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Working To Standardize Cancer Care

Published: July 15, 2015

Savitri Singh-Carlson

Cancer care can be a sensitive thing and such care in lower-income populations has its own unique challenges.

“There is a social and cultural impact of treatment delivery in those populations,” said Savitri Singh-Carlson, an Associate Professor and Assistant Director, Global Nursing in CSULB’s School of Nursing. “People may not want certain treatment. Patients diagnosed with cancer may not want treatment and prefer end-of-life care because they do not want to go through the treatment.

“What I found from my research is that the belief from this particular population is that this is karma,” she added, “It’s a different belief system than ‘Why is this disease happening to me?’ So the acceptance of the disease is a little bit different than it may be in other populations.”

Singh-Carlson’s work and research interests are low-middle-income countries, cancer survivorship, palliative care and looking at prevention and other related areas. Her focus of late has been in India, where she initially attended the nation’s first national cancer conference with oncologists, radiologists, nurses and counselors in November 2013. She was there as part of a group invited as plenary speakers for the open education resource through Cal State University’s MERLOT program for cancer India.

“We went with a team of oncologists to see how we could share the information and deliver it in a manner where somebody who doesn’t have access to textbooks and materials could actually download it from the internet and use it,” she said.

She recently returned from a 15-day trip to Cochin, Kerala India as part of her Fulbright Specialist Program Award. Just learning she received the award in March, her turnaround time was quick. While there she worked on the development of oncology nursing curriculum for chemotherapy treatment and survivorship for patients diagnosed with cancer.

“I got more done that I thought would be possible,” she said. “The trip was absolutely fabulous.”

The program’s goal was to assess this population’s cancer care needs utilizing a participatory approach that identified priorities on oncology curriculum development for health professionals, preventive/screening tools and strategies, along with research on cancer care and knowledge translation.

“I’m part of a curriculum development for oncology nursing, so we’re trying to do the education for the nurses for chemotherapy and radiation and all of the standards for preparation of,” said Singh-Carlson, noting that when approved, the information will be housed on a website for the Oncology Nursing Association of India. “We’re trying to standardize the protocols and policies for the entire state so that they can use these protocols and policies in any hospital setting. What we’re going to do is put this content together and put it on the open education resource for the Cancer India website (OERC-India) so anybody can download and use it.”

To that end she made great headway during her recent trip, her reach being greater than she had anticipated.

“We were able to talk to the major cancer centers that provide cancer care for the populations,” she said, “and we all realized there needs to be a standardization of protocols and procedures that all oncology nurses can work from.”

Just prior to her trip Singh-Carlson felt she might be able to teach and lecture to approximately 50 nurses. Instead, she estimates the number was closer to 300. In addition, she met with a dozen chief nursing officers and clinical nurse leaders who will be part of the standardizing process as well.

Challenges of providing cancer care in light of limited resources, education and social/cultural factors has heightened within the last decade, placing a demand on further education and research in cancer care. Oncology nurses are at the forefront of cancer care therefore providing opportunities to advance oncology nursing skills is a strategic move for institutions and the nation.

“What we’re trying to do is put this curriculum together in a format of standards and practices with current content,” said Singh-Carlson. “In that way, if an institution wants to put a curriculum together for continuous education for its nurses they are able to just go ahead and say, ‘This is what you should do.’ They can then tailor it to their own setting.”

This program will augment collaborative development of strategies for prevention/screening practices for cancer, especially breast, cervical, prostate, bowel and mouth cancers in light of social and cultural practices among this population. The program aims to collaboratively assess, develop and prepare oncology curriculum as modules for cancer care health professionals with a particular focus for oncology nursing.

Her trip also included a visit to the Tata Memorial Cancer Hospital in Mumbai which was key in making this a national effort because the facility houses the Oncology Nursing Association of India.

“I met with a lot of decision makers throughout this trip which is very important because the timing is so right,” she said. “The national health policy draft in 2015 has a paragraph saying we need to integrate nurse practitioners into our model of care because we don’t have the specialists, we don’t have the practitioners and we are short of doctors so we need to work to change the model in order to improve healthcare.”

Singh-Carlson believes the most important outcome she can leave the nurses with is the information that they need in order to deliver the quality of care according to the standards of practice and be able to set it up in such a way that it’s sustainable with a continuing education component.

“We want to continue to work with them to maintain this over the years,” she said, “and to empower the nursing profession so they are able to go ahead and be advocates for nursing as well as advocates for patients and their families.”

Savitri Singh-Carlson’s interview on AsianNet News during her recent trip to India can be viewed here.