E:\IBUK\NERS DESEMBER 2021\20-- 393Calle, Aquino, La-Riva, Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients Yuli Pilar Osorio-Calle1, Katterin Joely Sebastián-Aquino2, Mónica Elisa Meneses-La-Riva3 1,2,3Departamento de Enfermería, Instituto Nacional de Enfermedades Neoplásicas, Perú JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 11/06/2021 Accepted, 19/10/2021 Published, 15/12/2021 Keywords: Tele-nursing, self-care, education and oncology patients Article Information Abstract Telenursing is a way of caring for and educating oncology patients to pro- mote self-care management at home. The objective of the study was to ana- lyze the scientific evidence on telenursing in the care of oncology patients. This was a systematic and descriptive review in Spanish, Portuguese and English which was available in 3 databases: BMC, Pubmed and Scielo. The articles were selected in English, Spanish and Portuguese with data from 2010-2020. It was found that tele-nursing, a new form of access to the care service provided by nursing professionals to patients with oncology treat- ment, including technological tools allow a direct and timely relationship to respond to the detection of adverse events after chemotherapy, promote self-care and control and monitor the patient’s health status at home. Con- clusions: There is a need to use tele-nursing as an opportunity to care for the patient at home through virtual means by providing relevant information to promote self-care and quality of life. © 2021 Journal of Ners and Midwifery 393 Correspondence Address: Instituto Nacional de Enfermedades Neoplásicas – Suquillo, Peru P-ISSN : 2355-052X Email: ypilar0210@hotmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p393–400 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p393-400&domain=pdf&date_stamp=2021-12-26 394 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 393–400 INTRODUCTION Cancer is a public health problem that has been increasing in recent times according to the World Health Organization (WHO), which reported that more than 138 million new patients are diagnosed with cancer (OMS,2014). In this regard, the Pan American Health Organization (PAHO) indicated that in the countries of the Americas and the Carib- bean cancer is the second leading cause of death, predicting that by 2030, the incidence will be greater than 572,000 cases (OPS,2018). In view of this situation, most cancer patients receive the treatment of choice, such as chemo- therapy, which is applied in different schemes and constitutes a va riety of antineoplastic dr ugs (OMS,2014). These drugs have pharmacological action on the cells that are present in the organism and have an effect on cancer cells or not, causing destruction also of healthy cells, these drugs called cytostatics, have collateral or adverse effects on people, depending on the amount and time of treat- ment (Fundación para la excelencia y la calidad de la oncología, 2015). It should be noted that the adverse effects of chemotherapy that occur in patients are: nausea and vomiting occur in 35 to 80% of patients with can- cer, appearing late in a period after 5 days of hav- ing received the treatment and in some cases acutely before 24 hours (OMS,2014). In fact, the problems that can occur are: alopecia, fatigue and potentially fata l effects such as plateletopenia (Vida ll, Fernández-Ortega et al. 2015) (Cancer Institute, 2017) causing these symptoms of deterioration of the oncologic patient’s well-being and quality of life (Ca r neir o, Bezer r a, Fr eire, Alves, Ca rta xo, Alencar,2019). Indeed, the oncology patient requires profes- sional nursing care where the health condition is monitored, controlled and can be followed up con- tinuously to provide relief and comfort, for which the nursing professional must use all the means of communication in recent decades, such as the dif- ferent virtual platforms offering medical services and nursing consultations to meet the information needs regarding their health condition. The care approach to oncology patients should provide ac- companiment, information support and counseling to reduce post-chemotherapy adverse effects (Ca r neir o, Bezer r a, Fr eire, Alves, Ca rta xo, Alencar,2019). Undoubtedly, the follow-up phase is one of the steps that is contributing to make the trajectory of a cancer patient to that of a cancer survivor as less traumatic as possible (Graff, Blanchard, Thariat, Racadot & Lapeyre, 2019). Information and communication technology in the field of health has become a tool for a variety of resources, techniques and processes that are used to store, process and transmit relevant information required by cancer patients to respond to their health problems (Carneiro, Bezerra, Freire, Alves, Cartaxo, Alencar, 2019). Likewise, the recent and rapid ad- vances in informatics and telecommunications are showing the production and management of infor- mation through codes, texts, images, sounds (Garcia, Navarro, López & Rodríguez, 2014). The monitor- ing of side effects should be integrated into nursing practice as a routine task, because it has been seen that it is essential to