17th Swiss Oncology Nursing Conference

26th March 2015, Bern, Switzerland

Over 600 nurses attended the annual congress of the Swiss Oncology Nursing Society (SONS). This report was authored by Evelyn Rieder, Maria Flury, Sara Häusermann, Patrick Jermann, Marika Bana and Monique Sailer Schramm. It was translated from German to English by Manuela Eicher.

Conference theme: Cancer - and then? Consequences for people affected by cancer and consequences for nurses

Opening session: practice needs theory

The congress was opened by Irène Bachmann-Mettler and Lucienne Bigler-Perrotin, president and vice-president respectively of the Swiss Oncology Nursing Society (SONS).

Lucienne Bigler-Perrotin reminded the audience that nurses’ perception of the world reflects their beliefs, values, history, language and education. In line with the phenomenologist David Cooper, she posited that the way a human being acts is always a question of choice, thus he or she understands and values the meaning of things that he or she knows. To be able to know, one has to be able to interpret theoretical concepts and to be able to distinguish what is relevant and what not. Thus, nursing activity and engagement are facilitated by knowledge.

Over 100 years ago, Florence Nightingale was already convinced that nurses should move forward with personal and professional development rather than sticking with the same knowledge and viewpoints. This conviction led her to launch the first nursing school for professional nurses. Lucienne Bigler-Perrotin invited the audience to stay curious and to use the annual conference meeting to develop new visions and options.

Future of oncology nursing: Challenges and opportunities

Dr. Rosette Poletti, a “grande dame” of Swiss nursing science, presented a review of the developments within nurses over the past few decades. She was a pioneer of oncology nursing as a specialism and became the first EONS President when the organisation was founded in 1984. The work of pioneers such as Dr Poletti helped to increase the visibility of oncology nursing and the respect awarded the profession. However, she argues that oncology nurses still do not get enough professional attention.

Oncology nursing is still under-represented in cancer research and the scientific journals for oncology nurses are rarely acknowledged or cited by other professions. Swiss society does not perceive or know what oncology nurses are doing or what their added value is. This means that more work needs to be done to raise Swiss people’s awareness of oncology nurses, their skills and their valuable work. This could include publications with a focus on patients, showing how much oncology nurses know about their disease and treatment related needs.

For Dr Poletti, education and training of oncology nurses must remain clinic-based and cannot be solely delegated to universities. SONS and EONS have to make sure that future education and training reflect the reality of the clinical field. Thus, experienced cancer nurses from clinical practice always have to be involved in teaching. On the other hand, she clearly stated, that the different levels of nursing education in Switzerland (university vs school of higher education) are rather confusing. Nursing has to be based on a solid evidence base to meet patients’ needs - without research we cannot provide it and develop it further.

On a related note, Dr Poletti discussed burnout and its prevention. She encouraged the audience not to protect themselves behind a “panzer” but to maintain their ability to listen to patients. She further encouraged the audience to accept the challenges and not to forget that in research the heart should be at the centre of all interests. “Thank you for being there!” she closed her talk.

Therapeutic decision-making at the end of life

This workshop was led by two physicians, Dr Katrin Conen and Dr Sandra Eckstein, and clinical nurse specialist Felix Schläfli. They discussed whether patients in end-of-life situations are over-treated or under-treated. They presented current discussions around decision-making and how it might be applied in clinical practice. The guiding question should always be: “Which therapy is the best for this individual patient?” The guiding principles in this decision-making process are the right of self-determination, the principle to do no harm, the well-being of the patient and social justice. Depending on the situation, it is not always easy to find out how to decide or act in the interest of the patient. One has to find out who the patient is and what his believes and wishes are to better understand which treatment he / she might prefer. In clinical practice, addressing the following questions to the patient might be helpful:

  • “What bothers you most?”
  • “What is currently of highest importance for you?”
  • “What gives you hope?”
  • “What kind of treatment and support would be most helpful in that sense?”.

Furthermore, all therapeutic decisions at the end of life should be discussed inter-professionally.

“Help, I have to swallow morphine...”

