Theses and Dissertations at Montana State University (MSU)

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Improvement of cervical cancer screening in a rural primary care setting: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2024) Kelleher, Katie Carla; Chairperson, Graduate Committee: Amanda H. Lucas; This is a manuscript style paper that includes co-authored chapters.
Background: Cervical cancer (CC) is the fourth most diagnosed cancer among women. Cervical cancer screening (CCS) is a vital component of routine health care, as any individual with a cervix is at risk of developing cervical cancer, and nearly all diagnoses of aggressive cervical cancer are directly associated with a lack of screening, underscreening or inadequate follow-up of abnormal results. Unfortunately, the number of women overdue for CCS continues to increase gradually nationally and in Montana. Local Problem: At a rural primary healthcare clinic in northwestern Montana, 37.0% of patients have a current CCS completion documented, compared to Healthy People's 2030 benchmark of 84.3%. Methods: Participants included female patients ages 21-65 who presented to the clinical for an annual exam. Using the Plan-Do-Study-Act cycle, the intervention outcomes were measured biweekly throughout the six-week initiative. Measures assessed included: Adequate CCS eligibility determination, proper CCS documentation with the EHR, and the overall site CCS completion percentage. Data was collected over six weeks, de-identified, and analyzed using percentages and bar graphs. Interventions: Literature supported a multifactorial approach to standardize workflows and documentation practices among the nurses and medical assistants (MA) through the provision of educational material and a CCS clinical decision tree. Key process changes included offering of same-day CCS screening, follow-up scheduling prior to the patient leaving, and EHR alert creation if patient records were requested. Results: A total of 30 patients presented to the clinic. 100% of patients who presented to the clinic were assessed for CCS eligibility. 100% of eligible patients were offered CCS. 84.6% of patients had correct CCS documentation by the staff within the EHR, with four patients lacking proper documentation. A 4.1% increase was seen in the overall facility CCS completion percentage, reaching a total CCS completion percentage of 41.1%. Conclusions: Implementing education, standardized workflows, and the use of the CCS clinical decision tree improved CCS documentation and completion rates.
Decreased time-to-treatment delay through clinical guideline implementation for image-guided image biopsies in cancer diagnosis
(Montana State University - Bozeman, College of Nursing, 2024) O'Dell, Meghan Marie; Chairperson, Graduate Committee: Molly Secor; This is a manuscript style paper that includes co-authored chapters.
Background: International guidelines have been established defining the ideal period from referral to diagnosis of malignancy as two weeks. Increased time-to-treatment initiation is associated with a one to three percent increased mortality risk for each week of delayed treatment. Image-guided biopsy has emerged as a transformative tool in cancer diagnosis, impacting the rapid identification and treatment of malignancy. Clinical Problem: A rurally based oncology institute associated with a larger non-profit healthcare system in Montana identified concerns with extended time-to-treatment initiation related to delayed image-guided biopsy. The average wait time for image-guided biopsy was sixty-seven days. Methods: Utilizing the Replicating Effective Programs (REP) Implementation framework, an evidence-based clinical practice guideline was developed to define optimal referral-to-diagnosis timeframe for diagnosis or rule-out of malignancy via image-guided biopsy using the second edition of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Interventions: A guideline advisory committee including individuals from relevant professional groups was recruited to act as expert appraisers. Four-phase appraisal of the clinical practice guideline using the AGREE II tool took place over six weeks. The guideline was rated for overall quality based on a seven-point rating scale and appraisers were asked if they would recommend the guideline for use in the target facility. Results: The guideline received an average rating of 6.2 and was recommended for use by 100% of appraisers, with 18% recommending modifications during pre-implementation. During implementation, the guideline received an average rating of 6.7 and was recommended for use by 100 % of appraisers. The final guideline and appraisal data were presented to health system leadership and the guideline was successfully adopted into facility policy. Conclusion: Quality improvement initiatives will need to be implemented to identify and address systems-based complexities that could pose barriers to meeting the goal timeframe as defined by the guideline.