have post chemotherapy infor- mation collected by telephone, for example, post chemotherapy toxicity, to be attended in a timely manner. When the information is permanent, the patient has access to reach the facilities as soon as possible (Breen, Ritchie, Schofield, et al.,2015). Thus, the World Health Organization (WHO) points out that telemedicine is increasingly spoken of and emphasizes that it is nothing more than mak- ing efficient and economical use of ICT informa- tion and communication techniques (OMS,2014), (Bulechek, et al., 2011). Furthermore, in relation to the transfer of the patient to the hospital center and provides comfort to receive care in the comfort of your home, there- fore, this phase of monitoring is becoming an im- portant alternative nurse - patient communication (Alcázar y Ambrosio, 2020). Education accompa- nied by technology is an important tool for improv- ing the self-care skills of the ambulatory patient, in addition to favoring the ability to learn and modify life habits in the personal and family sphere based on the decisions made by the informed patient (Vialart, 2016). According to Alcázar y Ambrosio (2020), tele- nursing is a technological support where various virtual platforms can be used, facilitating interac- tion with patients to carry out follow-up activities that favor the continuity of nursing care in daily prac- tice (Heckel, et al,2018). It should be noted that there is resistance on the part of nurses in the use of the virtual environment. (González, Ballesteros, Crespo de las Heras &Perez, 2016). The virtual environment is necessary to improve access to health care, favor knowledge of the dis- 395Calle, Aquino, La-Riva, Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients ease, compliance with treatment, adaptation to the disease; favor self-care, improve satisfaction indi- cators, quality of life and reduce visits to medical services and health care costs (Qiao, Tang, Zhang, Tian, Liu, Yang, & Ye, 2019).) Finally, it is important to know and reflect on the incorporation of technology, especially tele-nurs- ing as a new modality to incorporate in the practice of care, education and care management to sustain the accessibility of health services aimed at indi- viduals, family and community. The reviews estab- lish a systematic search guideline of information sources to clarify and understand this phenomenon as an answer to the research question: What are the scientific evidences available on tele-nursing in the care of oncology patients related to the aspects: timely detection of METHOD The research method was a systematic and descriptive review in Spanish, Portuguese and En- glish available in 3 databases: BMC, Pubmed and Scielo. The following descriptors were used: “Tele- nursing” and “oncology patient” and their respec- tive synonyms in English and Spanish. The Bool- ean operators “OR” and “AND” were used, as well as the titles and abstracts in the different databases in the years from 2010 to 2020. The articles were then classified according to the inclusion and ex- clusion criteria that had been determined. This re- sulted in the articles that were analyzed. Articles were excluded when they did not meet the meth- odological quality or only had an abstract. The ex- traction of the articles was based on the author of the article, the year of publication of the article, the number of population or samples used, objective, research design and the results obtained in the ar- ticle. After obtaining the reviewed article, the edi- tor performed a critical appraisal and the final stage is the graphing of the data. Filtering and selection of the articles using the PRISMA flowchart. The search results using these two keywords yielded 1707 articles. The articles were then filtered using the inclusion and exclusion criteria and 1642 articles were obtained. Subsequently, articles were elimi- nated for duplicity, resulting in 65 articles, and fi- nally, the reading of the abstracts was performed, where 57 articles that did not meet the inclusion criteria were eliminated, leaving 8 articles on the base. Records identified in Pubmed database 778 items, Scielo 20 items, BMC 909 items = 1707 Records excluded for not having open Access or full text in PDF, or elimination of duplicates, for not meeting the objective a total of 1642 articles. Eligible articles A total of 8 articles Id en tif ic at io n R ev ie w Eligible articles by time interval from 2010 to 2020, a total of 65 full-text open access articles. In cl us io n E lig ib ili ty RESULT Table 1 Scientific Evidence on Tele-Nursing in The Care of Oncology Patients Heckel L., Fennell K. M., Reynolds J., Boltong A., Botti, M., Osborne, R., Mihalopoulos, C., Chirgwin, J., Williams, M., Gaskin, C. J., 2018 80 The aim of this single- blind, multi-centre, randomised controlled trial was to test the efficacy of a telephone outcall program to reduce caregiver burden and unmet needs, and improve psychological Randomised controlled trial Adherence, measured as the recruitment rate, was 96% (80/83) and the dropout rate was 6% (5/80). During the study period, 3/80 (4%) patients relapsed and 