Teddi Mellencamp, celebrity known for her appearance on the

, is currently battling stage 2 melanoma. She discovered this at her 3-month checkup after an initial melanoma surgery. Right now, Mellencamp is using her celebrity platform to stress the importance of returning for checkups as instructed to do that by a physician.

I live in Florida which has been ranked second in the nation for new melanoma cases.

In 2018, there were 7940 cases of melanoma diagnosed in Florida, and it is estimated that nearly 1 out of every 10 Floridians receive a skin cancer diagnosis in their lifetime. Although I have seen many cases of metastatic melanoma in the hospital where I work, melanoma awareness should extend beyond Florida. It is a common disease which affects individuals all over the country.

In 2022, the American Cancer Society estimated that there were 99,780 new cases of melanoma and approximately 7650 cases are expected to be fatal.

At the very least, 3-month checkups after an initial diagnosis are required, which is why Mellencamp returned to the dermatologist. The American Society of Clinical Oncology recommends that physical and skin examinations be performed every 3 to 6 months for the first 2 to 3 years following surgery and annually thereafter.

 For some patients, a chest x-ray, CT scan, MRI, and/or PET-CT scan may also be recommended.

Mellencamp originally received a diagnosis of stage 0 melanoma, also known as in situ, in March 2022. This was not her first 3-month checkup and it was during the most recent appointment that new findings near the original spot were discovered. In addition, a PET scan revealed lymph node involvement1. At the time of writing, she is currently scheduled to receive genetic testing.

Mellencamp has a huge Instagram following of 1 million fans and she is posting her photos and updates about her treatment plan. Her hope is that other patients with melanoma will take her lead and return to the doctor in a timely fashion. Many times, in the hospital setting, patients become what is known as “lost to follow-up.” I have seen this more times than I can count. For RNs and social workers, the risk of patients not returning to their oncologist or primary care doctor for screenings or later check-ups is a serious reality. Patient education and discharge instructions are something that we are all familiar with and that cannot be stressed enough to patients. 

Celebrities can be huge in raising awareness. For instance, celebrity shows like Stand Up To Cancer have a huge impact.

 Every 2 years, Stand Up To Cancer (SU2C) produces a roadblock televised fundraising special, supporting urgently needed research and new treatments for cancer. The last program aired in 2021 during the middle of the Covid-19 pandemic. The program highlighted all the research this organization has completed in the past decade and featured performances by noted Hollywood stars. The show is coproduced by Reese Witherspoon and her husband, Jim Toth, who is a talent agent as well. The program also showcased survivor stories. The mission statement of this program is “collaborative, multidisciplinary, multi-institutional scientific cancer research.”

Working on surgical oncology floors at night, I frequently see patients watching TV and movies all night in between getting pain medications. I think that the RN working in oncology should have an awareness of the importance of everyday heroes like our favorite TV and movie stars who have survived cancer. I know that nurses and social workers unwind with things other than journals, and this is a good opportunity to blend the 2.

Mccarthy A. I feel blessed!’ ‘ROBH’ star Teddi Mellencamp, 40, celebrates ‘good news’ after her frightening close call with cancer. Survivornet. March 24, 2022. Accessed November 3, 2022. 

Melanoma by the state: Florida. Aim At Melanoma Foundation. Accessed November 3, 2022. 

Key statistics for melanoma skin cancer. American Cancer Society. Accessed November 3, 2022. 

Melanoma: follow-up care. Cancer.net. December 2021. Accessed November 3, 2022. 

What we do. Stand Up To Cancer. Accessed November 3, 2022. 

Articles

Celebrated reality star Teddi Mellencamp is using her Instagram as a platform to stress the importance of follow-up visits for patients with melanoma.

Opinion: Oncology Nurses Should Know the Celebrity Stars Raising Cancer Awareness

Rebecca Kronk, PhD, MSN, CRNP, ANEF, FAAN, CNE

According to the World Health Organization

 there are over 1 billion individuals living with a disability, representing approximately 15% of the world’s population. In the United States, the Center for Disease Control reports that 1 in 4 adults have some type of disability.

Individuals with disabilities can be described as the largest minority group in the world; disability intersects across all demographics and rates of disability are increasing. Almost everyone will experience either a temporary or permanent disabling condition along their life span.

Early cancer detection saves lives, whereas delayed detection results in late-stage diagnoses and higher mortality. Compared with women without disabilities, women with disabilities have lower rates of breast and cervical cancer screenings. According to a study based on the 2013 National Health Interview Survey, prevalence of Papanicolaou tests among women with disabilities between ages 21 and 65 years ranged from 66% to 80%, compared with women without disabilities (81%).

