Update on EONS Prostate Cancer Education Project
In a European context there is currently a lack of evidence on what type of education is needed for nurses and doctors in relation to prostate cancer. Similarly there is more to learn about nurses working in different settings and whether education can help to advance practice. Importantly any new educational initiatives must reflect men’s expectations and needs when prostate cancer is diagnosed.
As most readers will be aware prostate cancer is increasing in incidence and will continue to place a significant burden on the health care systems of all developed countries. Across Europe there are currently more than two million men living with prostate cancer and a man now has a one in 12 lifetime risk of being diagnosed with prostate cancer as a result of clinical symptoms or PSA testing (Aus et al 2005).
It was only in 2001, however, that the European Association of Urology (EAU) issued guidelines on the medical management of prostate cancer. At present, however, there is no official consensus about the nursing management or how to meet the supportive care needs of prostate cancer patients across Europe (Aus et al 2005). Research into training needs in relation to prostate cancer has been lacking until now. The role that men with prostate cancer should play in educating professionals is also open to further development (Mc Namarra et al et al 2007).
EONS studyMembers of EAUN may remember being invited to take part in an email survey in 2009 about prostate cancer and educational needs that was sent from the European Oncology Nursing Society (EONS). This EONS study has been carried out in three phases. The first two phases surveyed nurses and junior doctors across seven European countries. The project was the result of close collaboration between colleagues representing professional groups and patient representatives across Europe, guided by the steering group with the following members:
- Prof. Daniel Kelly, School of Health & Social Science, Middlesex University, London, UK.
- Françoise Charnay-Sonnek, Hòspitaux Universitaires de Strasbourg, France
- Prof. Sara Faithfull, Professor of Cancer Nursing Practice, Faculty of Health and Medical Sciences, Division of Health and Social Care, University of Surrey, UK.
- Bente Thoft Jensen, Chair, European Association of Urology Nurses, Denmark.Louis Denis, EUROPA UOMO, Belgium
- Jane Cockle-Hearne, Research Fellow, Faculty of Health and Medical Sciences, Division of Health and Social Care, University of Surrey, UK.
The aim of this brief article is to update EAUN members about the study.
Aims The specific aims of the first phase were:
- To gain an understanding of cancer nurses and urological nurses’ current roles and work settings in relation to prostate cancer management in Europe;
- To explore existing training and skills in relation to prostate cancer, in particular the treatment process and supportive care;
- To identify perceived gaps in knowledge and training needs; and
- To identify potential change or growth areas for cancer and urological nurses in the care of men with prostate cancer.
Nurses who work with prostate cancer patients across seven (Denmark, France, Ireland, Netherlands, Spain, Turkey and the UK) European countries were invited to complete the online survey. The questions sought information on current role, work setting and experience; role functions and tasks currently performed; education profiles and requirements; levels of confidence in managing care and treatment, general medical prostate cancer knowledge and demographic details. The target was 100 completed responses from each of the countries with an acceptable lower limit of 50 from each.
Responses and findings We were delighted that the survey achieved an excellent response rate. All countries exceeded the limit of 50 completed responses. The response rate per country was Denmark 60, France 51, Ireland 57, Netherlands 58, Spain 55, Turkey 52 & The United Kingdom 112.
Key findings were that the majority of nurses were female (89%) and over the age of 40 years (57%). Half of those responding were members of a national nursing organisation (51%), with a smaller membership for the EAUN (17%) and EONS (16%).
The largest proportion of the nurses described themselves as working in urology (41%) followed closely by oncology (31%). Those who responded were most likely to be employed as clinical nurse specialists (20%). The remainder were involved in a variety of roles and settings.
Nurses were most likely to report having obtained a diploma as their highest qualification (32%), followed by bachelors’ degree (31%); masters, post-graduate diploma or doctoral level qualifications were rarer (16%, 13% and 1% respectively). Notably, whilst 42% had obtained a specialist qualification in cancer care, only 7% had achieved a similar level of education in relation to prostate cancer.
In relation to education achievement and country of origin, diploma level was most likely in respondents from France, bachelors in the Netherlands, with Irish nurses most likely to have a post-graduate diploma, masters or doctoral degree. A range of other qualifications were also listed which included continence nursing, with the largest number being reported for Denmark.
Around 78% of nurses reported routinely being involved in the treatment phase and 81% reported routinely providing patient support. Additionally, for over half of nurses, long-term follow-up and advanced disease care were also routine. In contrast, screening and diagnosis, and treatment decision-making are areas where nurses were most likely to report less routine involvement or where they recognised they lacked relevant skills. For screening and diagnosis, 20% reported they had no skills at all and 62% stated that it was not their primary role.
Symptom managementNurses also reported symptom management as the most dominant aspect of their role in advanced disease, with advice on home care, referral to specialist services and bereavement support also being important. Nurses working in urology were less likely to have skills in advanced disease than were those working in oncology. Urology nurses (67%) reported feeling more part of the multi-disciplinary team than oncology nurses (57%).
Nurses were also most confident in delivering care at the time of treatment. Again there were some differences between oncology and urology nurses; the former reported feeling more confident in caring for men at the time of screening, diagnosis and treatment, including follow-up, whereas oncology nurses were more confident in delivering palliative care. Nurses typically were allowed one to five days per year for education. However, just over one-fifth did not receive any paid leave at all. Within the sample, in-patient clinical nurses reported receiving the least number of education days, with one-third of this group saying they were given no leave at all.
In terms of preferred ways of accessing continuing education, most nurses listed short conferences, or ‘on-the-job’ learning. When looking across the countries it was evident that nurses from France and Spain were least satisfied with educational opportunities available.
Nurses also placed short courses or workshops at the top of their preferences, with distance learning as their least preferred method.
In the second phase of the study we proceeded to survey junior doctors from the same countries and have been able to identify interesting differences (as well some similarities) between the two groups.
Next stepsThe final phase of this project is underway and will involve asking men themselves about their experiences of care and what they actually want and need from their health care professionals. The survey will be available on-line and in paper format where requested and will go live at the beginning of October. Once again we are looking for your help with identifying men who might wish to take part. We are going to use patient groups and informal nurse contacts outside the clinical setting, so anything you can do to spread the word in this context will be very important. We will be contacting you direct in the next few weeks with more information about the survey and how it can be accessed
EONS is extremely grateful for the collaboration and assistance from all EAUN members. We will publish the results of this study in full and, once the final stage is complete, we will develop new ways to deliver education about prostate cancer.
Prof. Daniel KellyProfessor of Nursing & Cancer CareEONS Board Member School of Health & Social ScienceMiddlesex University London (UK)
Article from European Urology Today, volume 23, No. 4