5/80 (6%) patients returned to standard follow-up because they required closer medical observation. It was concluded that a shared care follow-up, supported by Researcher Year N Objective Design Resul 396 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 393–400 2019 2019 2015 2017 2016 Ashley, D. M., & Livingston, P. Qiao S, Tang L, Zhang W, Tian S, Liu M, Yang L, Ye Z . França A.; Rodrigues A.; Aguiar M.; Silva R.; Freitas F.; Melo G Williamson, S., Chalmers, K., & Beaver, K. Kelly, F., Carroll, S., Carley, M. Stacey, D., Green, E., Ballantyne, B., Tarasuk, J., Skrutkowski, M., Carley, M., Chapman, K., Kuziemsky, C., 231 61 26 490 119 well-being among cancer caregivers, as well as evaluating the potential impact on patient outcomes. To compare the effectiveness of nurse- led telephone calls plus WeChat versus telephone calls only for the pain management of outpatients with cancer. To verify the effectiveness of telenursing in the control of nausea and vomiting induced by antineoplastic chemotherapy This study aimed to explore patient views of TFU. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity. This study aimed to build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone based quasi- experimental study Randomized clinical trial Qualitative study Descriptive study Comparative case study PROs, was a viable alternative to standard follow-up for patients with B- cell disease in remission. Patients manifest major problems were constipation, nausea, vomiting and dizziness were lower ( p<0.01), while medication adherence ( p<0.05) and satisfaction with pain management were higher ( p<0.01). Nurse-led follow-up phone calls combined with WeChat significantly reduced opioid-related health problems such as pain intensity, side effects, and medication adherence The monitoring of telephone calls significantly helps in the control of nausea and vomiting in patients receiving chemotherapy treatment on an outpatient basis. All patients found TFU to be a positive experience and all expressed a preference to continue with (telephone follow-up). Three main themes emerged from the patient interviews; 1) accessible and convenient care, 2) personalized care, and 3) relationship with the nurse specialist. The study highlights the lack of knowledge tools and clinical practice guidelines available to guide healthcare professionals in assessing, classifying and/or offering self-care strategies to patients with cardiotoxic dyspnea related to cancer treatment. Nurses felt more confident with symptom management and using COSTaRS protocols ( p <.01). Chart audits revealed that protocols used were documented between 11% and 47% of patient calls. Training and other interventions improved nurses’ 397Calle, Aquino, La-Riva, Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients Kolari, E., Sabo, B., Saucier, A., Shaw, T., Tardif, L., Truant, T., Cummings, G. G., & Howell, D. Kondo, S., Shiba, S., Udagawa, R., Ryushima, Y., Yano, M., Uehara, T., Asanabe, M., Tamura, K., & Hashimoto, J 2015 253 symptom support to cancer patients using a series of case studies To assess adverse effects through a telephone consultation service for cancer patients receiving outpatient chemotherapy. Cohort study confidence in using the COSTaRS protocols and their acceptance was evident in some documented phone calls. The protocols could be adapted for use by patients and nurses worldwide. The occurrence of grade 2 or worse AEs (Hazard ratio = 6.58, P <0.001). Changes in planned chemotherapy occurred more frequently in cases of male patients (hazard ratio = 2.70, P = 0.02) and in cases of grade 2 or worse AEs (hazard ratio = 6.58, P <0.001).They found that AE assessment by CTCAE through a telephone consultation service is useful for both patient classification and prediction of severe AEs that may change clinical schedules. DISCUSSION Scientific evidence made visibly and identified the needs of home care, timely detection to reduce post chemotherapy adverse events and therapeutic demands of oncology patients that favor their self- care, thus requiring personalized advice from nurs- ing professionals through tele-nursing for control and follow-up of the oncology patient’s health condi- tion. This is supported in three categories which are detailed below. Timely detection of adverse events after che- motherapy. International studies indicate that the use of the various virtual platforms such as phone calls were useful for the detection of adverse events after chemotherapy (Stacey, Green, Ballantyne, Tarasuk, Skrutkowski, Carley, et al. 2016). In the case of WeChat it helped in monitoring post che- motherapy adverse symptoms, in addition to pain management in oncology patients. In addition to maintaining an adequate management of informa- tion, it is also very useful for the reduction of nau- sea and vomiting associated with chemotherapy (Kondo. S. et al 2015). It should be noted that the educational process between patient and nursing professionals has a great pillar which is dialogue, where it is possible to exchange doubts, question treatments or self-care management, transform the individual and collec- tive