Search

Numerous targeted therapies are currently available in breast cancer (BC) with gene amplification of the human epidermal growth receptor factor 2 (HER2), while those targeting HER3+ BC are still under clinical investigation. Oncology nurses and advanced practice providers are expected to stay abreast of these advancements to ensure patients with BC receive appropriate therapeutic education. The purpose of this study was to identify the challenges and barriers affecting the care of patients with HER2+ BC, with a focus of on the preparedness of oncology providers to educate and counsel patients on their diagnosis, treatment, and management options. A mixed-methods research study was conducted with semi-structured interviews followed by a quantitative survey. Participants included registered nurses (RNs), nurse practitioners (NPs), physician assistants (PAs), medical oncologists (MOs), and pathologists (PATHs) practicing in the United States. RNs, NPs and PAs were required to have an oncology specialization or a minimum of 2 years of practice in oncology. Interviews transcripts were coded and thematically analyzed in NVivo. Chi- square statistical tests were performed on survey data in SPSS to compare responses by demographic (e.g., profession). Thirty-two (32) interviews and 258 surveys were completed with similar breakdowns by profession. Interviews indicated that RNs, NPs/PAs experienced challenges in educating patients about their molecular diagnosis and available treatment options. Surveys indicated that 70% of RNs rated their skill at sub-optimal levels for explaining to patients the role of HER2+ gene amplification. Sub-optimal skills were reported among 43% of NPs/PAs for realigning patients' assumptions about HER2+ metastatic BC. In addition, 38% and 35% of NPs/PAs rated their skill sub-optimally in explaining to patients the risks and benefits of HER2 monoclonal and HER2-directed antibody drug conjugates, respectively. A similar proportion (33%) rated their skill sub-optimally in assessing patients' level of comprehension for available treatment options. To the co-authors' knowledge, this is the first study assessing the educational needs of oncology nurses in their communications with HER2+ BC patients. Oncology nurses and advanced practice providers would benefit from innovative and impactful professional development interventions designed to help them better understand, interpret/translate, and effectively communicate to patients the continually evolving scientific evidence related to HER2+ BC treatment options and their associated risks/benefits. [ABSTRACT FROM AUTHOR]

Purpose: The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic., Materials and Methods: The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods., Results: The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic., Conclusions: The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)