With cancer being recognized as a chronic illness, self-management has been identified as integral to person-centered cancer care.1 Self-management is defined as "the individual's ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition."2 The ever-changing cancer care environment, with many aspects of the care being shifted to the home setting, has created and sustained a pressing need for patients and informal/family caregivers to self-monitor and self-manage impacts of their cancer, treatment-related adverse effects, and cancer-related symptoms. However, those tasks cannot occur without support. Cancer nurses play pivotal roles in providing self-management support (SMS) and improving patient outcomes throughout the cancer care trajectory.3-5 Systematic reviews have reported that self-management education and support, delivered by nurses educated and skilled in facilitating patient engagement, can result in positive behavioral change and better clinical outcomes in chronic conditions (eg, reduced blood pressure in hypertension, lower A1c in diabetes,6 cancer, reduced symptom severity, better quality of life).7-9 Better integration of SMS in cancer care requires effective implementation strategies at multiple levels including system-level policy change, strengthening of the evidence base through effectiveness and translational research, and workforce capacity building. This editorial argues the importance of capacity building in the cancer nursing workforce to provide high-quality SMS to cancer survivors.
Several key international cancer nursing education frameworks10-12 acknowledge effective SMS provision as a core competency of cancer nurses. However, it was not the intent for these frameworks to detail specific SMS-related knowledge and skills in depth. Further, SMS-related knowledge and skills for nurses are seldom integrated into ongoing professional development pathways in cancer programs, or programs in undergraduate and graduate curricula.13 Building on existing frameworks applied to wider chronic disease and other disciplines,14,15 we have categorized the core competencies specific to SMS for cancer nurses into the following 3 domains:
General person-centered skills (ie, participatory communication skills that promote active patient/caregiver/survivor involvement in managing cancer and health; health promotion and prevention; assessment of health risk factors and self-management capacity including activation level and capability; tailoring patient education to health and cultural literacy; and developing shared agenda between the provider and the patient/survivor).
Behavior change skills (ie, application of health behavior change models and theory, mastery learning, motivational interviewing, health coaching, 5 A's counseling techniques,16 goal setting and action planning, structured problem solving, behavior adjustment in response to self-monitoring, coaching for positive coping strategies, and enhancement of self-efficacy; facilitation of group self-management programs; and supporting patient decision-making, collaborative problem definition and care planning).
Organizational/system skills (ie, measurement-based practice and evaluation of health outcomes for "real-time" tailoring of care; navigational skills to facilitate transitions across phases in the cancer trajectory; facilitating patient navigation of peer and other resources; environmental modification to create a context for successful SMS; and remote monitoring and telephone triage for self-management).
To further advance this area of practice, we call for 3 priority actions for the cancer nursing leadership community. First, we need to continue to advocate for the inclusion of SMS-related knowledge and skill development in the undergraduate and graduate curricula. The undergraduate educational efforts may be provided in a broader chronic disease management context. Core skills and knowledge should also be reflected in relevant specialty certification examinations where applicable. Second, research and education leaders should continue to strengthen the knowledge base and develop guidance through global consensus on the standards for knowledge and skill requirements specific to SMS at various levels of cancer nursing practice (ie, what should be the differences in standards for all nurses vs many nurses vs some nurses vs few nurses?).10 Last but not least, specific considerations regarding SMS in various social, economic, cultural, and geographical contexts should be taken into account in formulating future research and education strategies.1 As the largest cancer care workforce, nurses are well placed to systematize effective SMS, ultimately improving behavioral and health outcomes for all cancer survivors.
Raymond Javan Chan, PhD, MAppSc (Research), BN, RN, GAICD
Editorial Board Member, Cancer Nursing Princess Alexandra Hospital, Metro South Health, Queensland, Australia, and
School of Nursing, Queensland University of Technology, Brisbane, Australia
Deborah K. Mayer, PhD, RN, AOCN, FAAN
School of Nursing, University of North Carolina, and UNC Lineberger
Comprehensive Cancer Center, Chapel Hill, NC
Bogda Koczwara, MBioethics, BM, BS, AM, FRACP, FAICD
Flinders Medical Centre and Flinders University, Adelaide, Australia
Victoria Loerzel, PhD, RN, OCN, FAAN
College of Nursing, University of Central Florida, Orlando, FL
Andreas Charalambous, PhD, MSc, BSc, RN, PGCert (Research)
Department of Nursing, Cyprus University of Technology, and
Department of Nursing, University of Turku, Finland
Oluwaseyifunmi Andi Agbejule, BRadTherapy
School of Nursing, Queensland University of Technology, Brisbane,
Australia
Doris Howell, PhD, RN
Department of Supportive Care, Princess Margaret Cancer Research
Center, and Lawrence S. Bloomberg Faculty of Nursing, University of
Toronto, Ontario, Canada
References