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Evaluation on Education Impact

de Souza Institute has incorporated a strong evaluation component to assess its educational effectiveness since its inception.  A systematic documentation of user population, a comprehensive set of teaching methods and a detailed outcome evaluation process were implemented.

Guided by the research framework1, the evaluation approach focuses on the impact of the de Souza Institute educational activities:

  1. How well do de Souza courses advance learner knowledge and confidence in terms of evidence based activities
  2. How do various teaching method(s) meet the needs of different learner populations-across generations, practice settings and geographic?
  3. Do any of de Souza educational activities affect “measurable” clinical practices and subsequently patient outcome?  If so, what are the key “change agents”?

Addressing Educational Needs in Managing Complex Pain in Cancer Populations: Evaluation of APAM: An Online Educational Intervention for Nurses

  • Authors: Dr. Yvonne Leung, Dr. Jiahui Wong, Cathy Kiteley, Jerusha Ellis and Dr. Mary Jane Esplen (de Souza Institute, University Health Network – UHN)
  • Published in: American Journal of Hospice and Palliative Medicine®, February 2019 (Online), DOI: doi:10.1177/1049909119832819

Cancer-related pain is associated with significant suffering and is one of the most challenging symptoms to manage. Studies indicate that front-line clinicians often lack the knowledge on best practices in cancer pain management. The project, a quality improvement (QI) initiative, evaluated the learning outcomes of an online educational intervention for nurses on complex cancer pain management.

An online 7-module educational intervention, Advanced Pain Assessment and Management, was offered from 2012 to 2017. Pre–post course evaluations included self-reported knowledge and confidence across cancer pain management domains. In-course competency assessments included knowledge examination, online discussion forum participation, opioid dosage calculation assignment, and small-group-based case study. A mixed-model statistical analysis was used to assess pre–post course change in pain management confidence level.

The study concluded that a facilitator-led online educational intervention focusing on complex cancer pain management can significantly improve nurses’ confidence in knowledge and skills, and competency. Low baseline knowledge among nurses highlights the pressing need for health-care organizations to implement cancer pain management training as an integral part of health-care QI initiative.

Building A High Quality Oncology Nursing Workforce Through Lifelong Learning: The de Souza Model

  • Authors: Dr. Mary Jane Esplen and Dr. Jiahui Wong (de Souza Institute, University Health Network – UHN), Esther Green (Canadian Partnership Against Cancer), Dr. Joy Richards (UHN), Jane Li
  • Published in: International Journal of Nursing Education Scholarship, Volume 15, Issue 1, 20160079, ISSN (Online) 1548-923X, DOI: https://doi.org/10.1515/ijnes-2016-0079

Cancer is one of the leading causes of death in the world. Along with increased new cases, cancer care has become increasingly complex due to advances in diagnostics and treatments, greater survival, and new models of palliative care. Nurses are a critical resource for cancer patients and their families. Their roles and responsibilities are expanding across the cancer care continuum, calling for specialized training and support. Formal education prepares nurses for entry level of practice, however, it does not provide the specialized competencies required for quality care of cancer patients. There is urgent need to align the educational system to the demands of the health care system, ease transition from formal academic systems to care settings, and to instill a philosophy of lifelong learning. We describe a model of education developed by de Souza Institute in Canada, based on the Novice to Expert specialty training framework, and its success in offering structured oncology continuing education training to nurses, from undergraduate levels to continued career development in the clinical setting. This model may have global relevance, given the challenge in managing the demand for high quality care in all disease areas and in keeping pace with the emerging advances in technologies.

Evaluation of a NP program

The Nurse Practitioner Role in Complex Malignant Hematology: A Qualitative Descriptive Study

  • Authors: Forbes MF, Carter N, MacKenzie KL, Kouroukis CT, Balonjan KS, Bryant-Lukosius DE.
  • Published in: Seminars in Oncology Nursing. 2024 Mar 30:151625. DOI: https://doi.org/10.1016/j.soncn.2024.151625 Epub ahead of print. PMID: 38556365.

Objectives: Internationally, there is limited evidence about the role and impact of nurse practitioners (NPs) in complex malignant hematology (CMH). In one Canadian CMH program, NPs have existed for 20 years but not been evaluated. This study aimed to understand stakeholder perceptions of CMH NP role structures, processes, and outcomes and the extent to which the role meets patient and health service needs.

Methods: A qualitative descriptive study was conducted, guided by the PEPPA-Plus framework. Purposive sampling was used to recruit stakeholders who participated in focus groups and interviews. Content analysis was used to analyze the data.

Results: Participants included patients (n = 8) and healthcare professionals (n = 27). Themes about structures related to evolution of the CMH Program, model of care, and need for strategic vision. Process themes related to provision of accessible, comprehensive, and holistic care and NP workload. Positive and negative outcomes and lack of outcome measurement were identified.

Conclusion: Structures related to patient and NP characteristics, organizational change, staffing, and how NP work is organized impacts on NP role implementation and outcomes. Organizational structures can be strengthened to improve the model of care and NP role implementation and workload. Value-added NP contributions related to providing comprehensive care with attention to safety and social determinants of health. Research is needed to evaluate NP role outcomes in CMH.

Implications for nursing practice: The results can inform role design and organization policies and strategies to promote the recruitment, retention, and optimization of NP roles in CMH settings. Priorities for future research are also identified.

