Transcript Radon Education Project (REP) and

Engaging Oncology Nurses in a Primary
Prevention Program on Radon: Outcome
Analysis and Implications for Practice
MAUREEN H. QUICK, DNP, RN, OCN
DOCTOR OF NURSING PRACTICE SYSTEM
CHANGE PROJECT
ST. CATHERINE UNIVERSITY
ST. PAUL, MINNESOTA
Radon Education Project (REP) Agenda
 Review of the Oncology Nursing Society (ONS)
 REP objectives/overview
 Review of REP findings and potential implications
for practice
 White paper review developed from the REP
 Current issues/problem statement with radon
education in clinical practice
 Potential new avenues to improve outcomes
Oncology Nursing Society
 National organization of oncology nurses
 Mission is dedicated to promoting excellence in
oncology nursing and quality cancer care
 The national organization was founded in 1975 and
has grown to over 35,000 members, 231 chapters
 The Metro MN Chapter is located in the
Minneapolis, MN area and is the largest chapter in
the State
 ONS supports the role of oncology nursing in
primary prevention
REP Objectives
 To increase oncology nurses knowledge of the
association between radon exposure and lung cancer
through an educational program as evaluated by an
online survey
 To identify how primary prevention strategies related
to radon exposure can be incorporated into clinical
practice as recommended by participants in follow up
focus groups.
 The final output was the development of a white paper
as a guide for oncology nurses in clinical practice
Radon Education Project (REP)
 Radon Education Project used a mixed methods
design to explore knowledge and perceptions of
oncology nurses and educate them about radon
exposure and lung cancer.
 Project objectives were developed in collaboration
with the Minnesota Department of Health (MDH)
Indoor Air Unit. This is the first documented
initiative where oncology nurses have partnered with
a state department of health in a formalized,
programmatic approach to radon education.
Radon in the United States
Radon Education Project (REP)
 The REP was designed in three phases
 Phase I: An educational program was developed
and presented at the local ONS meeting. 66 people
attended the educational program.
 Attendees were offered free radon test kits
 41 Metro MN ONS members signed consent forms
indicating interest in participating in the next phase
of the REP
 33 completed the online survey
REP Participants
 Oncology nurses from
five health care
institutions within a
large metropolitan area
in the Midwest
 Majority of nurses had a
Bachelor of Science in
Nursing (BSN) degree
 Worked for more than 20
years in oncology
nursing.
Phase I –Online Survey Results
 46% tested their home for radon prior to the
educational program
 94% shared the information on radon and lung
cancer
 100% stated that the information was relevant to
them personally
 Majority identified applicability to practice
Phase I –Radon Test Kit Results
Test
Kits
Used
49
(74%)
Prior Inevaluable Test
Testing Tests
Level
Range
46%
6 (12%)
0.7 –
18.3
% Above % MN Homes
EPA
Above EPA
Action
Action Level
Level
28%
40%
Prior testing is high compared to one cross sectional
study where testing rate was seen in 9.7% and 15.5%
and in another study where patients had a radon
testing rate at baseline of 24.7%
Nissen, et al. (2012). Radon testing and mitigation: An intervention in a primary care setting. Journal of Cancer Education
Larsson et.al. (2009). Householder Status and Residence type as correlates of Radon Awareness and Testing Behavior
Public Health Nursing
Radon Education Project: Phase II
Phase II
 Focus groups were designed and offered to
individuals who attended the Phase I educational
program.
 Three focus groups were held in the fall of 2012 with
15 members attending
 Open ended questions were utilized to elicit possible
ways that radon education might be incorporated
into clinical practice
 Data were captured using a transcript-based analysis
ONS Member Comments
“I don’t know if it is a community or state or federal requirement or if it
is just widely considered best practice. The radon thing could be, at
least in MN, considered best practice to be addressed by all health
care providers.
Focus Group Participant, Metro MN Member, 2012
“Lung cancer due to radon is a preventable disease. Our mission should
be that we disseminate information about that.”
Focus Group Participant, Metro MN Member, 2012
“I think it is great that we as a chapter have something specific that we
sort of stand for or have a goal for or can present as part of as to why
we are in existence”
Focus Group Participant, Metro MN Member, 2012
Phase II –Focus Groups
Five themes were identified
 Theme one: Education. They identified education of
oncology nurses and physicians as important so health care
professionals could be knowledgeable on the topic of radon
and lung cancer when speaking with patients
 Theme two: Access. Data on radon and lung cancer should
be accessible and have contact information/websites
 Theme three: Timing. It was suggested that the timing of
this education should be individualized to the patient.
 Theme four: The role of ONS. Was recognized as
important endorsement for this work.
 Theme five: Barriers. Cost of testing and mitigation was
identified as a potential barrier to education.
Radon Education Project: Phase III
Phase III- White Paper for ONS
 The nurses suggested that a document that provided
educational information and web links for additional
resources would be most beneficial
 A prescriptive outline of data, information and references
was developed
 The white paper was adopted, without changes to format or
content, by a unanimous vote by the Metro MN ONS board
on September 10, 2013
 Metro MN ONS Home
Current Issue/Problem Statement
 Radon is a major health concern in MN and globally
 The REP data demonstrates that health care
professionals' knowledge of radon is limited
 The health care professionals (HCP) are the primary
source of health information to the public, yet there
is no systematic process for dissemination of radon
information to HCPs
 Racial and Economic Disparity Issue
 Treating the patient does not treat the “Toxic Home”
Potential New Avenues to Improve Outcomes
 The biology of alpha radiation DNA damage is
compelling, but the data is confusing to practitioners
 Need to package a scientific message that is
meaningful to practitioners
 Focus of HCP is on tertiary care, but the ACA is
focused on prevention. This new paradigm shift is a
perfect time to address this issue
 Develop standards for education with health care
professionals and study the impact
Potential Partnerships
 Institute of Medicine report calls for partnerships between public
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health and health care delivery organizations
Partner with knowledgeable HCPs to consult on effective
development and implementation of health care education and
standards
Partner with the scientific community to develop a “clinically
meaningful” message to health care providers
Partner with industry toward innovation in testing
Partner with insurers and legislators to educate and pay for
mitigation for the economically disadvantaged
Partner with NGOs to incorporate an anti-radon message into
their anti-smoking campaign
Institute of Medicine of the National Academes. (2012). Best care at a lower cost: The path to continuously learning health care in America
Acknowledgments
 Andrew Gilbert and Jim Kelly, Site Mentors at the MDH
 Dr. Roberta Hunt at St. Catherine University
 Joshua Kerber and Dan Tranter from the MDH Indoor
Air Unit
 The Minnesota Department of Health (MDH)
 The Minnesota Cancer Alliance (MCA)
 Bill Field, University of Iowa for scientific consultation