 Prevalence of mammograms among women with disabilities between ages 50 and 74 years was 61% to 68% compared with women without disabilities (73%). Women with mobility limitations had the lowest prevalence of receiving a Papanicolaou test, and women with cognitive impairment had the lowest prevalence for mammograms. Among adults with disabilities ages 50 and 75 years, screening for colorectal cancer ranged from 49% to 65% and was 57% among adults without disabilities. Individuals with disabilities experience disparities in cancer screenings and are at higher risk for late-stage diagnoses.

A mixed methods systematic review investigated the barriers and facilitators of access to cancer services for people with physical disabilities.

 Five themes emerged from eighteen studies including: reasons for not engaging in preventive health care behaviors; interactions with health care providers (HCPs); external factors; accessibility of facilities; and positioning for procedures. Barriers to care included a lack of knowledge, personal beliefs systems, time constraints, and competing priorities. HCPs with poor attitudes, lack of knowledge and sensitivity, or failure to give needed referrals or information also were viewed as barriers. Receiving letters, post cards, or phone calls as reminders were viewed as facilitators as well as treating the person with a disability as an expert in their own care.

Women with disabilities were more likely to return for repeat mammograms when initially treated with sensitivity. External factors such as finances, transportation and accessible facilities could be improved with reliable transportation, and disabled parking spaces. Referrals to clinics with accessible equipment, ramps, and allotting additional time for appointments to allow for personal needs such as dressing or undressing were seen as facilitators. Regarding positioning, having a second technician to assist with safety, handrails, or being able to sit for a mammogram were suggested.

Resources for Evidenced-Based Care for People With Disabilities

To be part of the solution, nurses and other HCPs need the right tools to gain the competencies as well as the confidence to advocate for change for indivduals with disabilities. 

Alliance for Disability in Health Care Education

offers a set of core competencies that define standards and care for interprofessional teams to address health care disparities and improve outcomes for individuals with disabilities.

It is never too early to introduce nursing competences specific to the care of people with disabilities within prelicensure curriculum. A set of 12 simple, yet flexible, competencies distinctly specific to disability culture and care were developed by this author and colleagues. These competences were divided into 4 dimensions—environment and care, communication, culture, and referral—and are adaptable to any nursing curricula (

National League for Nurses (NLN) has developed the Advancing Care Excellence for Persons with Disabilities Program

 to support nursing education so that high quality care is delivered by nurses who are both knowledgeable and sensitive to the needs of individuals with disabilities. This online resource provides case studies, teaching strategies, and other resources to expand nurses’ abilities.

Caring for People with Disabilities: The Nurse Practitioner Tool Kit

to help prepare nurse practitioner (NP) students and practicing NPs as frontline workers to be part of the solution and fill a significant gap in NP training.

To summarize, it is imperative that nurses and other HCPs not only recognize the disparities in preventive screenings, but also to be part of the solution. Early detection and cancer treatment must be accessible and will save lives.

Disability and health. World Health Organization. November 24, 2021. Accessed October 26, 2022. 

Disability and health overview. Centers for Disease Control and Prevention. Updated September 16, 2020. Accessed October 26, 2022. 

Steele CB, Townsend JS, Courtney-Long EA, Young M. Prevalence of cancer screening among adults with disabilities, United States, 2013. 

 2017;14:160312. doi:10.5888/pcd14.160312

Edwards D J, Sakellariou D, Anstey S. Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: a mixed methods systematic review.

2020;13(1):100844. doi:10.1016/j.dhjo.2019.100844

Teaching and learning resources. Alliance for Disability in Health Care Education. Accessed October 26, 2022. 

Advancing care excellence for persons with disabilities. National League for Nursing. Accessed October 26, 2022.

Caring for people with disabilities: the nurse practitioner tool kit. Villanova University M. Louise Fitzpatrick College of Nursing. Accessed October 26, 2022. 

Kronk R, Colbert AM, Smeltzer SC, Blunt E. Development of prelicensure nursing competencies in caring for people with disabilities through Delphi methodology. 

2020;45(3):E21-E25. doi:10.1097/NNE.0000000000000712

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology; Nurse Educator45(3):E21-E25, May/June 2020.

It is imperative that nurses and other health care professionals not only recognize the disparities in preventive screenings but become part of the solution. Early detection and cancer treatment must be accessible for those with disabilities, as it can help save lives.     

Improvements in Accessibility to Cancer Screenings Are Needed for Individuals With Disabilities

Electronic health record (EHR) optimization is about to get more challenging, but there are ways for organizations to prepare. With a looming economic downturn, a labor shortage in professional services, and continued supply chain disruptions, it may feel daunting to overhaul, enhance, or implement an EHR system. Optimizing these systems is critical for creating operational efficiencies, reducing high administrative costs, and improving financial stability. Here are some ways to optimize your EHR system during a time of continued disruption.

