From Cancer Patient to Cancer Survivor Lost in Transition (2006) / Chapter Skim
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5 Providers of Survivorship Care: Their Supply and Education and Training
5 Providers of Survivorship Care: Their Supply and Education and Training
Pages 322-362
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From page 322... ...
. Physicians and nurses are often links to many other important care providers, including those in the areas of social work, psychology, rehabilitation, and genetic counseling.
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From page 323... ...
STATUS OF PROFESSIONAL EDUCATION AND TRAINING Cancer survivorship care as a distinct phase of the cancer trajectory is a relatively new construct, and health professional schools' curricula have generally not included much content in this area. This needs to change, but a larger task is providing continuing medical education to professionals who have completed their formal training and are encountering cancer survivors in their practices.
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From page 324... ...
Aspects of survivorship that could be considered essential content of survivorship training for health care providers are shown in Box 5-1.
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From page 325... ...
Forthcoming from NCI is a resource for clinicians on cancer survivorship (Personal communication, S Wilcox, Office of Education and Special Initiatives, NCI, February 2,
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From page 326... ...
50,035 · APTA Oncology Section 600 Occupational therapists · Certified 111,151 · American Occupational Therapy Association 35,000b Social workers · Medical and public health social workers 107,000 · National Association of Social Workers 153,000 Oncology social workers · Association of Oncology Social Work 1,000 Mental health professionals Psychology · Licensed 85,000 · American Psychological Assocation (APA) 90,200 · APA, Health Division 2,947 Psychiatry · Board certified 34,114 · Focus on oncology 100 Pastoral counseling · Certified chaplains 9,100 Genetic counseling · Board certified 1,811 · National Society of Genetic Counselors 2,098c a Number of RNs employed in nursing, including nurse practitioners.
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From page 327... ...
. Physicians The status of undergraduate and graduate medical education is described in this section, followed by some examples of opportunities for continuing medical education on survivorship for practicing physicians.4 Given their educational potential, the availability of clinical practice guidelines related to cancer survivorship is included in this discussion.
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From page 328... ...
. A 4-year integrated curriculum in cancer survivorship is being developed under an NCI R25 grant for students at University of California Schools of Medicine (Los Angeles and San Francisco)
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From page 329... ...
Considers general preventative issues as well as those related to cancer survivorship in cancer survivors Knowledge 1. Understands that all cancer survivors are at increased risk for other cancers as well as recurrence of the original cancer, and need to avoid tobacco, eat right, and use sunscreen 2.
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From page 330... ...
According to a review of the curriculum for medical oncology, some of the 28 content areas listed are related to survivorship (e.g., knowledge of drug toxicity, rehabilitation, and psychosocial aspects of clinical management of the cancer patient) , but no specific mention of cancer survivorship is made (Winn, 2002)
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From page 331... ...
A module related to cancer survivorship could be developed to enhance specialists' knowledge of survivorship-related care. Continuing Medical Education For practicing clinicians, continuing medical education provides opportunities to gain skills in this relatively new area.
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From page 332... ...
· Integration of Cancer Survivorship Coursework into First Year Medical School Curriculum · Quality of Life: Native American Cancer Education for Survivors · Exploring the Needs of Cancer Patients and Their Family Caregivers Through a Training Workshop · Does Diet Modification Have Potential to Reduce Cancer Suffering and Extend Life? · Partners in Survival National Training Program: Training Minority Men to be Effective Caregivers for Women with Cancer SOURCES: ASCO (2005c)
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From page 333... ...
. Primary care A comprehensive review of cancer survivorship is available through an American Academy of Family Physicians (AAFP)
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From page 334... ...
Other Sources of Information on Cancer Survivorship The ideal situation for a clinician who cares for cancer survivors would be to have immediate access to comprehensive clinical practice guidelines (CPGs) based on high-quality evidence where available that included a full range of recommendations for the many clinical decisions that might be encountered in the post-treatment phase of care (see discussion of CPGs in Chapter 3)
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From page 335... ...
· Radiation enteritis · Sexuality and reproductive issues · Sleep disorders Psychosocial Issues · Anxiety disorder · Depression · Normal adjustment, psychosocial distress, and the adjustment disorders · Post-traumatic stress disorder Lifestyle Issues · Nutrition in cancer care · Smoking cessation and continued risk in cancer patients · Spirituality in cancer care · Substance abuse issues in cancer · Transitional care planning SOURCE: NCI (2005c)
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From page 336... ...
Based on the results of that study, beginning in January 2005, two different advanced oncology nursing certifications became available: Advanced Oncology Certified Nurse Practitioner (AOCNP®) and Advanced Oncology Certified Clinical Nurse Specialist (AOCNS®)
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From page 337... ...
