Registed Nurses' Association of Ontario

Implementing the Basic Principles of Biomarker Use in Oncology Nursing

Leslie Marvell
Bayshore Healthcare Ltd.

In 2013 Bayshore HealthCare embarked on a new journey for enhancing the oncology patient care: we established the Bayshore HealthCare Integrated Oncology Program (BHIOP) structured to provide education to pharmacists, nurses, therapists, and other professionals providing client/family centered oncology care. The BHIOP oncology program has been focusing on safety, quality, and efficient service delivery by all of our professional employees in a unique care environment following Canadian best practices in cancer care throughout the continuum of care. Our skilled infusion clinic nurses at Bayshore HealthCare delivered approximately 20,000 chemotherapy and biotherapy infusions for oncology patients across the country in 2014.

As the Clinical Practice Leader in Oncology at Bayshore it is my responsibility to ensure our oncology nurses are up- to-date and focused on learning about the most current treatment and care practices in our specialty. This means that we can approach cancer care with the highest levels of expertise, compassion, sensitivity, and can address patients’ questions and concerns about the most current oncology treatments and therapies available.

It was with great pleasure that I was selected to participate in the RNAO’s Advanced Clinical Practice Fellowship (ACPF) program of 2015-2016. Being an oncology nurse first and a Clinical Practice Leader second, I was thrilled to spend 20 weeks in my areas of interest: oncology, learning and education. Interested in life long learning in Oncology I chose a focus of cancer advancements and treatments. In writing my ACPF learning plan I asked myself a question, “could I or our infusion clinic nurses answer, with a level of competence, a patient question on biomarker testing and molecular profiling?” I know that in the last 10 years there has been significant growth in cancer research and treatment through the study of genomics and biomarkers which answered my question that I needed to know more. Cancer is no longer studied at the organ level and has shifted to a gene focused approach to cancer research and treatment development. I wanted to learn and then share my new knowledge with others. The fellowship goal was learn about and implement the basic principles of biomarker use in oncology nursing.

Learning Activities of the ACPF and Outcomes:
Through focus groups and a survey, a knowledge and practice gap was identified among our nurses’ in regard to current knowledge in the area of molecular oncology. The lack of exposure to and understanding of the new biological impact of cancer, the consistent changes in molecular technology used to study biomarkers, how their analysis can facilitate personalized treatments for our patients, has lead to the development of a Clinical Practice Guideline (CPG) in Biomarker use in Clinical Practice. The CPG was created based on a thorough review and critical analysis of the literature on biomarkers, molecular profiling, and personalized medicine. Through a comprehensive literature search, all articles relevant to the topic were identified. The following databases were searched: MEDLINE, PubMed, CINAHL, ProQuest, and BIOMED Central.. All searches were limited to English language and articles were from 2010-2015. In order to maintain competency in rapidly changing cancer care and meet the challenge of breaking through traditional barriers to continuing education, a CPG was developed in an e-learning format to increase access to nurses for continued education in oncology. This is Bayshore’s first clinical e-learning education module. The goal of my fellowship, enriched learning experience and knowledge growth was to support our nurses’ e-learning experience, through the development of The Basic Principles of Biomarker Use in Oncology Nursing.

The end goal of the e-learning CPG is to have a positive impact on patient care and infusion clinic nurses practice by bridging the gap between their practice and currently available evidence on biomarker use and application. This CPG was developed for educational and informational purposes and is intended to support a practitioner’s best nursing judgment based on the clinical circumstances of a particular patient or patient population.
Future sustainability of Learning and Outcomes:

The CPG contains 3 recommendations to help support sustainability in continued education in oncology at Bayshore HealthCare:

    Infusion Clinic Nurses will complete this module on Biomarkers upon hire or within 6 months of CPG implementation for existing nurses.
      Nurse Managers will provide instruction on required e-learning module(s) and ensure that the completion of the e-learning CPG module is met by all Infusion Clinic Nurses.
        Bayshore HealthCare will provide continuous education opportunities in Oncology nursing to Infusion clinic nurses by providing access to new e-learning modules annually.