It is important to understand the functionality and benefits of the tools your organization has already implemented but may not yet be adopted by your department or other departments. It is also crucial to know how updates or available features of your current EHR or a new system could affect overall business goals and drive value. Knowing the capabilities of an EHR system may reduce the need for a third-party system, decrease overall application and training costs, and lessen complexities for staff members working in multiple systems.

An optimized EHR system can improve workflows, catalyze queues of denials or referral responses, and improve scheduling templates to open access. Improving workflows through EHR optimization also creates an opportunity to reduce open encounters and lag charge times by enhancing clinical documentation tools and templates.

With continued labor shortages of frontline workers and back-office staff, it is more important than ever to ensure that digital solutions are integrated and implemented to reduce administrative burdens and increase provider and patient satisfaction. EHR systems can be updated with dashboards that include analytics for key metrics such as denials or provider efficiency metrics. By taking advantage of automated workflows and activities and ensuring the system provides support to both the provider organization and providers themselves, you may lessen the impact of labor shortages.

Right now, improving the patient experience is crucial across all provider organizations. Many patients are increasingly dissatisfied with their care and some may even choose to defer care altogether. Results of a recent Associated Press–NORC Center for Public Affairs Research poll showed that 8 in 10 Americans are at least moderately concerned about getting access to quality health care when they need it. Ease of access to telehealth and urgent care services and increased consumerization of health care continue to affect patient loyalty. An optimized EHR system can help enhance the patient's experience by simplifying the referral process.

Optimizing your EHR system also can boost the efficient use of the patient portal and empower patients or their caregivers to take the lead on managing care. A developed patient portal facilitates online appointment self-scheduling, allows patients to update their medical information, and offers the option to revise medications. Mature patient portals can simplify online check-in and arrival, online bill pay, and the patient’s ability to obtain their records and visit notes. An optimized EHR system and patient portal create real-time access to patient data for patients, their caregivers, and other providers in a way that was not possible before digital transformation. The ability for provider organizations and health care workers to share patient data more effectively may lead to better, more personalized treatment.

If a complete overhaul of your organization’s EHR system is out of the question, you can still make measurable, meaningful changes. Building and reestablishing relationships with patients should be top of mind for all provider organizations, so a good starting point is to optimize the patient portal. Make the most of the reports, dashboards, and other functionalities that the current EHR system offers, and use the technology you have to its fullest potential. EHR systems have the tools to generate documentation and ordering efficiencies for a high revenue-generating specialty—or you can use these tools to take a struggling specialty and improve its documentation and reporting.

The adoption and optimization of EHR systems not only have the potential to create operational efficiencies and lead to better outcomes for provider organizations, but they also may improve patient care with faster, safer, and more cost-effective decision-making. By optimizing your EHR system now, your organization will be better equipped to address future challenges in health care, the workforce, and the economy.

Julie McGuire, MSN, RN, is a managing director at The BDO Center for Healthcare Excellence & Innovation. She has more than 25 years of experience in health care and 15 years of experience collaborating with operational and clinical partners on delivering and transforming technology to new and existing facilities and services. BDO USA delivers assurance, tax, and financial advisory services to clients throughout the US and around the globe and is a member of BDO International, the world’s fifth-largest accounting network.

8 ways to get the most out of your EHR system. BDO. August 2022. Accessed October 12, 2022. 

Healthcare stability outlook report: 2022 and 2023. BDO. September 2022. Accessed October 12, 2022. 

Support for greater government role in health care for older adults. The Associated Press-NORC Center for Public Affairs Research. August 2022. Accessed October 12, 2022. 

Buying one for your practice or enhancing the one you have will help you cut costs and boost your financial stability.  

Opinion: Now Is the Time to Optimize Electronic Health Record Systems

The COVID-19 pandemic turned 2020 and then 2021 into the deadliest years in United States history.

In this time, the deaths caused by the coronavirus, an increase in deaths from heart disease and cancer, and the almost doubling of overdose fatalities has left the country living and working through unprecedented loss.

Health care professionals, and specifically those who manage the day to day care of patients such as nurses, have lived through a collective traumatic pandemic with little to no training on how to manage loss – their own, their patients’, and that of the families of their patients.

Although the pandemic has brought loss and trauma to the forefront, historically, most individuals in the United States die in hospital or nursing homes. Stanford School of medicine calculates that about 80% of all deaths happen in institutions.

By default, nurses become the first line of support for grieving family members. When engaging with a family member of a patient who has died, nurses should consider using immediate interventions aimed at supporting the loved ones who are in shock and in pain following their loss.

Given the devastating loss of the past two years, as a nurse, it is necessary to take a moment to understand and process your own experiences. When working with end of life and bereaved individuals, it is helpful to identity your own triggers, acknowledge and process your own losses, and find compassion for yourself and your experiences. Understanding yourself will allow you to better understand and support others.

