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Unlabelled: Fillion et al. (2012) recently designed a conceptual framework for professional cancer navigators describing key functions of professional cancer navigation., Purpose: Building on this framework, this study defines the core areas of practice and associated competencies for professional cancer navigators., Methods: The methods used in this study included: literature review, mapping of navigation functions against practice standards and competencies, and validation of this mapping process with professional navigators, their managers and nursing experts and comparison of roles in similar navigation programs., Findings: Associated competencies were linked to the three identified core areas of practice, which are: 1) providing information and education, 2) providing emotional and supportive care, and 3) facilitating coordination and continuity of care., Conclusion: Cancer navigators are in a key position to improve patient and family empowerment and continuity of care., Implications: This is an important step for advancing the role of oncology nurses in navigator positions and identifying areas for further research.

In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses' job satisfaction over time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses' job satisfaction and work life.

For many cancer control programs, cancer navigation has emerged as a specific strategy to improve access to supportive care and the patients' experience of cancer care. This study contributes to a better understanding of professional navigation by comparing two Canadian models: Quebec's Pivot Nurse in Oncology (PNO) and Nova Scotia's Cancer Patient Navigator (CPN). Qualitative interviews were conducted with professional navigators, patients and family members, front-line staff, physicians and health administrators (interviews: n = 49; focus groups: n = 10). The two models were analyzed using the professional navigation framework (Fillion et al., 2012). Although the models are different, results show that professional navigators in both programs perform similar functions and face similar challenges. This study highlights the complexity and the value of cancer navigation and recommends relevant actions to optimize its management within the health care system.

New evidence has emerged concerning the persistent presence of a combination of symptoms that can be indicative of ovarian cancer. Professionals need to be aware of this evidence and incorporate it into their practice. Ovarian Cancer Canada (OCC) has implemented an innovative program in selected Canadian universities, as a method to educate undergraduate medical and nursing students about ovarian cancer. Survivors Teaching Students has been offered to 3,620 undergraduate students. This article presents the evaluation of the program using pre and post session surveys. Overall, students reported a change in knowledge related to the progression of ovarian cancer, symptoms of ovarian cancer, risk factors for the disease, and perspectives about what a woman with ovarian cancer might feel on being diagnosed. Having survivors provide the classroom session brought "a face and a voice" to the issue of ovarian cancer for the students.

As the cadre of cancer survivors grows, more information about the long-term impact of cancer and its treatment is becoming evident. Ovarian Cancer Canada (OCC) responded to identified needs of women who had been treated for ovarian cancer and developed a workshop program for survivors entitled, Picking Up the Pieces. This article describes the evaluation of the workshop, as it was offered to 170 survivors in eight sessions across Canada. The written surveys and in-depth interviews revealed the participants found the workshop very helpful in validating their experiences in coping as a survivor, connecting them with other survivors and a network of support, and providing practical tools to help them move forward to live the lives they envisioned. Cancer nurses are in ideal positions to encourage women to attend workshops designed for survivors. In addition, this program could serve as a model and be adapted for patients with other types of cancer.

Before developing interventions for stomatitis, nurses require a simple, valid and reliable approach to staging severity. The eight-item WCCNR(R) was previously validated for chemotherapy-induced stomatitis. In this study, the validity and reliability of the WCCNR(R), a shorter three-item tool for staging stomatitis caused by chemotherapy, radiotherapy, or both, was assessed. Pairs of data collectors evaluated 207 patients from 10 Canadian cancer centres. The WCCNR(R) correlated well with the MacDibbs Mouth Assessment (r = 0.44, p = 0.0002 to r = 0.54, p < 0.0001), a standardized tool for staging radiotherapy-induced stomatitis. Agreement between data collectors at five sites was acceptable (kappa = 0.75); three additional sites were close to this target. Findings indicate that the WCCNR is a valid and reasonably reliable tool for staging stomatitis due to cancer therapy.

In their search for information and in making decisions about complementary and alternative therapies, patients will turn to oncology nurses. How oncology nurses respond to the patient's questions or comments can have an impact on the decision a patient makes about pursuing a particular therapy or whether the patient feels supported. The impetus for this work was the desire to understand how oncology nurses are responding to the patient trend of using complementary and alternative therapies. Twenty-eight nurses were interviewed over the telephone and a content analysis was completed from the transcribed interviews. The nurses who participated in this study regularly engaged in conversations with patients about complementary therapies and were aware of the reasons patients pursued these therapies. Conversations about alternative therapies occurred less frequently, but often created turmoil for the nurse. The nurses thought they had a role in maintaining an open dialogue about therapies, but felt their knowledge about particular therapies was limited. Obtaining information was a challenge and they often learned about specific therapies from patients and the popular media. Turmoil arose for nurses most often with regards to patients pursuing ingested therapies or alternative therapies. Nurses suggested complementary therapies to patients, but usually waited for patients to raise the topic of alternative therapies. Providing support to patients, whatever course they are choosing to pursue, was seen as an important nursing role.