Early integration of palliative care in patients with terminal cancer prognosis
(Montana State University - Bozeman, College of Nursing, 2024) Martin, Jamie Jo; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.
Cancer ranks as the second leading cause of death in the United States, with a significant portion of patients facing terminal diagnoses and symptom burdens. Despite advancement in cancer treatments, early integration of palliative care remains a challenge, often resulting in delayed referrals and unmet patient needs. This quality improvement initiative focuses on screening all new oncology patients using a distress thermometer tool to identify those suitable for early palliative care involvement. A standardized process is implemented to offer referrals to palliative care services for patients with terminal diagnoses and positive screening results Over a six-week data collection period, 88 new oncology consult appointments were made, with 25% identified as appropriate for palliative care referral. The distress screening tool was completed by an average of 93.3% of patients. Of those appropriate for palliative care, 72.9% were offered a referral, and 43.9% were referred to palliative care. Notably, 100% of referred patients received an initial consult with palliative care within the project timeframe, exceeding the set goals. Early integration of palliative care for terminal cancer patients is crucial for improving quality of life and reducing symptom burden. Standardized screening tools and referral process can facilitate early involvement, although barriers such as patient refusal and provider hesitancy still exist. Effective multidisciplinary communication and patient education are key components in ensuring successful early palliative care integration. Continued efforts in screening, referral, and education are recommended to address these barriers and enhance the quality of care for patients facing terminal cancer diagnoses.
Improving new patient cancer treatment education: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2024) Wilcox, Jamie Michelle; Chairperson, Graduate Committee: Elizabeth A. Johnson
Background: A cancer diagnosis invokes high levels of uncertainty and anxiety. Healthcare professionals task themselves with providing appropriate education to help patients traverse their cancer treatment experience. Effective communication and educational interventions help patients acquire appropriate coping strategies to manage the disease process and reduce uncertainty. Purpose: This project aimed to improve patient satisfaction and decrease anxiety and uncertainty through an enhanced patient education process. The project took place in a rural outpatient oncology center. Participants included newly diagnosed oncology patients receiving intravenous (IV) chemotherapy/immunotherapy and clinic staff. Method: This project used the Demming Cycle quality improvement method. The education components drew on the guidance of literature reviewed for best practices and national guidelines for patient education and teaching techniques. Data obtained through surveys from patients and RNs, observations from the project lead, and additional feedback from staff informed the development of the education visit components. Intervention: A nurse education visit was scheduled the week before IV treatment started and included a learning needs assessment, clinic tour, education on port-a-cath care, regimen-specific side effects and self-management, and how and when to contact the healthcare team. Nurses provided content using the teach-back method. Results: Patient and staff completed surveys over six weeks of implementation. Sixteen patients completed surveys. 100% (n=16) were confident they could manage their symptoms at home after the education visit. Thematic findings from survey responses regarding the most valuable education piece included Theme 1, logistics of treatment; Theme 2, anticipated side effects and management; Theme 3, other value of knowledge and education regarding managing the disease process. Nine nurses were surveyed 17 times during the project, with each nurse completing 1 to 2 education sessions. 88% (n=17) of nurses surveyed felt the education visit improved from the previous system, and 71% (n=17) of nurses found the teach-back method was supportive of patient outcomes surrounding patient education. Conclusion: Providing a structured education visit for new oncology patients receiving chemotherapy/immunotherapy improved patient confidence in identifying and managing symptoms and side effects of therapy at home. The teach-back method reinforced the education content and demonstrated an understanding of the material.
