Petra Stolz Baskett Final Report EONS Research Travel Grant 2014

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1 Petra Stolz Baskett Final Report EONS Research Travel Grant 2014 Report on visit from to Peter McCallum Cancer Centre in Melbourne, Australia At the ECCO 2009 in Berlin, I had the opportunity to hear Prof. Mei Krishnasamy (then Director of Cancer Nursing Practice and Research, and now Executive Director: Cancer Nursing and Allied Health) speak about a project involving ward nurses who were undertaking three months rotation to the research unit of Peter MacCallum Cancer Centre (PeterMac) with the aim to facilitate closer research practice collaboration and, therewith, enhance evidence based practice. Since back in my Master s study almost ten years earlier, I had a strong interest in this research practice interface and, impressed by Mei s talk, I wished I could go and visit PeterMac one day

2 Geronto oncology patients and their informal caregivers In the meantime, I have gotten underway with my PhD studies at the Florence Nightingale Faculty of Nursing and Midwifery of King s College London. I am investigating the experience and needs of informal caregivers of geronto oncology patients receiving ambulatory chemotherapy. The study used a sequential mixed methods design and n=86 informal caregivers of cancer patients aged 70 years and over were included in the first quantitative phase; nineteen of these were then interviewed in semi structured interviews in the second qualitative phase. After being able to report on preliminary results (Stolz Baskett, et al., 2011; 2013; 2013) and having thoughts on the integrated data analysis taking shape, I started to think about future applications of my study s findings in practice. How might such a translation of results also open up new research avenues at the same time? A central idea within these thoughts was, and still is, occupied by possible service models integrating an advanced practice nursing role for the provision of cancer care to geronto oncology patients and their families. Peter MacCallum Cancer Centre PeterMac is Australia s only dedicated cancer hospital. It provides multidisciplinary care in a cancer treatment and research environment within twelve specialist tumour streams. Over cancer patients are seen each year, with approximately outpatient appointments per quarter. The centre employs over 2500 staff; and around 520 people are employed in research. One research division at PeterMac is the Department of Care Experiences Research (DCER)(Figure 1). In 2012, a project was undertaken at the DCER under the lead of Mei Krishnasamy to evaluate the need and possible scope of a Geronto oncology nurse practitioner (GONP) role (Lambros & Krishnasamy, 2012). Purpose of the research visit Finding the information about the GONP in my searches for possible research practice interfaces in the thematic area of my PhD study ignited the old wish to visit PeterMac and luckily EONS had established the opportunity of the Research Travel Grant by this stage. I contacted Mei with my idea and with her positive feedback and welcoming encouragement my application to EONS in the 2014 round was successful! Figure 1 DCER entrance

3 My objectives for the visit were to: 1. Establish a network with experienced researchers and to learn about, examine and discuss diverse and novel methodological approaches to develop, implement and evaluate new models of care in the cancer care setting 2. Establish an international network with experienced researchers to examine research and practice issues and collaborative research opportunities around structured needs assessments of cancer patients and their informal caregivers 3. Be able to discuss the influence of cultural contexts on cancer care research in the area of geronto oncology from a global perspective. My week at the Peter McCallum Cancer Centre For my week at PeterMac, Mei had put a very full and exciting program together for me. I had the opportunity to meet up with over twenty people in various roles and diverse disciplines across the institution, and to focus upon the care of older cancer patients and their families from the many involved perspectives. Monday The first day started meeting up with Mei and another guest scholar, i.e. Prof. Julia Downing, a renowned palliative care nurse researcher and educationalist, leading important projects in Uganda, Africa at large and also active in Eastern Europe over the past decades. Our discussion centred on the thought that the integration of palliative care into 'mainstream services' might be taken as an example for the integration of geronto oncology services into current structures and processes. We agreed that the key questions that need to be answered in such a discussion were: Who owns the patient? Who is driving the treatment agenda and for whom? What are the strategies to cross boundaries more easily for patients to receive the level of care/consultation they need? After such a engaging kick off, I received a tour of the institution, comprising of just under 100 inpatient beds across four wards and an intensive care unit, a radiation department, outpatient clinics, and a chemotherapy unit and medical day care unit. I was also informed that the site of PeterMac is about to be relocated in 2016, with a brand new, purpose built facility situated close to the Royal Melbourne Hospital in the East end of the city (Figure 2). Figure 2 Preview of new Peter MacCallum Center form us/our new home parkville

4 The tour ended in the DCER office (Figure 3), my assigned home for the week amidst the friendly and very welcoming staff in charge of looking after me. Figure 3 DCER office One of the staff, Allison Drodsdowsky, is responsible for statistical advice and input in various projects given her background in epidemiology and biostatistics. She told me about one of her special interests in what was referred to as CALD (culturally and linguistically different) populations and projects that are planned in house with this focus. Australia s population is in general multicultural, and in Melbourne very much so, and therefore, there are many cancer patients with diverse cultural beliefs about disease and treatment, as well as older immigrant patients that have limited English language competency and rely on their family for communication with the health care team. To end the day, I had an interesting session with the pharmacist Brett Janson about the need to educate nurses on important pharmacological issues in the care of older people with cancer. He had previously delivered a lecture on this at a specific professional development day focusing on gerontooncology. Due to my experience as a lecturer, Brett and I could share our thoughts on educational practices as one way to bring research results back to the clinic. Tuesday The next day was probably the most challenging with regards to keeping up with all that was on offer, meeting up with seven different colleagues for half to one and a half hour long talks and presentations. First was Tegan Murnane, a social worker with a Master s degree in Gerontology. Tegan is responsible for the skin tumour stream, palliative care and the veterans, and she gave me a comprehensive overview of what the issues are for older cancer patients and their informal caregivers in Australia and Victoria. She was also able to provide me with a wealth of resources and links to materials covering the themes rehabilitation, advanced directives and caregiver support as they relate to the older population. An especially helpful encounter was my time with Donna Milne who is an APN in the skin cancer stream and a doctoral trained researcher in the DCER. We discussed the barriers and facilitators for