Two nursing students, Cornelia Baltis and Maja Vaterlaus, analysed the prejudices of patients against opioids in a systematic literature review. They presented the results together with their BScN-Thesis supervisor Sara Häusermann from the University of Applied Science (Zurich) in a workshop. The under-use of analgesics in adult patients with cancer-related chronic pain can be associated with such prejudices. Patients are often afraid of opioids since they believe they might lead to a potential addiction, cognitive impairment, nausea and emesis, constipation, sedation and build-up of tolerance. Furthermore, many patients associate the prescription of opioids with an end-of-life situation. These patient concerns are well-founded, at least in terms of nausea and emesis (especially during early opioid therapy and if no therapy against this side-effect is applied) and constipation (90% of all patients show constipation at least once during therapy) and sedation (usually at the beginning of therapy). However, the other concerns are not evidence-based. Thus, Baltis, Vaterlaus und H&aum;usermann developed a patient information flyer to provide information and qualify the concerns around opioids. Participants had the chance to review and discuss the flyer in the workshop.

PanCare

Prof. Dr. phil. Gisela Michel from the University of Lucerne presented the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (http://www.pancare.eu/en/) and their current activities. Today in Switzerland, more than 80% of children and adolescents with cancer do survive (Schweizer Kinderkrebsregister, 2014). PanCares aim is to reduce the frequency, severity and impact of late side effects of treatment for cancer in childhood or adolescence, and the quality of life, and to improve the chances of survival for all. Most survivors have to learn to live with long-term consequences of their disease and treatment: e.g. scars after surgical interventions, neurological problems after a brain tumour, fertility issues and heart failure. Thus, a systematic follow-up is very important. For eight years PanCare has been advocating for these concerns. The organisation is developing guidelines for survivorship care and is working towards improving equal access to survivorship care. PanCare is also engaged in research with a focus on late side-effects and the improvement of quality of life after a cancer disease.

Self-management of symptoms: Information for patients

If patients are able to self-monitor and manage their symptoms their sense of security might be increased. Two oncology nurses, Susanne Kropf and Cristina Studer from Lindenhofspital, developed information flyers (PIF), which are currently tested and revised in collaboration with the Universities of Applied Science (Western Switzerland and Zurich), SONS and the Swiss academic society for oncology nursing. Testing also included patient interviews in focus groups. Written information leaflets alone do not facilitate better patient self-management; the PIF are individually provided during a session in which an oncology nurse discusses systemic treatments orally with the patient. The workshop highlighted three more elements of this combination of structured information provision and self-management support:

a) family nursing (including family assessment),
b) motivational interviewing as method to support patients to self-monitor and manage their symptoms,
c) application of the PLISSIT-Model to structure the information provision.

Application of such frameworks might encourage oncology nurses to respond to individual needs and are empowering patients. Early evaluation results of the design and content of PIFs are promising. The adapted flyers will be available on the website of Lindenhofgruppe
+  http://www.lindenhofgruppe.ch/de/downloads.

Supportive Care

Two clinical nurse specialists in oncology, Monique Sailer Schramm and Andrea Serena, presented the current knowledge and future directions in supportive care in cancer. After proposing a definition for supportive care in oncology nursing, they presented the best available methods for assessing supportive care needs. These methods lead to tailored interventions, that have to be provided inter-professionally, but oncology nurses often have to guarantee that interventions are coordinated and evaluated in the interdisciplinary team. Particularly in outpatient settings, when nurses have limited access and time with the patient, a rapid and efficient assessment of supportive care needs has to be guaranteed. This might in turn allow the development of best symptom management strategies and guaranteeing a support system. During the workshop some examples of symptom specific assessment and intervention guidelines were presented
https://www.cancercare.on.ca/toolbox/symptools/.

The recently-published Euro PEPs were also presented during this session.
+  http://www.cancernurse.eu/education/europeps.html

Personal Resource Management

Dr. phil. Hans Kernen, of Kernen Ressource Management AG, reminded conference participants to consider themselves as travellers and voyagers that should discover every day a new region in their soul - as was stated by famous writer Khalili Gibran. He described resources management in different dimensions. Participants learned how to balance resources against stresses and strains.

For Dr. Kernen, “work-life balance” is a misleading concept, in the sense that work can also be an essential source of resources. Being unchallenged in one’s own work can be even worse than finding the work too demanding. Being challenged from time to time can even improve one’s sense of coherence. Finally Dr Kernen invited all participants to reflect how they experience the spiritual side of their lives. He motivated the audience to reflect which “stage of life” is relevant to everyone individually and who one would define as the stage director. He closed his speech with the words: “It is important to find our own voice for our life.”


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