.8 Nurses generally receive some exposure to cancer care through coursework related to surgical and medical care of chronic diseases. Cancer centers have worked with local nursing training programs to increase the number of students who rotate in oncology in an effort to attract students to oncology nursing positions upon graduation (Erikson, 2000)
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From page 338... ...
. Continuing Nursing Education ONS provides opportunities for continuing education on cancer survivorship through its "Institutes of Learning" added to its annual congress.
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From page 339... ...
. Other Sources of Information on Cancer Survivorship · American Cancer Society has published A Cancer Source Book for Nurses that includes information on advances in symptom control and issues related to survivorship (Varricchio et al., 2004)
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From page 340... ...
. Other courses cover topics such as lymphedema, osteoporosis, and urinary incontinence, which, although not specific to cancer, may be relevant to cancer survivors (APTA, 2005b)
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From page 341... ...
Psychosocial and Mental Health Providers Cancer may cause psychosocial distress, so referrals to social service and mental health professionals may be indicated. Psychosocial services may be provided by cancer caregivers, such as nurses, primary care physicians, surgeons, or oncologists, or by professionals with special training in social work, psychology, psychiatry, or pastoral counseling.
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From page 342... ...
Although there have been advances in psycho-oncology research of relevance to social workers assisting cancer survivors, reductions in staffing and increased caseloads have made it difficult for social workers to translate these findings into their practices (IASWR, 2003; NASW, 2003)
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From page 343... ...
There are several continuing education opportunities for social workers. A web-based continuing education course, Understanding Cancer: The Social Worker's Role, is available through the National Association of Social Work and CancerCare, an organization providing psychosocial services (NASW, 2005b)
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From page 344... ...
They have made major contributions in cancer prevention, cancer control, and lifestyle change, such as smoking cessation. The APA offers continuing education opportunities for psychologists, although cancer-related offerings are somewhat limited.
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From page 345... ...
. Rehabilitation and Employment-Based Counseling Master's-level counselors trained in specialized areas of counseling who work outside of oncology settings may be of assistance to cancer survivors.
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From page 346... ...
Cancer survivors may seek assistance in coping with illness and its meaning from religious or spiritual counselors. Professional health care chaplains provide supportive spiritual care and may help educate the health care team on the relationship of religious and spiritual issues to aspects of clinical care (VandeCreek and Burton, 2001)
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From page 347... ...
In addition to this opportunity available through APOS, continuing education opportunities in psycho-oncology are provided by several professional organizations: International Psycho-Oncology Society, Academy of Psychosomatic Medicine, Society of Behavioral Medicine, American Psychological Association, and American Psychiatric Association.
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From page 348... ...
. Genetic Counseling As knowledge of the genetic basis for some cancers has expanded and tests for genetic susceptibility to cancer have become available, genetic counseling and testing have become more important to cancer survivors and their families (see Chapter 4, Appendix D)
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From page 349... ...
Other recent R25 grants of relevance to cancer survivorship include those related to cancer genetics training for nurses and physicians, and cancer nursing training, including training that targets minority nurses and nurses working with minority groups (Box 5-7)
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From page 350... ...
. Private American Cancer Society The ACS provides several kinds of support for professional education and training for physicians, social workers, and nurses (Table 5-3)
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From page 351... ...
. Master's Training Grants Awarded to institutions to support in Clinical Oncology the training of second-year Social Work master's-degree students to provide psychosocial services to persons with cancer and their families.
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From page 352... ...
. FINDINGS AND RECOMMENDATIONS Few cancer care and primary care health professionals have had formal education and training regarding cancer survivorship.
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From page 353... ...
The American Association TABLE 5-5 Methods of Survivorship Continuing Education Educational Approach Example 1. Meeting on survivorship · NCI/ACS cancer survivorship biennial conference 2.
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From page 354... ...
Add more survivorship-related CME: · The American Board of Medical Specialties' new program, "Maintenance of Certification," will require continuous assurance of professional skills for board-certified physicians. The development of a module on cancer survivorship as part of this program could facilitate the assurance of competence for these and other specialty providers.
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Social workers and other providers of psychosocial services 1. Support efforts of APOS to standardize and promote continuing education.
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From page 356... ...
. AOSW (Association of Oncology Social Work)
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From page 357... ...
2004. ASCO Announces New Task Force to Address Needs of Cancer Survivors.
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From page 358... ...
2003. The role of oncology nursing to ensure quality care for cancer survivors: A report commissioned by the National Cancer Policy Board and Institute of Medicine.
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From page 359... ...
2002. Psychosocial aspects of cancer survivorship.
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From page 360... ...
. Cancer Survivorship: Pathways to Health After Treatment Program Book.
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From page 361... ...
2001. The changing face of cancer survivorship.
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From page 362... ...
2004. American Society for Therapeutic Radiology and Oncology, American Cancer Society Join to Promote Cancer Survivorship.
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