Congress Abstracts 2005

34

ANALYZING AMBULATORY ONCOLOGY NURSES TELEPHONE MEDIATED DECISION SUPPORT: FACILITATING SYMPTOM MANAGEMENT SELF-CARE. Lisa Bitonti, BSCN, RN, CON(C), The Ottawa Hospital, Ottawa, ON, Canada; Annette O’Connor, RN, PhD, Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada; Margaret Fitch, RN, PhD, Toronto Sunnybrook Regional Cancer Centre, Cancer Care Ontario, Toronto, ON, Canada; and Helen Bunn, RN, PhD, University of Ottawa, Ottawa, ON, Canada.

Cancer patients today are receiving increasingly complex treatment protocols causing more severe toxicities than ever before. Resource constraints are forcing oncology nurses to re-evaluate didactic methods of patient education and care around disease management. This reconceptualization of nursing care emphasizes the need for patient education to more on motivating behaviour change.

Research shows that self-care symptom management programs involving face to face interactions with nurses are effective at minimizing/preventing serious side-effects from cancer therapy and improve patients’ self-care skills. As cancer treatment is increasingly being delivered in out-patient centres far from patients’ homes, patients phone oncology nurses seeking advice for treatment related side-effects. Little is known about how nurses in cancer centres support patients over the telephone to make self-care decisions. The purpose of this study was to develop, validate and evaluate a research tool to analyse oncology nurses’ provision of telephone mediated decision support to promote self-efficacy in symptom management self care to patients receiving breast cancer therapy.

This two-phase study is guided by Self-Efficacy Theory (Bandura, 1986) and the Ottawa Decision Support Framework (O’Connor et al., 1998) to identify performance criteria for ambulatory oncology nurses providing telephone-mediated decision support to promote self-efficacy in symptom management self-care to patients receiving breast cancer therapy

In Phase I, the Symptom Management Telephone-Mediated Decision Support Analysis Tool (Bitonti & O’Connor, 2004) was adapted from the existing Decision Support Analysis Tool (Bunn, O’Connor, & Jacobsen, 2003) and reviewed by an expert panel. A Standardized Patient Program and Rater Training program were developed to support reliability and validity testing in the subsequent phase. In Phase II, nurses’ recorded interactions (n = 40) with standardized cases were analysed by two trained raters using the new tool.

Content validity was calculated using the interrater agreement and content validity index. Interrater reliability was established by analyzing the nurses’ verbal responses in each of the categories of decision support skill.

This new tool can be used to train nurses less experienced in telephone mediated decision support and improve these skills in nurses who already provide cancer care over the telephone, in turn supporting patients to engage in self-care while at home.