cancer patients might require and how planning for service delivery might be approached. The framework has been presented in various arenas and utilized in program and the number of requests has been growing for a wider distribution of a full description of the framework. The purpose of this article is to share the Supportive Care Framework for Cancer Care with the cancer nursing community. As a conceptual framework, it may be a useful tool for service or program planning, a basis to organize educational approaches in cancer care, or as a model underpinning research projects.

La restructuration des soins de santé a entraîné des changements importants sur le plan de la charge et du milieu de travail pour les infirmières en oncologie. De récentes études décrivent l’impact de ces changements sur l’ensemble de la main-d’oeuvre infirmière de plusieurs pays, mais aucune étude publiée n’a porté sur les questions de la vie au travail chez les infirmières en oncologie du Canada. C’est pour cette raison que nous avons mené une étude qualitative afin de bien saisir la manière dont les soins infirmiers en oncologie ont changé au cours de la dernière décennie et la manière dont les infirmières en oncologie du Canada gèrent ces changements. L’analyse des entrevues téléphoniques réalisées auprès de 51 infirmières en oncologie qui exercent actuellement au pays a permis de dégager trois thèmes principaux. Le premier « Le milieu des soins de santé » dessinait une image du milieu et du système des soins aux personnes atteintes de cancer ainsi que des changements qui avaient marqué la pratique infirmière et les populations de patients durant la décennie précédente. Le deuxième thème intitulé « Des intérêts contradictoires » se rapporte aux défis que les composantes du changement et les forces sociales ont présentés pour la pratique professionnelle des soins infirmiers en oncologie. Quant au troisième thème, « Trouver le moyen », il décrit les types de comportement utilisés par les infirmières en oncologie pour gérer l’évolution des soins de santé et pour trouver un sens dans leur travail. Dans l’ensemble, le portrait des infirmières en oncologie canadiennes ébauché à l’aide de nos résultats, révèle qu’elles fonctionnent en mode survie. Elles font face à de nombreux défis dans leur lieu de travail et sont capables de continuer pour l’instant parce qu’elles trouvent jour après jour le moyen d’équilibrer leurs responsabilités et parce qu’elles croient et savent que leurs compétences et connaissances infirmières spécialisées leur permettent de faire la différence sur le plan des soins aux patients.