Patients with cancer are increasingly being asked to manage the symptoms and side effects, navigation between transitions in care, and long-term lifestyle and survivorship issues on their own. These skills, called self-management, are essential to ensure patients receive optimal cancer care and proactively manage their ongoing health needs. Oncology nurses are traditionally the clinicians who most frequently and extensively support patients in gaining self-management skills, yet standards for oncology nurses’ knowledge and skills related to patient self-management are lacking.
Responding to recent calls to create a competency framework, an international group of nurse leaders published a novel list of self-management competencies and performance criteria for broad implementation by oncology nurses. A group of oncology nurses with the International Society of Nurses in Cancer Care (ISNCC), led by Raymond Chan, PhD, RN from the College of Nursing and Health Sciences at Flinders University in Australia, published their process and outcomes for developing a self-management competency framework for oncology nurses in Cancer Nursing.
The consensus-building process to develop this framework included multiple rounds of deliberation and prioritization from a diverse, international group of experts in oncology nursing. First, an initial list of competencies was curated from existing white paper reports, studies demonstrating effective nurse-led strategies to support patient self-management in cancer, and international curricula for self-management. Second, a group of 21 ISNCC leaders reviewed this list and provided feedback multiple times to narrow down and clarify the list of competencies. Third, the resulting list of competencies was finalized based on feedback from the prior two rounds of review.
The final framework includes 6 domains. Within these domains are 10 competencies and 42 performance criteria. Below are brief descriptions of each domain. Detailed explanations of the performance criteria for each competency are listed in the publication.
- Person-centered and motivational interviewing communication skills. This includes establishing rapport and engaging individuals as partners and applying motivational interviewing skills.
- Whole-person assessment of self-management support needs and capacity for self-management. This includes assessing patient and family self-management support needs and assessing capacity for self-management of medical, emotional, and lifestyle tasks.
- Health promotion theories and interventions. This includes applying health promotion theories and interventions to promote patient uptake of healthy lifestyle behaviors, both if the patient is at risk for or already diagnosed with cancer.
- Coaching for behavior change tailored to the patient’s phase in the cancer continuum. This includes applying knowledge and skills of coaching or motivational interviewing to support patient adoption of self-management behaviors. It also includes applying behavior change theories to promote patient autonomy relative to behavior change.
- Monitoring and evaluating patient changes in self-management behaviors and health outcomes. This includes evaluating patients’ changes in self-management behaviors and outcomes and assisting patients in self-monitoring their self-management behaviors.
- Quality improvement for integration of self-management support in cancer care. This includes using quality improvement strategies to evaluate how the provision of self-management support impacts patients’ self-management behaviors and health outcomes.
As the first competency framework for oncology nurses to support patient self-management, this study provides a starting point for implementing these competencies within educational and clinical settings. Oncology nurses likely use several of these self-management supports already, but the uniform knowledge and application of these skills can further improve the person-centered supportive care oncology nurses provide. Developing training and educational curricula around these domains can have broad impact in patient care and outcomes.
The researchers acknowledge the next steps in adoption and implementation of this framework include recognizing the context of care and organizational supports available to nurses seeking to adopt this framework. For example, researchers can work with practicing oncology nurses to understand the best ways to integrate these competencies into practice and minimize the impact of barriers to practice change. Moreover, this framework can help health care leadership and administrators see where additional support (time, financial, and educational) can address patient and clinician needs to ensure compliance with international standards. Ultimately, the goal is to improve oncology nurses’ training, and practice can ultimately improve patient self-management and outcomes.