Hospitals and hospice institutions have traditionally offered bereavement support through educational materials, referrals to services, individual counseling, and support groups, which typically begin weeks after the death. These services are necessary and provide a map for bereaved individuals as they move through their grief. But what happens at the moment of death? What interventions can you use to support people as they are witnessing their loved one die and immediately afterwards?

Immediate interventions at the time of loss:

1. Be present and hold the space: Although death is inevitable, most of us are not comfortable seeing, talking, or thinking about death – our own or someone else’s. To be a good support for a grieving family member, you must identify, acknowledge, and accept your own feelings. Perhaps you are feeling scared, frustrated, impatient, numb, or simply sad.Be aware of your own emotions so that you may be able to provide the emotional space needed for your patient’s grieving loved ones.

2. Emotional safety first: Always assess family and friends present. Are they able to feel and sustain the emotions they are experiencing? Are they physically able to stand and be present in the room? Do you need to offer a chair or a drink of water to those present? Should you offer psychiatric or bereavement resources?

3. Acknowledge and normalize: Regardless of how long their loved one was sick or how expected or unexpected the death is, almost everyone’s initial reaction will be shock or numbness. Your best approach is to use concrete and clear language to communicate and normalize what has happened (I am sorry that your loved one has died, I cannot imagine your feelings right now, etc). Remember, you cannot make things worse by using accurate and precise language.

4. Say no to platitudes: You can make things worse by using platitudes. Never make assumptions about people’s feelings or experiences. Even though you may believe that the death is a relief from the patient’s pain, the griever may not be ready to see it at that moment.Statements such as ‘he is in a better place’ or ‘at least she is no longer suffering,’ will not help the loved one see the loss in a different way. But such comments will make the griever feel guilty about the yearning for more time with their loved ones.

5. Always use the name of the deceased: “I am sorry Peter has died” or “I know you loved Mary very much.” Most of us wrongly believe that using the proper name will elicit painful reactions from their grieving friends and family. On the contrary, hearing the loved one’s name brings comfort.

6. Validate: Allow the person to feel exactly what they are feeling and confirm for them that that is exactly what they should be feeling. As nurses, you are trained to cure or alleviate pain. When supporting a griever, nobody can fix or take away their pain.The grieving person must experience the intense emotions that come with the death of a loved one.

7. Psychoeducation: Share with the grieving family and friends that grief is an emotional, behavioral, and a physical experience. Review with them the basic symptoms of grief.Emotionally, they might feel sadness, anger, guilty, anxiety, loneliness, etc. Physically, they might feel exhausted, unable to sleep/sleeping too much, change in eating habits, tightness in throat, shortness of breath, general distress. And their behavior is likely to change as well: forgetfulness, excessive worrying, withdrawal from normal activities.

Nursing is a profession that has always been defined by compassion, understanding, and empathy. Applying the traditional nursing skills, coupled with the immediate interventions mentioned in this article, will help the newly bereaved begin their grief journey in a supportive way.

Stobbe M. U.S. deaths in 2020 top 3 million. PBS. December 22, 2020. Accessed October 12, 2022. 

COVID-19 was third leading cause of death in the United States in both 2020 and 2021. National Institutes of Health. News release. July 5, 2022. Accessed October 12, 2022. 

Stobbe M. COVID helped make 2021 the deadliest year in U.S. history. April 12, 2022. Accessed October 12, 2022

Cavallo J. Determining the best place to die for patients with cancer. The ASCO Post. June 25, 2020. Accessed October 12, 2022. https://bit.ly/3CUdRlj

When engaging with a family member of a patient who has died, nurses should consider using immediate interventions aimed at supporting the loved ones who are in shock and in pain following their loss.

Immediate Interventions to Support The Newly Bereaved

My childhood experiences with my mother and grandmother, my family history, and my own personal experiences drove me to become a nurse, and most importantly, an 

 nurse. My passion for genetic testing comes not only from my clinical background, but also my personal experience. My sister Copelan and I pursued genetic testing after watching our mother and grandmother battle breast cancer. We both tested positive for the 

genetic mutation, putting us at a significantly increased risk for developing breast cancer and ovarian cancer at a young age.

genes produce proteins that repair damaged DNA—but when mutated, some variants increase the risk of developing cancer. After finding out we were carriers of this mutation, Copelan and I decided to act. She underwent a risk-reducing double mastectomy at 21 years old, and I did the same 3 years later when I turned 20 years old.

 carriers will develop breast cancer in their lifetime. In men, this rate is 1% to 5% and 5% to 10% for 

, respectively. During my 2 years in oncology nursing, I have met many patients who, like me, tested positive for a 

 variant. I try to share my story with patients, when appropriate, because it creates an immediate connection between us. From my perspective, this enhances the patient care experience and sparks their interest in learning more about genetic testing.

