Development of an Undergraduate Oncology Nursing Elective With a Focus on Palliative Care.

The demand for a skilled oncology workforce is ever increasing and required to meet the increasing palliative care (PC) needs of cancer survivors. Palliative care improves the quality of life for patients with a serious disease with or without curative intent treatment.1 Exposure to PC experiences for undergraduate (UG) nursing students impacts both clinical skill acquisition and career selection. An academic-practice partnership was created in 2016 to provide support for clinical and didactic practice experiences for UG nursing students to stimulate their interest in oncology nursing. With funding from University of North Carolina (UNC) Lineberger and generous private donors, the UNC Lineberger, Sylvia Lauterborn, and Warren Trent Piver Oncology Nursing Fellowship was created.2 In this article, we describe development of a pilot oncology nursing elective course with a focus on PC knowledge and attitudes during summer 2021. Methods Course The elective course focused on cancer experiences of individuals and families across the lifespan (Table). This single-group pilot study was reviewed and approved by the Office of Human Research Ethics. This was a 4-hour weekly course for 11 weeks. Table. - Care of Individuals and Families With Cancer Course Outlinea Class Topic, wk Description 1 Welcome and introduction to incidence/prevalence 2 Palliative care, risk reduction, screening, and diagnosis 3 Treatment modalities 4 Palliative and supportive care 5 Caring for pediatric patients with cancer 6 Caring for adolescent/young adult patients with cancer 7 Caring for adult and geriatric patients with cancer 8 Survivorship 9 Psychosocial and caregiver support 10 Inclusive cancer care 11 Ethical, legal, and professional issues aCarolina core tenets were diversity and inclusion, ethics, global health, health innovation, informatics, leadership, population health, quality and safety, relationship-centered care, research, and scholarly communication, and writing and spanned across all 11 weeks. Sample This study used convenience sampling. On day 1 of the course, study information was shared, students were recruited, and those interested signed the written consent. To eliminate students' concerns that their survey responses might impact their grades, surveys were completely anonymous. Data Collection An electronic survey was administered by the research assistant (30 minutes allotted to complete). Faculty were not present during the survey. Students' demographic characteristics were collected at baseline, and their PC knowledge level and attitudes toward caring for the dying patient were assessed at week 1 (T1: baseline), week 6 (T2: mid-semester), and week 11 (T3: end of semester) of the course. Measures Demographic questions included type of program the student was enrolled in (traditional bachelor of science in nursing (BSN) or accelerated BSN, age, gender identity, race and ethnicity, desired post-graduation work specialty, and personal and clinical experiences caring for self, a patient, or a loved one with cancer. The Palliative Care Quiz for Nursing (PCQN)3 is 20-item multiple-choice quiz with true, false, and do-not-know responses that assesses 3 aspects of PC: philosophy and principles (4 items), control of pain and other symptoms (13 items), and psychosocial aspects (3 items). The total score range is 0 to 20, with a higher score representing increased knowledge of PC. Cronbach's α= 0.78. The Frommelt Attitude Toward Care of the Dying (FATCOD), a 30-item scale,4 reflects how nurses feel about certain situations with patients. Two domains—(1) positive attitude toward caring for the dying patient (Cronbach's α= 0.80) and (2) perception of patient- and family-centered care (Cronbach's α= 0.53)—are examined. Scores range from 1 (strongly disagree) to 5 (strongly agree) (range 30-150). A higher score represents a more positive attitude toward caring for the population. Data Analysis Mean and standard deviation were used to describe the total PCQN score and scores in the 2 domains of attitudes toward caring for dying patients. Results Demographics Eighty-two students registered and consented; the majority were accelerated bachelor of science in nursing (ABSN) (n = 80, 98%) with a small number of BSN (n = 2, 2%). Eighty percent were between 18 and 30 years of age; 84% identified as female (n = 70), 13% male (n = 10), transgender male (n = 1), and gender nonconforming (n = 1). Four identified as Black/African American, 7 Asian/Pacific Islander, 1 multiracial, and 5 Hispanic/Latinx. Thirty-seven (45%) desired to work in pediatric and/or adult oncology after graduation. The majority had personal and/or clinical experiences caring for self or a loved one with cancer (see Supplemental Digital Content Table 1, available at: https://links.lww.com/NE/B458). We found an increasing trend in PC knowledge scores at T1 = 11.4 (3.1); T2 = 12.5 (4.4); and T3 = 13.4 (2.8). Two questions—the use of placebos as appropriate in the treatment of some types of pain and the loss of a distant or contentious relationship is easier to resolve than the loss of one that is clear or intimate—had a striking increase from T1 to T3 (see Supplemental Digital Content Table 2, available at: https://links.lww.com/NE/B459). Attitudes Toward Care of the Dying Patient A positive attitude toward care of the dying patient had an identical score between T1 = 67.1 (6.1) and T2 = 67.4 (7.9), but went up from T2 to T3 (mean = 68.3, SD = 7.3). Similarly, students' perception of patient- and family-centered care was identical between T1 (mean = 55.5, SD = 3.8) and T2 (mean = 55.3, SD = 4.1), but decreased from T2 to T3 (mean = 54.2, SD = 4.5) (see Supplemental Digital Content Table 3, available at: https://links.lww.com/NE/B460). Discussion Findings demonstrated improvement of nursing student knowledge on PC and attitudes toward dying. Bolstering their knowledge is imperative for the oncology workforce, as cancer care shifts toward long-term disease management and symptom control, and requires a multidimensional approach toward patient-centered cancer care. Overall, mean scores of the FATCOD trended upward from T1 to T3. One way to address attitudes of nursing students and nurses is by continual competency assessments aimed at decreasing negative attitudes. There is a lack of cultural integration of death and dying in informal and formal settings, and this can be viewed as a foundational problem requiring systemic change. Strengths of the course were: first, it was taught by 2 oncology-certified nurse faculty with current clinical experience caring for individuals with cancer and who also had PC experience. Second, course content was designed from input from key interested parties and recent literature. Third, students completed a pre-, mid-, and postsurvey to assess their knowledge about PC and caring for the dying, and identify areas for focused educational interventions. Limitations included inconsistent numbers across 3 timepoints with a decrease in number of students who completed surveys. One key methodological limitation was our inability to use the same participant ID across 3 timepoints to decrease risk of bias and increase anonymity of students since this was a graded course. As a result of not being able to follow these students at 3 timepoints, our numbers were also inconsistent when students where asked where they would like to work after graduation. Conclusions This elective addressed the gap in nursing education in oncology and demonstrated the significant impact a single course can have on improving knowledge and changing nurses' attitudes toward PC. Future efforts include transitioning to an interprofessional education course.