Last year, I had the opportunity to represent nursing on the Institute of Medicine (IOM) committee to review the science on Psychosocial Services for Cancer Patients and their Families in a Community Setting.1 The committee concluded that there is now considerable evidence to demonstrate that psychosocial interventions can positively improve patient and family caregiver outcomes. Included in the IOM evidence was intervention research from around the world, including our work.2 Over the last 30 years, we have tested a nursing intervention to stabilize patients in their homes after they have been discharged from the hospital after cancer surgery. We have repeatedly demonstrated that both patients and family caregivers benefit from knowing what is happening to them and what to expect, how to recognize and manage their symptoms, how to perform skills needed to care for themselves, how to use strategies to communicate with health providers and support each other, and how to access and use needed resources.2 Despite these positive findings, we have done little to change clinical practice.

There is more interest than ever before in interventions to meet the needs of patients with cancer and their family caregivers. The IOM report states that the standard of care should be that all patients with cancer and their families receive high-quality cancer care that includes appropriate psychosocial health services. It is universally recognized that patients at risk for poor outcomes have complex physical and psychological problems. Our research in the postsurgical care of patients who have transitioned from the hospital to their homes is to stabilize patients first by managing symptoms. Symptom relief could be provided by home care nurses in consultation with experts in oncology. Repeatedly, home care nurses are placed in the position of being responsible for patients who have these complex needs but without expert oncology consultations. One solution is to teach home care nurses how to access and use evidence-based research in symptom management. For example, Schumacher and colleagues3 used standard pain management strategies to teach nurses to change their practice in the home. Other promising strategies include the use of medication kits containing prescription medications to treat pain and dyspnea with dying patients as they approach death4 and a research-based intervention, the Symptom Management Toolkit, that is readily available on the Web.5,6

There are major challenges to achieving the goal of translating research into everyday clinical practice including home care. Bradley and colleagues7 analyzed 4 different evidence-based programs and identified 4 elements critical to the use of new evidence: an infrastructure dedicated to translating the evidence, support of administration, commitment of clinical leaders, and a positive perception that the evidence warrants the change. Home care nurses need to be provided with access to the evidence in a timely and efficient manner, persuaded to value indicators of needed change, and to act to implement changes in how they deliver care.8 To achieve positive outcomes in home care, oncology experts must work collaboratively with nurses and be available to solve problems as they arise to avoid admitting patients to the hospital rather than working to keep patients at home.

Diffusion of evidence into clinical practice could be accelerated by the systematic use of Internet technology to unite human resources and knowledge. Nurses need quick access to the evidence and quick access to the experts, and the experts need the nurses' professional assessment in the home to understand the real-time needs of the patients. Technology integration is an enormous opportunity to create a future based on evidence to ensure standards of care. Telephone contacts have been shown to be an effective strategy to help families cope with the caregiver role. Telehealth programs have also been used effectively with patient populations at home.9 Other technology interventions could include the use of the Internet or e-mail.10 As the technology becomes less expensive and more ubiquitous, increased opportunity to implement these strategies will occur, but the first step must start with each of us as individuals. Each nurse who wants to make a difference in patient outcomes must take personal responsibility for identifying the evidence and finding ways to adopt its use in clinical practice.

My best.

Ruth McCorkle, PhD, RN, FAAN

Editorial Board Member, Cancer Nursing(TM)

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