With the rapidly increasing use of immunotherapy in the treatment of some cancers, oncology nurses need to be comfortable and knowledgeable in administering immunotherapeutic treatments and assessing patients for immune-related adverse events. In this interview with i3 Health, Keri Mahoney, JD, RN, CPHRM, discusses her immunotherapy educational intervention for nurses, which she presented in a poster at the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California.
What was the problem that you investigated?
Keri Mahoney, JD, RN, CPHRM: The problem I investigated was the need for oncology nurses to have a better understanding of the new immunotherapies that were coming out, specifically checkpoint inhibition with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1).
What was your approach?
Ms. Mahoney: I started doing the research because I was interested in learning about it myself. I did a lot of research online. I found some articles. I spoke to the pharmacists that I work with to get some help in the broader classification of things. I spoke to a lot of the oncologists that I work with. Then, as I gathered knowledge, I put it together in a presentation format for the nurses.
What were the results of your research?
Ms. Mahoney: The results were really good. Our goal was to increase the nurses' subjective comfort level in how they administer these drugs, as well as increasing their objective level of knowledge of what the drugs are and how they work. We gave them a pretest to see what their baseline was before any intervention, then we gave them access to our specially designed educational materials, and then we gave them a posttest to see how their knowledge had changed. With that, we saw that their overall knowledge and comfort level in administering the drugs increased significantly.
What did the educational materials focus on?
Ms. Mahoney: The educational materials focused on three main things. First, they focused on the mechanism of action of the drugs. We made it visual as well as auditory to give the nurses multiple ways to learn.
Second, we talked about grading adverse events, and again we tried to take a broad approach. We taught the nurses a little bit about using the Common Terminology Criteria for Adverse Events (CTCAE) to help them have an objective way of grading adverse events that they might not be used to seeing. Interestingly, we noticed that although the nurses' knowledge and comfort increased overall after the educational intervention, the nurses struggled more in this specific subcategory on the posttest than on the pretest. With that in mind, we revisited the materials we had generated and noticed some areas that needed clarification. For that reason, we are working on a second version of the materials before we roll them out more broadly. This shows the importance of evaluating the efficacy of any quality project, not only in terms of its general goals, but also within each subsection of the project.
Finally, we talked about some special considerations like the use of steroids and how they might be used to treat severe side effects from immunotherapy, but to also be mindful that steroids have the potential to interfere with the efficacy of the drug. This is something that a lot of nurses might not have known before the presentation.
What is the key take-home message for nurses?
Ms. Mahoney: The key take-home message for nurses is to be mindful of what you're doing. Before we did this research, if we asked the nurses, "What do you know about nivolumab or any of these immunotherapies?" they certainly would have been very familiar with how to safely infuse the drugs, but maybe would not have been thinking about some of the bigger picture items. It's important for us all to be mindful in our practice, especially as so many new drugs come on the market, to consider why we do what we do. All of us can improve our practice by doing that.
About Ms. Mahoney
Keri Mahoney, JD, RN, CPHRM, is a nurse and an attorney who practices both professions in Suffolk County, New York. Ms. Mahoney has focused her nursing career exclusively in oncology and has practiced in outpatient medical oncology at Stony Brook Cancer Center for the past 12 years. Ms. Mahoney feels particularly passionate about promoting patient safety. To that end, she frequently involves herself in educational and other initiatives throughout her unit in order to promote the best outcomes for her patients and her colleagues alike. Ms. Mahoney appreciates the support of her organization, Stony Brook University Medical Center, as well as her co-author, Michele DeGraw, NP, in helping her to complete this project.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.