Some patients are unsure if they are candidates, and some—even if they have tested positive—are not always well-informed on the subject. I try to surface the subject, especially with patients who are 

, often known as a “breast cancer gene,” can be passed down from 

parent—it is not exclusive to female family members. I urge patients to familiarize themselves with their family history and, if they feel the need, to talk with their primary care physician about the possibilities of genetic testing. If a patient tests positive, I further encourage them to educate their children and grandchildren so they can take proper precautions and begin early surveillance of the breast and ovaries, and eventually have genetic testing done themselves. The hope is these preventive measures reduce their risk for cancer.

I feel incredibly fortunate I learned of this mutation at a young age and took the steps that were right for me, hopefully allowing our family to reduce the risk of cancer in future generations. I have served patients who were simply unaware of their genetic mutation and, if they had known sooner, may have been able to change course. This reality fuels my pursuit, as an oncology nurse, to spread awareness, knowledge and empowerment about genetic testing and help others take more control of their health.

During Breast Cancer Awareness Month and beyond, I encourage nurses to lean into conversation with patients about family history and genetic testing. As cornerstones of care and compassion, we may very well be the difference-makers in their journey.

Information for carriers of BRCA1 and BRCA2 gene mutations. Penn Medicine Abramson Cancer Center. Accessed October 20, 2022. 

Liz-Hunter Brack, RN, discusses how oncology nurses can play an important role in patient education surrounding genetic testing. 

Opinion: Nurses Need to Start Conversations About Genetic Testing

In the middle of Breast Cancer Awareness month, First Lady Jill Biden visited Miami, Florida, where I am based, to spotlight President Biden’s Cancer Moonshot initiative, which is designed to combat and end cancer. Biden and US Senator Debbie Wasserman Schulz, who is a breast cancer survivor, visited Sylvester Comprehensive Cancer Center for an event to spotlight the Moonshot initiative, Breast Cancer Awareness Month, and National Mammography week.

This month has been a revelation in terms of breast cancer awareness. Katie Couric, noted broadcast journalist, has once again shone the spotlight on a potentially lethal cancer. The University of Michigan coined the term “the Couric Effect” in the year 2000 when she advocated for colonoscopy screening after her husband from colon cancer in his 40s.

 There was a national jump in colonoscopy screening rates that year by approximately 20%. The same phenomena may be in the process of happening again.

Couric was in the middle of filming her 3D mammogram and ultrasound when her physician spotted a suspicious area. The camera was turned off. Katie found out that she needed a biopsy and then was given the diagnosis of stage IA HER2-negative breast cancer. She had a lumpectomy and 15 radiation therapy treatments this past summer. She received her diagnosis on June 21; on July 14 she had surgery, and on September 7, she began her first of 15 sessions of radiotion. Couric has shared that for the next 5 years she will be taking an oral aromataste inhibitor in order to decrease her estrogen level.

In addition to sharing various detrails about her diagnosis and treatment plan, Couric has also shared that she has dense breasts and that her diagnosis required a breast ultrasound. On TV, she has stressed the importance of this 2-step process. During an appearance at the TODAY show where she was a co-anchor for many years, Couric noted that only 70% of women who meet criteria for breast cancer screening complete this important step. The COVID-19 pandemic had an impact on women going for screening as well. Couric herself did not go for these annual tests since December 2020. In her personal blog, she wrote that the pandemic may have skewed her sense of time.

In addition to advocating for annual mammograms, Couric is educating the public about dense breasts and the importance of ultrasounds. Approximately 40% to 50% of women between the ages of 40 years to 74 years have dense breasts.

 Couric, at 65, also falls into this category.4 Patients with dense breasts may be at increased risk of developing breast cancer and it is recommended that they get routine mammaorgrams similar to other individuals. However, women with dense breasts may also benefit or a 3D mmammogram, or an ultrasound, as these screening devices may be able to better detect tumors in this population. There is also a new modality called SoftVue, which is a new form of ultrasound. It has received FDA approval and, when coupled with mammography, increases detection accuracy by approximately 20%.

Currently, 38 states, including Florida, New York, California, and New Jersey, as well as the District of Columbia have a requirement for “some level of breast density notification after a mammogram.”

 A federal national standard for reporting dense breast findings to women does not exist at the present time. Since 2019, there have been efforts for legislation on a federal level. In addition, the FDA has been trying to push for a standard covering reporting these findings.

I personally believe that there is a benefit to additional screenings for this patient population. I hope standard guidelines emerge in the coming years, and I believe that Katie Couric’s advocacy may be the incentive needed to get us there.

Last call for 10.11.22-A prime-time read of what's going down in Florida politics. Florida Politics. October 11, 2022.October 14, 2022. https://bit.ly/3EQ0AeS

Berman M. Katie Couric's Breast Cancer. MEDPAGE today. October 6, 2022. Accessed October 12, 2022. 