The purpose of this qualitative study was to describe the perspectives of women living with ovarian cancer about their experiences with diagnosis, treatment, and follow-up care. A convenience sample of 18 women was interviewed using an open-ended interview guide. This paper will focus on their perspectives during the peri-diagnostic period. Most of the women in this study experienced changes in their bodies--bloating, weight gain around their middles, indigestion, bowel changes, and abdominal pain. The vagueness of the symptoms and lack of awareness by the women and, in the women's opinion, health care professionals caused delays in diagnosis and initial investigations of other body systems. The symptoms were often dismissed by the women as being related to normal body changes such as childbirth, menopause, or stress responses. It was often not until the women's symptoms became severe or included pain that referrals were made to relevant specialists. At this point, many of the women were physically and emotionally spent, leaving them vulnerable and in a weakened state for confronting the diagnosis and coping with the difficult course of treatment. Clearly, the subtle, nebulous nature of the symptoms confounded the diagnosis of ovarian cancer for these women, resulting in patient delays and physician delays.

This paper describes the application of art therapy in assisting cancer patients to visually express their cancer experience on several levels--physically, psychosocially, and spiritually. The art therapy/museum education program was developed in 1996 at the McMichael Canadian Art Collection in partnership with Toronto-Sunnybrook Regional Cancer Centre-Bayview Support Network. To date, the program has run for three rounds with 16 sessions in each round. The facilitator for all three rounds was a trained art therapist. The program provided an unique opportunity for an arts institution to serve the community at large by offering an artistic outlet in a peaceful, rural setting in contrast to a sterile hospital environment. The specific goals of the program and the general therapeutic benefits of art therapy are described. In addition, the effectiveness of an existential/phenomenological approach in not only serving the cancer population, but also bridging the two diverse disciplines--art therapy and museum education--is explored. It is suggested that an existential therapeutic approach promotes the confrontation and acceptance of death that is necessary in order to lead a more meaningful life. Moreover, a phenomenological approach promotes the act of "seeing" as an essential ingredient in gaining objectivity and bringing unconscious thoughts into consciousness. The importance of social and emotional support in the way of art therapy in addition to medical care is emphasized. Through art therapy, cancer patients are encouraged to discover ways to face pain and misfortune and be creative in their "art of living."

Art therapy is a healing art intended to integrate physical, emotional, and spiritual care by facilitating creative ways for patients to respond to their cancer experience. A new art therapy program was designed to provide cancer patients with opportunities to learn about the McMichael Canadian Art Collection and to explore personal feelings about their cancer experience through combined gallery and studio components. The role of the facilitator was to assist in the interpretation of a participant's drawing in order to reveal meaning in the art. This paper presents patients' perspectives about the new art therapy program. Content analysis of participant feedback provided information about the structure, process, and outcomes of the program. Evaluation of the art therapy/museum education program demonstrated many benefits for cancer patients including support, psychological strength, and new insights about their cancer experience.

Providing effective care for individuals with prostate cancer is an important issue for oncology nurses. However, the paucity of empirical work regarding the impact of prostate cancer presents a limitation in designing and implementing appropriate nursing interventions. This article presents the findings from a national survey of 621 Canadian men living with prostate cancer regarding the impact of their disease and the availability of support. The most frequently identified problems included sexual function, side effects, fear of dying, incontinence, anger and pain. Approximately one-third of the respondents experienced a lifestyle change, but relatively few indicated experiencing a negative impact from the changes they experienced. The majority of respondents indicated they had been informed accurately about their treatment, but dissatisfaction was expressed regarding lack of information about emotional reactions, alternative therapies, how to speak with other prostate cancer patients and the availability of counselling and self-help groups. Clearly these results have implications for oncology nurses.

As the 1990's draw to a close, the cancer care environment is undergoing rapid change. Many issues exist within the complex environment of cancer care that could create a challenge in providing quality nursing care to patients. This study examined the current challenges oncology nurses face in their daily practice. Surveys were mailed to members of the Canadian Association of Nurses in Oncology asking them to indicate on a list of 80 issues which were problems in their daily practice. From the responses of 249 oncology nurses, the following items were ranked as the top 10 problems: anxiety, coping/stress management, bereavement/death, fatigue, metastatic disease, comfort, pain control and management, quality of life, recurrence of primary cancer, and nurse burn-out. Principal component analysis was conducted to determine if patterns existed in the way problems had been rated. Five components explained 42% of the variance in the data set: comprehensive cancer care, communication, experience of loss, terminal illness, and signs and symptoms. Implications for nursing practice, education and research are highlighted.

Little is known about the cancer-related knowledge, attitudes and health behaviours of older adults (> 55 years), or about designing health promotion and early detection interventions responsive to their learning needs. A collaborative project was established with the intent of designing an appropriate program for older adults. The initial work included a community needs assessment using focus groups, one-on-one interviews and self-report surveys. The use of key community contacts was effective in locating older adult subjects (> 55 years) through pre-established linkages with agencies. Various ethnocultural groups, low income communities and isolated individuals, as well as other pre-established groups, were included in this study. The needs assessment found that: age is not perceived as a cancer risk factor; transportation is a barrier to screening; fear inhibits people from being screened; physicians are viewed as both the main source of expert cancer knowledge and as the gatekeepers to screening; family and peers are the main source of support, ethnospecific groups have different information needs; and finally, that lifestyle suggestions can reduce the risk of cancer. The findings indicated that community health promotion programs for older adults will require multiple approaches with a combination of strategies in order to meet their learning needs.