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2018 Geriatric Oncology: Educating Nurses to Improve Quality Care

July 9-11, 2018
Sheraton Universal Hotel, Universal City, California

This NCI-funded national project is a two and a half day program for oncology nurses to increase their knowledge of caring for older adults with cancer.

Download the flyer here.

For Application information please click here.

Background

Life expectancy in the U.S. is increasing, and the number of "baby boomers" age ≥65 is expected to almost double by the year 2030. Since nearly 60% of all cancer cases and 70% of all cancer mortality occur in patients over the age of 65, the number of older adults with cancer is predicted to dramatically increase with the aging of the U.S. population. The mission of this proposal, "Geriatric Oncology: Educating Nurses to Improve Quality Care," is to teach the essential principles of geriatrics and geriatric oncology to oncology nurses by working with a multidisciplinary team of educators in geriatrics and oncology.

Despite the rapid increase in the U.S. aging population, there remains a shortage of healthcare specialists with geriatric training. This includes a current and projected future shortage of nurses with experience in geriatrics who will be needed to care for this growing population of older adults with cancer. Because this training is not part of a standard nursing curriculum, most nurses require supplemental knowledge specific to the healthcare needs of older patients with cancer.

The overall goal of our program is to develop and implement a national education curriculum in geriatric oncology to be given for oncology nurses. This proposal unites the fields of nursing, geriatrics, and oncology through the creation of a curriculum including geriatric principles geared to oncology nursing professionals who are already caring for an aging oncology population. Dr. Arti Hurria and colleagues have formed a national consortium, the Cancer and Aging Research Group, which brings together individuals with expertise in both geriatrics and oncology. These individuals, along with others representing a multidisciplinary team, will serve as faculty for the curriculum consisting of four annual workshops. An estimated total of 400 nurse participants is planned over the course of the 5 year grant period. Continuing follow-up after the workshops will focus on dissemination of the findings and evaluation of the impact of this geriatric oncology curriculum on the development of geriatric oncology nursing initiatives by participants in their home institutions.
The overall strategy of the program plan is to educate oncology nurses in geriatrics by providing training from experts, allowing for direct practice of techniques, and implementing and communicating the knowledge in their home settings. We will request that each institution interested in participating in the program commit to sending a 3 person nursing staff team from different roles in the organizational structure, ideally: a nurse manager, a nurse educator, and a nurse who provides direct patient care (RN or NP). Participants will be asked to develop implementation plans for their own institutions based on the conference instruction. The team will work together throughout the conference in order to not only gain the knowledge for themselves, but also for their colleagues, as they develop a plan for integrating this information upon return from the conference. A team of three as outlined above will be the preferred attendee model; however, there may be situations that do not allow for three members settings (e.g., smaller community settings), and we will review those applications on a case-by-case basis. If a manager or administrator is not a part of the team which attends the program there will be an identified member of the management team that we will follow-up with to determine if the team is progressing on their established goals.

Our program moves beyond the lecture format. The course content will consist of case studies and opportunities to practice geriatric assessment skills, while experts oversee and provide input or answer participant’s questions about application of the techniques. To practice skills, participants will interact with the faculty and each other, and receive feedback on site. This innovative program emphasizes participant interaction, a strategy recognized as particularly effective in learning and integrating new information.