5 nurses to be able to have a career path that combines clinical and research/academic work. Donna had just recently completed a pilot project assessing the unmet needs of early stage melanoma patients. The results informed a nurse led clinic that did assess symptom burden in a telephone follow up consultation. The reminder of the day was spent meeting up with a nurse in radiology outpatients, an exercise physiology researcher investigating functional interventions with older lung cancer patients and two surgical nurse coordinators facilitating a nurse led colorectal cancer clinic and a bowel and urinary function clinic, before Ruby Lipson Smith from the DCER presented the CareTask Study to me and facilitated phone contact with the primary investigator Dr. Anna Ugalde (Deakin University and Cancer Council Victoria Research Fellow), who shares with me an interest in caregiver research. Wednesday The next day I was able to get to know an online nursing education resource program developed to raise geriatric knowledge for nurses working in oncology settings. Rose Kamateros showed me through the website and its modules and we discussed the plan for evaluating the efficacy and effectiveness of this professional development activity. After that I was invited to the senior nurses Christmas lunch in a beautiful park setting right next to PeterMac. Thursday On the fourth day, I had several more opportunities to jig my thinking about research issues in my field and possible practice applications as well as follow up projects post PhD. The first meeting was with Reverend David Dawes, the head of the pastoral care services. David laid out his view that spiritual issues centre around three themes, i.e. meaning, belonging and purpose. Based on that he visits all in patients regardless of their faith "Those who could be described as having no faith still have a belief system. It's up to us to honour how meaning is derived in a person's life it might be grandchildren, roses in the garden, magpies, cockatoos or a footy club," says Reverend Dawes (form Interview with Place, 2006). In the near future, he is planning to commence a mixed method research project that will incorporate the FACITSp12 Scale (Petermann et al., 2002), an instrument for assessing spiritual wellbeing that I myself had used in my PhD project to measure how informal caregivers are impacted in this area. Another valuable highlight was my attendance at the DCER Team Meeting. Next to an interesting discussion on specific research issues such as problems with recruitment, I was given an overview on the many projects they are currently conducting, as well as the way the team is working within and across disciplines and institution boundaries. Friday In the morning of my final day, I met up with Mary Duffy, one of the APN for the lung cancer tumour stream and one of the first Nurse Coordinators of the institution back in Mary s views on research practice bridging, gained over decades of experience, were a pleasure to hear about. The last day seemed to have come about far too quickly and it was sad to have to say good bye already. After a last cup of tea with the DRPE team and an exchange of business cards, I had the opportunity to again talk to Mei. The night before, I had mulled over if it would be possible to ask her about her secret tips on leadership. During the week, I was impressed by the many and varied

6 unsolicited remarks about the great job Mei is doing in her role from many of the people I had met; I m happy that I mustered the courage to ask her and her answer was a testimony to the appropriateness of the many complements I had heard. It went along the line of: Listening to and being there for the people that do the work with the patients and families, and believing that it is not these people having to honour the leader for a prestigious looking position but the leader supporting them to be able to do their best possible job That was the essence of her humble answer and a valuable last lesson to collect during this visit! Conclusions My visit to PeterMac with the stupendous and immensely appreciated support of the EONS Research Travel grant was a very enriching experience for me and for my future working life. I was able to engage in stimulating conversations with a great bunch of people about one of my favourite practice and research subjects and learn a lot from the perspectives of many different disciplines. Moreover, I was able to witness an inspiring environment nurtured by exceptional authentic leadership. Especially this last, unanticipated, experience has an outcome insofar as I am sure that it will guide me in my own future personal and professional leadership endeavours within the research practiceeducation setting.

7 References Lambros, B., & Krishnasamy, M. (2012). Report Peter MacCallum Cancer Centre Geriatric Oncology Nurse Practitioner proposed model of care. Downloadable on: data/assets/pdf_file/0006/835062/peter MacCallum Cancer Centre GONP Model_July 12.pdf Peterman, A., Fitchett; G., Brady, M., Hernandez, L. & Cella, D. (2002). Measuring spiritual wellbeing in people with cancer: The functional assessment of chronic illness therapy spiritual well being scale (FACIT Sp). Annals of Behavioral Medicine, 24, Place, A. (2006) Taking care of the spiritual side of illness. The Sydney Morning Herald, March 25, Stolz Baskett, P., Taylor, C., Milligan, P., Imhof, L.; Roberts, J. (2013). Needs assessment in caregivers of older cancer patients using the German version of the supportive care needs survey for partners and caregivers (SCNS P&C44). Journal of Supportive Care in Cancer, 21, 1 Supp. Stolz Baskett, P., Taylor, C., Imhof, L., Glaus, A., Roberts, J (2013). Qualitative exploration of experience and needs of informal caregivers of geronto oncology patients undergoing ambulatory chemotherapy. Supportive Care in Cancer, 26, 1 Supp Stolz Baskett, P., Roberts, J., Glaus, A., Imhof, L., Ream, E. (2011). Review of Subjective Caregiver Impact Experience and needs of informal caregivers of adults/older adults with cancer. European Journal of Cancer Supplements, Petra Stolz Baskett RN MA(Nursing) GradDipDes PhD(candidate) is a lecturer at the Institute of Nursing, Zürich University of Applied Sciences (ZHAW) in Winterthur, Switzerland

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