Orlando, FL—Nurse practitioners (NPs) are key members of the cancer survivorship care team, but their training in cancer survivorship is lacking, according to Margaret Rosenzweig, PhD, CRNP-C, AOCN, FAAN, Professor, Acute & Tertiary Care, School of Nursing, University of Pittsburgh, PA.
The role of the NP is associated with a long history of patient outcomes that are either equivalent or superior to those of physician-provided care. “Nurse practitioners, however, have scored higher for patient perceptions of empathy, psychological support, and coaching as compared to physicians,” she said at the 2018 Cancer Survivorship Symposium.
In only 1 analysis, patients questioned the expertise of nursing in monitoring for cancer recurrence, she reported. Although no differences were noted in actual recurrences, patients said they felt more secure when physicians told them there was no evidence of their cancer.
However, regardless of the setting—academic center, community cancer center, or primary care—initial training for NP survivorship care is poor, she said. For advanced nurse practitioners, no mandates related to basic cancer care proficiency are required to begin practicing in survivorship care (although these gaps can be met through credentialing individual institutions, mandated orientation, or institutional onboarding).
“Education and training resources for cancer practice, specifically survivorship practice, are sparse, variable, and very much needed,” Dr Rosenzweig added.
The ONc-PoWER Program
To address these gaps, Dr Rosenzweig and her colleagues at the University of Pittsburgh developed a basic, 5-module, web-based training program for oncology NPs new to cancer care, called ONc-PoWER.
NPs taking the course are introduced to a character named “Gina,” a new NP seeking guidance, and a mentor who guides Gina through several case presentations. The modules are designed to make the subject matter less overwhelming through task-oriented content and a clear focus on specific guidelines.
“When I developed this course, I struggled with the vast amount of information to present to someone who is new to cancer care. But with the assistance of educational experts, I learned to turn all of the educational content into lessons,” explained Dr Rosenzweig.
For example, in Module 3, which focuses on cancer survivorship, students are introduced to 3 patients in need of survivorship visits. One patient requires an emphasis on health promotion, another requires empathic communication, and a third patient is presenting with a possible cord compression. Students are also introduced to the concept of oncologic emergencies as a presentation of metastatic cancer.
What Can Be Done?
According to Dr Rosenzweig, NPs who are delivering cancer care must be counted and provided with educational resources. NPs should also be educated on patient communication and prepared to address uncertainty when delivering information about a patient’s recurrence.
“We also have to think about the mechanisms and ingredients by which outcomes are improved with NPs. Why do patients like the empathy and the communication, and can we put that into training programs for providers?” she said.
NPs in academic centers may benefit from mentorship, whereas NPs at community centers may need more web-enhanced resources when being introduced to cancer survivorship, she suggested.
And because primary care NPs have specific and even greater educational needs due to the fact that they are prepared as generalists and function more autonomously, she suggests that web-based enhancements be incorporated into their general coursework.