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breast cancer, people affected by
pancreatic cancer, and people living with
multiple myeloma.
So we really are trying to find these
groups of patients who we know have
suboptimal outcomes in terms of their
cancer diagnosis because of the complexity
of the disease. There’s a program of work
where we’ve been doing core design
studies with patients and their family
members to say, “Actually, what sort
of interventions do you need to help
you manage?”
It could be the informational challenges
of a complex cancer diagnosis, and all
of these new novel therapies, or what
you need to manage the cognitive
decline that comes with the treatments,
or the pain that’s associated with some
cancer diagnoses.
Then there’s a program of work that is
looking at developing our skills as nurses,
particularly nurses who have cancer
knowledge, but developing skills on caring
for older adults with cancer.
We know we’re an ageing population;
we know that’s where the majority
of cancer diagnoses are; and yet the
challenges facing somebody who may have
comorbidities, or may be at risk of frailty
because of their cancer, or their cancer
treatments, are particularly challenging.
So, we’re looking at developing new
interventions, and then testing those to see
what the impact of that is on the quality
of care that is then delivered to these
older adults.
We’re also working with the older adults
themselves on a core design study to say,
“What do you need nurses to know about
caring for you when you’re older with a
diagnosis of cancer?”
So we’re really using the experts’
experience to drive our programs and
research, and to inform the system
changes we need.
Then the final program we’re working on
is looking at the workforce. We know we
have this remarkable workforce of nurses.
But we also know that by 2025 we’ll be
around 85,000 nurses short in Australia.
So how do we profile the impact and
importance of specialist cancer nurses
to make sure that resource-strapped
organisations are investing in these
nurses? That we can carry out studies to
show the contribution of expert clinical
decision-making, of being able to triage
complex and less complex patients, so
that we’re really directing our expertise to
those patients who need us most, but also,
who have the greatest capacity to benefit
from interaction with specialist nurses.
The breadth of programs allows nurses
who are interested in many different things
to tap into our programs and say, “I’d really
like to know more about research, and I’d
like to do it in that program of work.”
How does it work when a nurse approaches
you? Is it run through the university, or
through their hospital?
There are a couple of different ways. A
lot of it is informal. I’m very lucky to have
access across the clinical partners, so a lot
of it is conversations with nurses on a day-
to-day basis. The other way is people may
contact me formally through the university
website, either through the Department of
Nursing, or the Centre for Cancer Research
at the University of Melbourne.
But very excitingly, we just got a new
initiative that’s being funded by the Victorian
government, through the VCCC, which is
a million-dollar investment for a nurse-led
cancer innovation research hub, which
will allow us to engage with nurses, both
face to face, but also online, and flexibly,
so that they can learn research skills. But
really, importantly, they can also apply to
spend 12 weeks with us in the research hub
to learn skills, and to think about how they
would use those skills for a project that has
been prioritised by their organisation, as
something that is really important for the
care of people, and in the organisation they
come from.
The hub also has seed funding for
research grants. So we will say to nurses,
“If you can pitch an idea that has real
resonance with your organisation, and
importantly with at least one of the VCCC
organisations, we will give you seed funding
to kick start that program of research work.”
In your time in academia, how have things
changed in the way we teach students
cancer nursing?
I think things are changing really quickly.
For a long time we’ve been fairly stable –
I’m trying not to say stagnant – in the way
we’ve approached teaching cancer nurses.
It’s been quite didactic. It’s been heavily
classroom-based.
What we’re seeing, in lots of organisations,
and what we’re investing in at the University
of Melbourne at the moment, is taking
content that is appropriate and relevant to
take online, so that we can begin to bring
cancer nurses education that is flexible, that
is there for them at point of delivery, when
they can get to it, but also allows them to
access it in the clinical environment.
So they can maybe look at a quick three
or four-minute learning module about
how to talk to a person about exercise and
cancer if they’re not sure how to introduce
the conversation.
So there’s a shift in mode of delivery, but I
think the critical piece is that we’ve seen an
enormous shift in two of the big domains,
the first being that we actually have to
embed the voice of the patient and the
consumer in our education.
We have to make the experience of
having a cancer diagnosis and treatment
real for nurses, because the more we can
do that, the greater we will hone people
skills of empathy, communication and
the desire to support people, which we
Nurses are quite
research naive. There are
few of us who have doctoral
or postdoctoral studies.
know from the data we have mastered is
fundamentally important to the quality of
care, the people see that experience of
care, but also they have constant care.
The other piece that, obviously, we’ve
seen shift, exponentially, is we have this
incredible, remarkable advancement
in cancer therapy. So we have
immunotherapies, targeted therapies, these
new CAR T-cells. We have remarkable
technological changes in radiation therapy.
We are doing surgery that we could only
have dreamed of 5–10 years ago.
With that comes a complexity around the
patients that we’ve never seen before. We
are getting older patients, people who are
coming in with far advanced disease, and
we’re seeing these people thankfully live
much longer.
But they live longer with consequences
of complex therapy, so we’re having to
teach nurses not just the acute care of
people with cancer, but survivorship care,
complex long-term comorbidity care and,
importantly, expert, exquisite end-of-life
care and the communications that go
with that. ■
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