Nurse scientist Donna Berry, PhD, RN, received the 2011 ONS Distinguished Researcher Award, which recognizes a nurse researcher whose work has enhanced the science and practice of oncology nursing. Berry is the director of the Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at the Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston, Massachusetts. Berry discussed several of her research topics with OncLive Nursing, including patient adherence to oral oncolytic therapy, symptom management, patient quality of life, and patient decision making in cancer treatment.
OncLive Nursing: What are some of the challenges oncology nurses face when patients take oral oncolytics?
Nurses have to prepare [patients] to give themselves chemotherapy, or give themselves their anti-tumor therapy, whereas traditionally, the nurse was right with the patient, giving an IV chemotherapy or an IM, intramuscular injection. But now the patients are going to do this at home…and…without adequate understanding, the patients may not take the medication as prescribed and they can get in big trouble. Their blood counts could go down. They could get really sick—have gastrointestinal side effects. So patient education becomes critical for these drugs, and nurses don’t always have that kind of time scheduled into their visit.
So one of the ways that we’ve started to address that, not just at Dana-Farber, but at other cancer centers as well, is to provide a very systematic way of preparing people to take oral oncolytics, and that begins with the prescription, when the patient makes a decision…with their cancer specialist, to take the oncolytic and to receive the prescription. Then we teach them about the side effects, but we know very well they’re not hearing everything we’re saying.
So we’ve designed and tested 2 different projects, one led by our nurse practitioner, Robin Sommers, and I’ve mentored her to do this on the project, to teach the patients as we get the prescription and follow up with a 72-hour phone call that takes them through a series of questions to teach and inquire at the same time—teach and inquire about everything that’s happening. “Where do you keep your medication? How often are you taking it? Have you experienced anything new since you’ve been taking that pill?” And that way, at 72 hours after [the patient begins treatment], we get some really good information, and it is the critical time that we can tweak what might not be quite right.
We [also] ask the patients to keep track at home, using a diary of how often they’re taking [the medication], and they do really well using the diary. When we pilot tested it in the first 30 [patients], 27 of them did a really great job of keeping track of things with their diary. What we did notice is that many of them didn’t know what to do about their side effects, so we have continuing work to do and we’re following up on that.
Then we have another project…in the gastrointestinal treatment center…We have another project with our patients with lung cancer taking erlotinib [Tarceva], which is one of our oral oncolytics. And we’re doing a very similar process, only this time it’s the feasibility of can this [adherence intervention] actually happen without, say, a research nurse involved?
It’s not a study. It’s actually what’s going on in real practice. Do the nurses have time to go over this? Do they make the phone calls? Is it possible? Is it practical? We’re taking the evidence that these follow-up phone calls and these written instructions work, and we’re testing whether it’s practical in a busy cancer clinic.
So that’s how we’ve gone about it. We’re not using any high technology or anything fancy yet. We’re simply looking at it practically to do this systematic teaching, systematic follow up with this questionand-answer inquiry and asking patients to track it. And it looks good. It looks really good so far.
Dana-Farber Cancer Institute, Boston, Massachusetts
What is the current and future status of evidence-based practice in oncology nursing?
That’s a really excellent question because the future is where we’re going very rapidly. We have a practice in oncology that has traditionally stood shoulder to shoulder with our physician colleagues. And during the last few decades, our physician colleagues have developed monumental treatments for cancer that have changed the cure rates. And we have been right there, alongside the physicians, as they’re treating these tumors, working on that with them.