title: Perceived factors influencing nurses' use of evidence-informed protocols for remote cancer treatment-related symptom management: A mixed methods study.
abstract: OBJECTIVE
  To assess factors perceived to influence nurses' use of symptom protocols when providing remote management for oncology patients.
  
  
  METHODS
  A mixed methods descriptive study was guided by the Knowledge-to-Action Framework. In 2013, 8 focus groups and 7 interviews were conducted with 49 nurses or patients/family members in three ambulatory oncology programs within different provincial healthcare systems. Role-play with a protocol was used during nurse focus groups/interviews. Nurses who provided remote symptom support received a survey. Data was triangulated using thematic analysis guided by the Ottawa Model of Research Use.
  
  
  RESULTS
  Over 90% of nurses provide telephone support during regular hours only. These symptom protocols were being used by 14% of nurses at one program. Nurses rated the protocols positively for content and format (>85%) but 20% indicated too complex. Protocol facilitators were systematic approach, comprehensive, and evidence-based. Protocol barriers were too long, not for symptom clusters, and inadequate space for documenting. To facilitate use, nurses need to enhance their knowledge (73%) and skills (58%), get access to resources, and obtain performance feedback. Nurse barriers included the learning curve, being unaware of protocols, and feeling tied to a script. Organizational barriers were communication challenges with patients, lack of electronic charting, and no clear direction to use them (54%).
  
  
  CONCLUSIONS
  Several barriers and facilitators were perceived to influence the use of symptom protocols. Nurses and patients/family members identified similar factors. Interventions are needed to overcome barriers to nurses using the protocols such as education, clear organizational mandate, and integration with documentation.
authors.affiliation: School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: dstacey@uottawa.ca.
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.affiliation: Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: meg.carley@queensu.ca.
authors.forename: Meg
authors.initials: M
authors.lastname: Carley
authors.affiliation: Northeast Cancer Center, Health Sciences North, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1, Canada. Electronic address: bballantyne@hsnsudbury.ca.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ballantyne
authors.affiliation: Cancer Care Mission, McGill University Health Centre Research Institute, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada. Electronic address: mskathome@gmail.com.
authors.forename: Myriam
authors.initials: M
authors.lastname: Skrutkowski
authors.affiliation: Capital Health, 1276 South Park Street, Victoria Building, Halifax, NS B3H 2Y9, Canada. Electronic address: angela.whynot@cdha.nshealth.ca.
authors.forename: Angela
authors.initials: A
authors.lastname: Whynot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003142:Communication; D055318:Evidence-Based Nursing / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D009859:Oncology Nursing / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D017216:Telemedicine / Q000592:standards*; D013689:Telephone
keywords: Cancer; Clinical practice guidelines; Implementation; Nurse; Symptom management