Tobacco cessation: a quality improvement project in an ear, nose, and throat clinic
(Montana State University - Bozeman, College of Nursing, 2023) Myers, Cierra Nicole; Chairperson, Graduate Committee: Amanda H. Lucas; Lindsay Benes (co-chair)
Background: Due to the correlation of head and neck cancers with tobacco use, tobacco cessation conversations are crucial. Healthcare professionals play a vital role in consistently identifying and documenting the smoking status of their patients. Problem Statement: While the clinic nurses at one Montana ear, nose, and throat (ENT) clinic are aware of the cancer risks involved with tobacco use, they were not screening 100% of their patients or providing tobacco users with educational materials to assist in cessation. Methods: During a six-week project, the Replicating Effective Programs (REP) quality improvement model was used. Data was evaluated using descriptive statistics. Interventions: Three nursing interventions were initiated: new ENT adult patients were screened for tobacco use (intervention 1), tobacco users were offered a Montana Quitline educational brochure (intervention 2) and referral (intervention 3). Results: The screening rate increased from 63% during the pre-implementation phase to 100% during the fourth week of the implementation phase. During the implementation phase, 16% of the tobacco users identified were agreeable to a Montana Quitline brochure and 5% were agreeable to a referral to the Montana Quitline. Conclusion: The project did increase nurses' rates of tobacco screening. However, the implications of time constraint on the nurses and a patient's readiness to quit proved to minimally impact the accepted number of brochures and referrals.
Increasing oncology patient engagement in treatment decisions: a CNL driven educational approach
(Montana State University - Bozeman, College of Nursing, 2022) Northrop, Kayla Marie; Chairperson, Graduate Committee: Denise Rivera
Cancer is the second leading cause of death in Montana affecting 40% of men and 38% of women (MCTR, 2019). In the state of Montana Cancer is attributed to 452 new cancer cases per every 100,000 people, or one in every four persons (MCTR, 2019). Current best practice treatment options for cancer include chemotherapy and biosimilar medications of chemotherapy also known as Biologicals. Biosimilar medication is a product that contains a similar but not identical, version of an active compound of that of the originator medication authorized by the FDA for treatment of cancer (Edwards and Bellinvia, 2020). A literature review was conducted containing fifteen journal articles that included: four systemic reviews, a randomized double-blind study, two observational studies, and one retrospective study. When evaluating the information gathered, it was clear that due to the recent development and lack of public knowledge of biosimilars there is missing and unknown information. The missing information could alter the education needed and topics patients may want to know in an educational program. The plan for this quality improvement project is to create an educational program for biosimilars in oncology offices for providers to use with patients that may need to switch to a biosimilar in their treatment plan and allow for increase patient outcome and safety.
The clinical nurse leader role in accreditation of a rural stem cell transplant center
(Montana State University - Bozeman, College of Nursing, 2021) Huleatt-Baer, Rachel Erin; Chairperson, Graduate Committee: Denise Rivera
In 2020 the National Cancer Institute's annual estimation of newly diagnosed cancer cases was reported at 1,806,590, with 606,520 people expected to die from cancer during the year. In 2017, cancer was the second leading cause of death in the United States. Autologous hematopoietic stem cell transplant is an intervention used to manage and cure hematologic malignancies, extend life, and improve quality of life. A microsystem assessment was completed for a rural stem cell transplant center located in the western United States to better understand factors associated with deficiencies cited during accreditation renewal process. A Clinical Nurse Leader, certified in oncology nursing, is uniquely positioned to act as an expert clinician within the stem cell transplant center and support attainment of accreditation renewal. Eight accreditation priorities were identified through the microsystem assessment that fall within the expertise of the Clinical Nurse Leader. A color-coded scorecard was investigated, and a draft tool was adapted to link CNL competencies with accreditation standards and deficiencies. The proposed scorecard will help monitor client-based improvement measures and guide accreditation success.
