A master’s level oncology specialization program prepares nurses with the clinical, cultural sensitivity, and research skills they will need to deal with issues impacting underrepresented minorities. By educating nursing professionals such as advanced practice nurses (APNs) in oncology about disparities in cancer care, government cancer care initiatives, and different cultural practices in symptom management, they will have a unique opportunity to transform the healthcare system and improve the quality of care that is delivered to patients who represent diverse, underserved, and underrepresented minorities.
This is important because, as highlighted in a poster presented by Theresa Pluth Yeo, PhD, MPH, AOCNP, associate professor and coordinator of the Oncology Nurse Practitioner Program at Thomas Jefferson University School of Nursing, and her colleague Anne Delengowski, MSN, RN, AOCN, oncology clinical nurse specialist at Thomas Jefferson University Hospital’s Department of Nursing in Philadelphia, there will be a 100% increase in new cancer cases among underrepresented minority populations in the United States by 2030.
“Advanced practice nurses can play a big role in alleviating some of these disparities,” noted Yeo, who is the program’s codesigner along with Delengowski. “Number one is just being aware of what the statistics are, and what the problems are in this country. Also knowing what the resources are for minorities, what is available for them to obtain care, get proper screening, and get better access to better cancer treatments.
“We didn’t focus on attracting nurses from minority backgrounds, although we did increase our number of minority nurses in the program by 30% over the 3-year program,” said Yeo. “The fact is we were limited in that we did not have scholarships to offer, because the training program does not support scholarships.”
The program was designed to give nursing professionals expertise about how race and ethnicity influence cancer diagnosis, treatment, prognosis, and outcomes, and also to increase awareness about available screening opportunities and related resources.
The existing master’s curriculum was revised and expanded to focus on disparities in cancer care, web-based tools for patients and healthcare providers, and both state and federal cancer care initiatives.
The nurses in the program learned how to assess their cultural knowledge and attitudes, how to interview patients from different ethnic and cultural backgrounds, and how to analyze national reports on healthcare disparities. They also learned about healthcare practices, preferences, and influences among minorities.
The program has been very successful, said Yeo.
“Students report overwhelmingly that their knowledge and awareness of cancer disparities in this country have increased, both in terms of incidence and outcomes for those patients,” she said.
Thirteen students have graduated from the master’s program and there are 16 in the pipeline. All graduates have been offered APN positions and have either passed or are eligible for national certifying examinations.
Most patients from minority populations are diagnosed with cancer at a later stage, are less likely to be seen at a university- based cancer treatment or specialized center, and are much more likely to seek care in the community from private doctors who may or may not be oncologists.
“They are much less likely to receive state-of-the-art treatment and they have worse outcomes because of a lack of resources,” said Yeo. “They lack ability to pay for the medications. And even if they know they are sick, they delay coming for treatment, either for lack of insurance, or for family commitments, putting others first. People from minority backgrounds are also less likely to participate in cancer screening programs. The exception is mammograms—we are doing very well with mammograms because of the federal program that covers minority women,” she said.
Delengowski added that it is important for APNs to understand the different nuances and implications around screening for different cancers. “For example, knowing the incidence of colorectal cancer in African Americans would help the nurses target a population for screening. It is important for them to get this education so that they can understand the populations at higher risk, and perhaps teach these different cultures about these risks. The result, we hope, would be to improve screening rates and access,” she said.
“We believe that graduates of this program will make important contributions to culturally competent care in the United States,” concluded Yeo.
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