Weisholtz, D. TODAY. Exclusive; Katie Couric on telling daughters she has breast cancer: 'Hard to deliver that news'. October 3, 2022. Accessed October 12, 2022. https://on.today.com/3MOpyx1

Uda, R. Do you have dense breasts? Here's how to find out-and what to know about the cancer risks. Katie Couric Media. October 14, 2022. October 11, 2022. https://bit.ly/3So4ezS

State legislation map. Dense Breast Info. Accessed October 13, 2022. 

Katie Couric is educating the public about the importance of ultrasounds for women with dense breasts.

Opinion: The Couric Effect May Be Just What the Breast Cancer Community Needs

Over the past few decades, the number of advanced practice providers (APPs) in oncology has increased dramatically and the role they play expanded greatly. One reason for this is that there are more patients who need oncologists in the US than there are physicians practicing the specialty. According to the American Society of Clinical Oncology, the nation will see a shortage of more than 2200 oncologists by 2025 and an increase of 40% in demand for cancer treatment during the next 6 years.

 This growth in demand is driven not only by new patients, but by those who have completed active treatment and require follow-up care. Thanks to advanced therapies, better outcomes are being achieved and survival rates are improving. Cancer survivors—even with complex comorbidities—are living longer than ever before.

Survivorship care can readily be performed by APPs, given their wide breadth of expertise and training. A closer look at how these highly skilled professionals deliver survivorship care will provide some insight into why they areideally suited to lead these programs, meeting a critical need that will only grow in the future.

In many practices, APPs are the backbone of survivorship programs, playing a key role in their planning and execution. They are well suited to lead these programs because of their extensive education, training, and scope of practice.

They also develop strong relationships with patients and caregivers during active treatment. As trusted members of the care team, it makes sense for them to discuss the key elements of survivorship with patients, some of which—like lifestyle changes and advance care planning—can be difficult to talk about.

Many patients are under the misconception that survivorship doesn’t begin until they have finished active treatment. According to the National Cancer Institute, however, a patient is considered to be a survivor from the time of diagnosis until the end of life.

APPs can help patients understand that survivorship encompasses everything from diagnosis onward—be they undergoing treatment, in remission, or facing recurrence.

A Critical Role at All Stages of Survivorship

APPs make valuable contributions at all stages of the survivorship journey.

They manage patients during active treatment, helping them keep side effects under control so that they can adhere to treatment. They educate patients about what to look for so that side effects can be caught early and dealt with more easily. They support the psychological well-being of patients by addressing their expectations and fears. They talk with patients early on about the emotional impact of the diagnosis, teach them stress-coping skills, and refer them to mental health professionals if and when necessary.

Once active treatment ends, the focus shifts to long-term surveillance. Patients may not be cured but they may be in remission, so ongoing follow-up care is critical, from a clinical and psychological standpoint.

By this stage, a long-term care plan has been developed that spells out exactly what treatment has been given and what follow-up care is needed and when. It details intervals between office visits and the imaging, lab tests, and other surveillance that may be needed. It also includes information that helps patients and their care team recognize signs of recurrence, the emergence of a secondary cancer, and potential long-term side effects like cardiotoxicity.

The transition away from active treatment is always stressful for patients because they must adjust to many changes, including less frequent office visits, which may make them feel as if they lack support. APPs play an important role at this stage, as by now they have a good relationship with patients and their caregivers. They can thus communicate effectively about such sensitive topics as patient emotions, lifestyle changes, and advance care planning. APPs are able to recognize signs of distress during this transition and provide appropriate assistance, whether that be by getting patients into support groups, referring them to mental health professionals, or prescribing medication.

Once active treatment concludes, patients may transition to receiving most of their care from a primary care physician. A detailed survivorship plan makes the PCP intimately familiar with a patient’s condition and needs. And APPs are always available to offer advice about mutual patients.

There is always a concern that the patient may not adhere to a survivorship plan. Because they interact less frequently with the oncology care team, they may lose motivation. APPs must make sure patients understand not only the plan but the need for them to become more responsible for their own health.

This is also a time when APPs are very vigilant about checking for anxiety and depression so that they can catch the conditions before they get out of control. Primary care providers can also be brought into the discussion and intervene if need be.

A survivorship plan is key to providing high-quality, patient-centered care. It must be developed early on to ensure the best patient experience and quality of life. APPs are ideally situated to manage or lead cancer survivorship because of the close relationship they establish with patients and their caregivers. Practices also benefit from such work because it allows physicians to focus on other priorities. Integrating APPs into survivorship care is a trend that will only grow in the future owing to the tremendous benefits it offers to the practice and its patients.

Finnegan J. Another physician shortage: oncologists.Fierce Healthcare

https://www.fiercehealthcare.com/practices/another-physician-shortage-oncologists

Survivor. NCI Dictionary of Cancer Terms. National Cancer Institute. Accessed July 13, 2022. 