Applications should include 3 tentative goals that the attendees would like to implement after the course. At the completion of the course, the attendee teams will finalize 3 goals that they will implement at their home institutions. We will follow up with the teams at 6, 12 and 18 months to check progress toward goals. Additionally, there will be a monthly conference call post program to provide support to attendees throughout the implementation process.
Instructions: Teams will develop 3 goals at the conference for implementation over the next 18 months. One goal will be focused on providing additional education to individuals at their home institution. The remaining two goals should focus on a policy or practice change within the institution. Goals will be reviewed at 6, 12, and 18 months post conference with a member of the project team. Goals may reflect the utilization of nursing sensitive indicators that the institution is already measuring. In all these examples a time frame for completion would also be included. Goals are scalable to the institution's needs and resources available.
  1. Add geriatric assessment parameters to admission assessment, such as measures of function, nutrition, cognition, social support, comorbidity, and psychological state.
  2. Utilize a chemotherapy toxicity predictive model in new patients over 70 years of age who are anticipated to receive chemotherapy.
  3. Develop an interdisciplinary team to review cases of oncology patients 75 years of age and older to determine geriatric needs or resources which could be offered (example: rehab, nutrition, pharmacy, supportive care, etc.).
  4. Pilot the use of a short geriatric assessment for patients 70 years of age and older in a particular practice and determine further referrals that might be needed.
  5. Perform a Timed-Up-and-Go (TUG) upon inpatient admission to assess functional status and fall risk.
  6. Implement the use of a pain assessment scale (such as PAINAID) for patients with dementia at our institution.
  7. Develop a polypharmacy review program in which inpatients over 70 years of age with more than 5 medications receives a pharmacist review of medications for interactions, duplication, and appropriateness for use in older adults (using the Beers Criteria).
  8. Perform a preoperative assessment in patients 70 years of age and older to evaluate physical function and cognition prior to surgery to predict the risk for postoperative delirium, morbidity, and mortality by using a clock drawing test (mini-COG) and a TUG.
  9. Hospitalized patients age 65 and older with a Body Mass Index (BMI) of 20 or below will have an Mini-Nutritional Assessment (MNA) performed and nutrition consult prior to discharge.
  10. Develop a list of community-based geriatric resources for patients based on areas of need.
  11. Disseminate knowledge of geriatric assessment in a series of educational presentations to staff nurses on a quarterly basis.
  12. Track National Database of Nursing Quality Indicators data in patients age 65 and over to monitor rates of catheter-associated urinary tract infections and falls in the older population. Develop plans for impacting rates through education of staff and monitor rates pre- and post-education.
Geriatric Oncology: Educating Nurses to Improve Quality Care
  1. Understand the demographic changes of aging of the US population and how this affects future trends in oncology care
  2. Understand the ability to utilize the science of geriatric nursing and how those skills can be integrated into oncology care including reviewing initiatives from the Hartford Institute for Geriatric Nursing that can be applied to oncology nursing.
  3. Identify physical and biological changes associated with aging and how they affect cancer diagnosis, treatment and survival.
  4. Assess physical functioning in an older adult and identify interventions to improve or retain function and promote safety.
  5. Describe cognitive and psychological changes that can occur with aging and identify assessment techniques and follow up care that are appropriate in patients with cancer.
  6. Understand unique nutritional concerns for the elderly patient with cancer and recommended interventions that can improve nutritional status.
  7. Discuss the identification and management of polypharmacy in the older adult with cancer and review methods to optimize drug adherence.
  8. Identify the factors in a geriatric assessment which can identify older adults at increased risk of chemotherapy toxicity.
  9. Learn techniques to assess and manage pain and insomnia concerns in the older adult with cancer.
  10. Instill in oncology nurses an understanding of how to advocate for the older adult and how to work with leadership in their institution to impact changes to care for this population.
  11. Develop an understanding of legal concerns facing older patients with cancer and identify available resources.
  12. Review community resources available to the older patient with cancer and their caregivers to support identified needs.
  13. Delineate methods for disseminating information about care of the older adult with cancer through various strategies.
  14. Develop an implementation plan for effective techniques for improving the care of the older patient with cancer.
Arti Hurria, MD Comprehensive Geriatric Assessment, Predicting Toxicity
Peggy Burhenn, MS, CNS, AOCNS Project Implementation, Sleep Management, Tapping into Community Resources
Denice Economou, RN, MN, CHPN Supporting Caregivers
Christopher Okamoto, RN, BSN Accessing Web-Based Resources
Mathy Mezey, EdD, RN, FAAN Nursing Initiatives
Supriya Mohile, MD, MS Physiological Changes and Comorbidities
Janine Overcash, PhD, ARNP, BC Assessing Functional Status
Karen M. Mustian, PhD, MPH Exercise Screening and Prescription
Wendy Demark-Wahnefried, PhD, RD Nutrition and Aging
Stephanie Fajuri, JD Legal Resources
Sarah Kagan, PhD, RN Integrating Geriatric Oncology
June McKoy, MD, MPH, JD, MBA Medical Legal Concerns
Beatriz Korc-Grodzicki, MD, PhD Cognitive Changes
Matthew Loscalzo, LCSW Identifying and Addressing Distress
Timothy Synold, PharmD Polypharmacy
Bonnie Freeman, RN, MSN, ANP-BC, CHPN Pain Management
Shirley Johnson, RN, M.S, MBA Leadership
Betty Ferrell, PhD, MA, FAAN, FPCN Implementing an Evidence-Based Model
Can you define "direct patient care"?
A direct patient care nurse can be a nurse from any area that is providing direct care to older adult patients whether they are inpatient or outpatient or in a specialty area, such as infusion, radiation, clinic, etc. The purpose of having a direct care nurse is to have the expertise at the conference of how the new knowledge can be implemented from that perspective, is it realistic? Is it practical? Does the direct care nurse have the time to perform the planned interventions? Etc.

What is the cost of the program?
This is an NCI funded course that provides free registration, course materials and resources as well as a continental breakfast and lunch. We have a very competitive hotel rate at the Sheraton Universal Hotel of $189.00/night plus tax and city fees per room. The grant provides $325.00 per participant (up to the max total room cost for shared participant rooms) staying at the Sheraton Universal Hotel. So participants are responsible for all travel (air and ground transportation) and dinner and part of the hotel room costs.

Does the program offer Continuing Education Units?
Yes, the program offers 18 continuing education units for full attendance. No partial credits will be offered for partial attendance.

Is there a paper application that you send?
The application is online via Survey Monkey so there is not a hard copy version that you submit. To facilitate the application preparation, here's a sample application for reference only as the drop down menu will not work. The online application allows you to scroll back and forth between pages, save your work and complete the process at a later time. Please note that the application deadline is May 18th, 2018.

When will I know if I'm accepted?
We will notify you whether you have been accepted by May 28th, 2018.

Will this program be offered next year?
Yes, the program will be offered annually, four times (2016 -2019) over a 5 year period, and all will be held in the Los Angeles area.

Can other disciplines such as social workers apply for the program?
Other disciplines such as social workers are welcome to apply. However, since our main focus is to educate nurses (manager, educator, and direct care nurse) in geriatric oncology, we will review the application on a case by case basis.

Do you have any information about things to do around Universal City?
Universal Studios Hollywood is a short walk from the Sheraton Universal Hotel. For more information, please visit https://www.universalstudioshollywood.com/
For more information on the city of Los Angeles, please visit https://www.discoverlosangeles.com/

The application for the 2018 conference is at https://www.surveymonkey.com/r/2018_r25
Applications are due May 18th, 2018.

For more information:
Anait Arsenyan
(626) 218-9463
Email: aarsenyan@coh.org

Christopher Okamoto
(626) 218-0764
Email: cokamoto@coh.org
2017 Session Materials

Session slides and handouts can be found here

2017 Monthly R25 Conference Calls

View and/or signup as presenters for the calls here

Sign-in for the monthly calls here

2017 R25 Conference Participant Contact Information

View the contact information for the conference participants here
2016 Session Materials

Session slides and handouts can be found here

2016 Monthly R25 Conference Calls

View and/or signup as presenters for the calls here

Pictures from the 2016 R25 Conference