Knowledge Translation Research

Improving distress management knowledge and skills for oncology nurses

  • Principal Investigator (PI): Dr. Deborah McLeod, Nova Scotia Cancer Centre
  • Co-PI: Dr. Mary Jane Esplen, de Souza Institute, University Health Network
  • Co-Inv (UHN site): Drs Doris Howell, Jiahui Wong
  • Other 4 participating sites: see webpage
  • Funding Source: CIHR, CPAC

Effective management of cancer related distress is an important issue given that 30-45% of cancer patients experience clinically significant levels of distress. The Canadian Association of Psychosocial Oncology, with the support of the Canadian Partnership Against Cancer, developed several clinical practice guidelines (CPGs) to guide oncology health care professionals in distress management (Howell et al., 2009, 2010, 2011, 2015). Nurses can be, and often are, key players in assessing and intervening with distress, particularly when distress is mild to moderate. However, nurses often express lack of confidence and skill in assessing and responding to distress and may be inclined to refer to other health care professionals rather than intervening themselves.

The Therapeutic Practices for Distress Management (TDPM) education program focuses on supporting the integration of four clinical practice guidelines for cancer related distress management into clinical practice: fatigue, pain depression and anxiety. This project included a one-year education and supervision program (24 hours in virtual class; 12-hour group supervision). Participants included 80 (90%) nurses, and 9 (10%) social workers (N = 89). The measurements comprise a Knowledge and Self-Efficacy Survey (KSES) and observer-rated standardized patient exams (objective structured clinical exams). Results from the study showed that participants had significant improvement in knowledge, self-efficacy, and performance over time. Further, through focus group data, there was evidence of a shift in barriers and enablers to practicing in alignment with the CPGs.

Patient Portal

The following papers have been published, based on research using artificial intelligence such as deep learning–based natural language processing system. This technology was used in the study to analyze online support group text data to track participants’ expressed emotional distress, including fear, sadness, and hopelessness. Funding Source: Ontario Institute for Cancer Research, Cancer Care Ontario

  1. Natural Language Processing–Based Virtual Cofacilitator for Online Cancer Support Groups: Protocol for an Algorithm Development and Validation
    • Study Authors: Yvonne W Leung, PhD; Elise Wouterloot, MA; Achini Adikari, BSc; Graeme Hirst, PhD; Daswin de Silva, PhD; Jiahui Wong, PhD; Jacqueline L Bender, PhD; Mathew Gancarz, MMSc; David Gratzer, MD; Damminda Alahakoon, PhD; Mary Jane Esplen, PhD
    • Published in: JMIR Research Protocols, Volume 10, Number 1, 2021, DOI: 10.2196/21453
  2. Pathways to Acceptance in Participants of Advanced Cancer Online Support Groups.
    • Study Authors: Pereira CF, Cheung K, Alie E, Wong J, Esplen MJ, Leung YW.
    • Published in: Medicina (Kaunas). 57(11):1168. 2021. DOI: 10.3390/medicina57111168
  3. Empathic Conversational Agents for Real-time Monitoring and Co-Facilitation of Patient-Centered Healthcare.
    • Study Authors: Achini Adikari, Daswin de Silva, Harsha Moraliyage, Damminda Alahakoon, Jiahui Wong, Mathew Gancarz, Suja Chackochan, Bomi Park, Rachel Heo, Yvonne Leung.
    • Published in: Future Generation Computer Systems. 126: 318-329. 2022. DOI:10.1016/j.future.2021.08.015
  4. Providing Care Beyond Therapy Sessions With a Natural Language Processing-Based Recommender System That Identifies Cancer Patients Who Experience Psychosocial Challenges and Provides Self-care Support: Pilot Study.
    • Study Authors: Leung YW, Park B, Heo R, Adikari A, Chackochan S, Wong J, Alie E, Gancarz M, Kacala M, Hirst G, de Silva D, French L, Bender J, Mishna F, Gratzer D, Alahakoon D, Esplen MJ.
    • Published in: JMIR Cancer. 8(3): e35893. 2022. DOI: 10.2196/35893.

Cancer and its treatment can significantly impact the short- and long-term psychological well-being of patients and families. Emotional distress and depressive symptomatology are often associated with poor treatment adherence, reduced quality of life, and higher mortality. Cancer support groups, especially those led by health care professionals, provide a safe place for participants to discuss fear, normalize stress reactions, share solidarity, and learn about effective strategies to build resilience and enhance coping. However, in-person support groups may not always be accessible to individuals; geographic distance is one of the barriers for access, and compromised physical condition (eg, fatigue, pain) is another. Emerging evidence supports the effectiveness of online support groups in reducing access barriers.

Text-based and professional-led online support groups have been offered by Cancer Chat Canada. Participants join the group discussion using text in real time. However, therapist leaders report some challenges leading text-based online support groups in the absence of visual cues, particularly in tracking participant distress. With multiple participants typing at the same time, the nuances of the text messages or red flags for distress can sometimes be missed. Recent advances in artificial intelligence such as deep learning–based natural language processing offer potential solutions. This technology can be used to analyze online support group text data to track participants’ expressed emotional distress, including fear, sadness, and hopelessness. Artificial intelligence allows session activities to be monitored in real time and alerts the therapist to participant disengagement

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1 Oandasan, I et al. (2004) Interdisiplary Education for Collaborative, Patient-Centred Practice, Research and Findings Report. Health Canada, Ottawa