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivor

Advanced practice providers are the future of survivorship care because of the tremendous value they offer to the practice and its patients. 

Advanced Practice Providers Are Uniquely Suited for Survivorship Care

According to the American Association of Nurse Practitioners, over 36,000 new nurse practitioners (NPs) completed academic programs between 2019 and 2020, and licensed NPs reportedly increased from 325,000 in 2021 to 355,000 in 2022.

As the number of new graduates continues to rise, so will the need for preceptorship, especially in specialties such as oncology.

Preceptors help novices navigate their new role as health care providers, coaching them on such core competencies as diagnostic reasoning, clinical judgment, and critical thinking skills.

 The transition from student to NP can be very difficult, and thus the importance of highly experienced preceptors, particularly in oncology, cannot be overemphasized.

To provide care to oncology patients, NPs need highly specialized training and education, which they usually receive during postgraduate fellowships.

The preceptors’ primary goal is to help the novice bridge educational gaps and advance from entry-level competence to high-level proficiency.

They share knowledge and clinical skills, facilitate experiential learning scenarios, and encourage the development of social, critical thinking, and clinical judgment skills. Preceptors provide this for the novice NP while simultaneously providing safe, high-quality, and holistic care to patients.

Although preceptors are considered to be experts, they still need guidance themselves. According to Pleshkan et al,

 a structured preceptorship improves the process of training a novice NP. Preceptors share their knowledge with the NPs and teach them effective ways to analyze their clinical decisions and manage their workload.

Preceptors must employ the teaching strategies that are best suited to each learner’s style

 and assess the preceptees’ depth of knowledge and level of clinical expertise to facilitate a positive experience.

 In addition, an open dialogue between preceptor and novice gives both the opportunity to become acquainted with one another, clarify goals and expectations, and give/receive constructive feedback. Open dialogue has also been shown to be an effective way to build the preceptor-preceptee relationship and create mutual respect and trust as well as a positive learning environment.

Emotional Support and the Preceptorship Experience

Transitioning from new graduate to proficient NP in any specialty takes time and determination as the process can be intimidating and, at times, anxiety-inducing.

 However, having a guide who has been through the same process can make the transition a healthy and pleasant experience.5 Preceptors ensure the competence of novices. From them novices learn to provide safe, cost-effective care to patients with complex diseases.

What may at first seem like a daunting journey becomes less so thanks to the preceptor’s ongoing reassurance. Preceptors are like personal coaches: they teach learners what to do and offer emotional support throughout.

As I transition from an experienced RN to a novice oncology NP, I see that preceptors have been a critical part of my personal and professional growth. Although most preceptorships are short and not all encounters are positive, many of the connections are genuine. Several of my past preceptors have become lifelong friends and continue to be mentors of mine. Because of their willingness to share their knowledge and clinical expertise, I am confident that when my turn comes, I will be able to pass on what they taught me (plus some tips and tricks of my own) to the next generation.

Novice oncology NPs require a great deal of support as they transition to their new role.

 A structured preceptorship that caters specifically to them promotes a safe environment that is conducive to learning, builds competence, confidence, and job satisfaction and encourages intra- and interdisciplinary collaboration.

 To novice oncology NPs starting their journey in clinical practice, I say that to succeed, you must pay attention, ask questions, and maintain a flexible and positive attitude.

1. NP fact sheet. American Association of Nurse Practitioners. Updated April 2022. Accessed July 15, 2022. https://www.aanp.org/about/all-about-nps/np-fact-sheet

2. Pleshkan V, Boykins AD. Cognitive preceptorship: an emerging nurse practitioner role transition to practice model. 

.2022;39:194-205. doi:10.1016/j.profnurs.2022.02.002

3. Pleshkan V, Hussey, L. Nurse practitioners’ experience with role transition: supporting the learning curve through preceptorship. 

4. Bazzell AF, Jones T, Dains JE, Champion JD. Assessing the needs of oncology APRN preceptors. 

5. Pirschel C. Competencies create expert, accountable nurses delivering quality care. 

.April 3, 2017. Accessed July 15, 2022. https://voice.ons.org/news-and-views/core-competencies-of-oncology-nurses

6. Alencar M, Butler E, MacIntyre J, Wempe EP. Nurse practitioner fellowship: developing a program to address gaps in practice. 

7. Pearson T, Hensley T. Positive precepting: identifying NP student learning levels and needs. 

8. Thomassen A. Fellowship programs: reflections of an advanced practice nurse fellow. 

9. Kelly DE. Initiation of a new nurse preceptor program in the era of COVID-19. 

10. Bazzell AF, Dains JE. Supporting nurse practitioner preceptor development. 

Structured preceptorships promote competence, confidence, and job satisfaction in new oncology nurse practitioners. 