Assessment of an educational binder for newly diagnosed oncology patients
(Montana State University - Bozeman, College of Nursing, 2020) Woloszyn, Sarah Christine; Chairperson, Graduate Committee: Angela Jukkala
Newly diagnosed oncology patients have many complex educational needs. These needs can be affected by stress, age, health literacy, and culture/ethnicity. It is important to take these factors into account when developing and evaluating patient health information. It is imperative that oncology patients are provided with quality health information to ensure that they are able to participate in shared decision making, thereby improving their outcomes. A new patient binder has been developed for patients seeking cancer care at the Benefis Sletten Cancer Institute. It is important that this educational tool be evaluated for readability, understandability, and actionability. The Patient Education Material Assessment Tool and the Flesch Reading Ease formula are two proven methods to evaluate patient health information. These tools will be used to evaluate the newly developed patient binder at the Sletten Cancer Institute. The results of the evaluation will be shared with the developers of the educational tool and leadership team. The continual evaluation of patient health information materials is essential to ensure that patients are receiving information that will meet their needs. The Clinical Nurse Leader can play an important role by acting as an educator, patient advocate, team leader, and expert clinician to ensure patients are receiving high quality patient health information.
Improving survivorship care at a community cancer center: a program evaluation
(Montana State University - Bozeman, College of Nursing, 2020) Bowen, Melissa Raelene; Chairperson, Graduate Committee: Jennifer Sofie
Survivorship care is an opportunity to prepare cancer survivors for living a life impacted by cancer. The physical, psychological, and spiritual effects of cancer goes beyond the days or hours patients have spent receiving treatment. Over a decade ago, the Institute of Medicine created the survivorship care plan (SCP) as a solution for improving care for cancer survivors. The Commission on Cancer (CoC) since adopted the SCP as an accreditation standard which requires SCP delivery to at least 50% of eligible survivors. However, the implementation of SCPs has been challenging as the evidence supporting its use is mixed. There is minimal evidence to support SCPs positively impact patient outcomes, yet, patients report higher satisfaction with survivorship knowledge, find the SCP helpful, and recommend its use. As a result, organizations are confronted with meeting a CoC standard that is difficult to implement and has discordant evidence to support its use. The purpose of this project was to provide a program evaluation for a CoC accredited community cancer center that is committed to improving survivorship care for adult oncology patients. Three objectives were assessed; percentage of SCP delivery completions, evaluation of the SCP and visit with a pre and post survey, and assessment of survivors ongoing needs with a Cancer Impairment Screening Tool. A small case study was also conducted. Between February 1st and July 31st fifty-seven SCP visits were completed, however, only 36 survivorship visits met eligibility criteria making the completion rate 35.6%. The pre and post survey revealed patients had an increase in; knowledge of the SCP visit purpose, available resources, familiarity with treatment side effects, and importance of the visit. There were no reports of unmet needs on the post survey. Survivors most common treatment concerns were numbness in extremities, muscle weakness, fatigue, physical limitations, and sleep difficulties. In conclusion patients find value in the SCP and visit and its use should not be abandoned. It is well understood that survivorship care can be complex. Advancing survivorship care from the sole provision of the SCP to a more individualized process may better address the specific needs of individual cancer survivors.
An assessment of surgical oncology patient education
(Montana State University - Bozeman, College of Nursing, 2018) Bartholomew, Cody Sue; Chairperson, Graduate Committee: Susan Raph
Cancer patients are faced with tremendous amounts of information during a very vulnerable time, challenging the medical community to provide patients and families with up to date, relevant, evidence-based information to make informed decisions that promote positive health outcomes. Lack of standardized pre-operative patient educational efforts for adult surgical oncology patients has the potential to negatively impact system efficiency, patient outcomes, patient satisfaction and trust in their healthcare team. When patients possess understanding of their care process, their role in recovery, and trust in the healthcare team increases (Reiter, 2014). The aim of the project was to assess the current structure and process of surgical oncology patient education within one integrated health system in the northwest United States using the Donabedian framework for healthcare quality (Donabedian, 1980). A non-experimental descriptive exploratory survey was used for data collection. Project findings include identification of systematic structure and processes of surgical oncology education due in part to the complexity of the health system structure and lack of standardization across care settings. Documentation of education provided is varied by location and provider type with an absence of formal pre-operative or post-operative education plan within the system. Information collected will be used for future quality improvement projects and interventions to improve surgical oncology patient education across the continuum one of the integrated health system.

Theses and Dissertations at Montana State University (MSU)

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