Supporting the Novice Oncology NP: The Benefits of Preceptorship

October is Breast Cancer Awareness month. This disease is relentless and again back in the news. This past week, TV journalist Katie Couric, revealed she had received a diagnosis of breast cancer in June. Couric, age 65, has been treated with radiation and a lumpectomy. She had her mammogram taped in real time to raise awareness about screening just as she had done to raise awareness with her colonoscopyafter her first husband died from colon cancer in his forties.

Breast cancer awareness has been in the media spotlight for many years now. At hospitals across the country, RNs and social workers wear pink to raise awareness of this cause. Branding is powerful. AIDS related causes use red, and organ donation goes with green. I was curious as to why breast cancer related causes had a pink theme. As ironic as it seems, this was not a Madison Avenue campaign from New York.

This was the brainchild of Charlotte Haley from Simi Valley California in 1991. Charlotte Haley was not in the public relations business. Her goal was to simply create some attention around breast cancer. At age 68, 3 of her close family members had gone through the battle with breast cancer. She began raising awareness in the grocery store by handing out postcards with 5 peach ribbons. Interestingly, by many accounts, peach was the first color recognized for breast cancer awareness. Peach eventually evolved into pink.

The postcards that Charlotte Haley handed out explained that only 5% of the National Cancer Institute’s annual budget out of $1.8 billion was earmarked to prevent cancer in general.

 The ribbon was supposed to create attention and it did; both through word-of-mouth and though catching the attention of major newspapers. Before Instagram, Tik Tok, and brand influencers, newspapers created a firestorm around causes. As Haley was handing out ribbons in 1991, by 1992, the 

 had dubbed the year as “The Year of the Ribbon,” on account of other ribbons gaining attention, such as the yellow ribbons associated with the First Gulf War in 1991 and the red AIDs awareness ribbons from that same year.

However, the grassroots efforts of Haley gained national attention once Alexandra Penney, 

magazine editor and Estee Lauder of the cosmetics firm, became involved. Penney wanted to use Haley’s ribbons as part of her second annual “Breast Cancer Awareness Issue.” Haley was uninterested, she felt they were too corporate and commercialized. However, Penney’s legal counsel advised her that if they changed the ribbon to a different color, they did not need Haley’s permission. Breast cancer ribbons were born. The peach color was left behind.

Coincidentally, the Susan G. Komen for the Cure® Foundation has been affiliated with the color pink since its start in 1982, although they did not begin handing out pink ribbons until 1991. From the mid-1980s to the early 1990s, their brand design used a pink ribbon with a woman running. Since 1990, pink was the color used to identify breast cancer survivors. When women ran in the Komen Race for the Cure in New York, pink ribbons were given to all runners and disease survivors alike. Again, Alexandra Penney of 

wanted to get involved. Unlike Haley, the Susan G. Komen for the Cure® Foundation was interested in working with Penney. The result was a pink ribbon which Penney enlisted cosmetic companies to distribute throughout New York City stores.

Now, just like a stop sign is universally red, breast cancer awareness is universally pink. And although any generic pink ribbon can be used to represent breast cancer awareness, the Komen “running ribbon” is reserved solely for use by Susan G. Komen for the Cure®, the name the foundation officially adopted in 2007.

They also decided to create a new brand recognition item, that is, a new pink “running ribbon.”

As I read about Katie Couric, I wondered how many oncology nurses had heard of Charlotte Haley. I hope nurses in all specialties will honor her work and pay tribute to Couric’s advocacy by educating their patients about breast cancer risk and emphasizing the importance of early detection.

France Respers, L.Katie Couric reveals she was diagnosed with breast cancer. CNN. September 28, 2022. Accessed October 1, 2022. https://cnn.it/3CzhJId

Waxman, O. Wearing a pink ribbon for breast cancer awareness? Here’s how awareness ribbons became a thing. 

. October 1, 2018. Accessed October 1, 2022. https://bit.ly/3Cwgn0P

In memoriam: Charlotte Haley, creator of the first (peach) breast cancer ribbon. Breast Cancer Action Website. Accessed October 1, 2022. 

The pink ribbon story. Susan G. Komen for the Cure. Accessed October 1, 2022. 

By certain accounts, the breast cancer awareness ribbon was actually peach before it was pink. 

Opinion: Oncology Nurses Should Know the History of the Pink Breast Cancer Awareness Ribbon

Florida’s First Lady, Casey DeSantis has used her role as a breast cancer survivor to advocate for new funding for the state. This started in December 2021, when the First Lady spearheaded a $100 million proposal for cancer treatment as well as research.

DeSantis is now cancer free since March 2022 after undergoing lifesaving surgery and radiation therapy.

I find that I am interested in Florida’s new program, called Florida Cancer Connect.

Debi Fischer, MSW, BSN, BA, LCSW, RN, discusses the launch of the Florida Cancer Connect program and what this initiative represents for patients across the United States. 

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