behavior of the patient and family in learning and modification of life habits which allows them to make decisions in favor of their health, all this is carried out in an atmosphere of trust, a basic as- pect for this process to work. (Benavent., et al., 2012) (Bulechek, et al.,2013) Likewise, another important pillar is the permanent monitoring of the patient to identify timely information for effective management and even if necessary to reach the hospital fa cilities immediately (Alcázar a nd Ambrosio,2019). Undoubtedly, technology is an indispensable element in communication and the patient has this resource as an opportunity to strengthen health edu- cation favoring holistic care to respond to the needs and therapeutic demands. Self-care. These are actions that the person assumes in a mature way daily activities to adopt healthy lifestyles to reduce symptoms and discom- fort after chemotherapy (Li, G., Zhang, S., & Xu, B,2019) argue that in tele-nursing it was possible to identify and assess the needs and situations faced by the patient during oncological treatment through telephone calls. This tele-care favors the follow-up and control of the specialized nurses, they provided answers to the problems they presented in the con- sultation and stated that this form of care is a viable option to achieve timely care and satisfaction with the service provided. Patient satisfaction is an indi- cator that benefits adherence to treatment, self-care and ensures continuity of visits to the health facil- ity. Heckel, et al. (2018), indicate that tele-nursing is a viable alternative to standard follow-up for can- cer patients in remission. 398 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 393–400 It should be noted that continuity of care was an important factor in building a relationship of trust between the patient and the nurse. This Platform is innovative and it may be useful for specialized nurses to meet personally with eligible patients to establish a good therapeutic relationship where self- care is promoted. On the other hand, Williamson et al. (2015), expresses that recruitment adherence is rescued which raises awareness and awareness to promote their own self-care being lower the drop- out rate so the author considers that the results are encouraging on the confidence and satisfaction of patients. Control and follow-up of the oncologic patient’s health condition. Most of the published articles show that patients who come to health institutions need information about their self-care at home. The lack of information brings doubts and fears so they re- quire counseling to address their health problems. For control and follow-up activities, nursing profes- sionals need to innovate in care through virtual media which are technological tools where health education is emphasized to achieve control and fol- low-up of the oncology patient’s health condition in addition to identifying the effects of chemotherapy post-treatment. These activities based on telephone consultations such as tele-nursing increase recruit- ment and adherence, while reducing abandonment, guaranteeing an improvement in the quality of life of the individuals, as well as their personal well- being (Heckel, et al., 2018). Likewise, in the care provided, the causes of the self-care deficit of the oncology patient during chemother a py tr ea tment wer e ma de visible (França, Rodrigues, Aguiar, Silva, Freitas & Melo, 2019). In this sense, telenursing is a positive expe- rience for the patient in their follow-up and control, besides being an accessible and convenient form of care, it reduces the cost of travel to the health institution and the advice is personalized (Williamson, Chalmers, Beaver, 2015). In fact, the use of these new forms of educa- tion through telephone follow-up strengthened edu- cation, self-care, reduced hospital visits and con- trolled post-treatment symptoms with chemo- therapy (González, Ballesteros, Crespo de las Heras y Pérez,2016). The transcendence of caring is a nursing responsibility according to their institutional functions is to follow up patients, in addition, the nurse is interested in knowing more about the dis- ease, trust between the patient-nurse to promote health education and achieve effective communi- cation. This activity requires knowledge and a clini- cal practice guideline available to health profession- als who are required to assess, classify and/or of- fer self-ca r e str a tegies to ca ncer pa tients (Williamson, Chalmers & Beaver, 2015). The use of protocols demonstrated that tele- phone calls to identify postchemotherapy patient symptoms. The prior training nurses received in the use of this protocol provided confidence and pa- tient acceptance was evident through documented calls. The protocols could be adapted for use by patients and nurses worldwide (Kelly, Carroll, Carley, Dent, Shorr, Hu, et al., 2017). Undoubtedly, specialized nursing care services through the use of virtual environments allow the strengthening of nurse-patient therapeutic relation- ships and trust to transmit information to help over- come risk situations, self-care deficits and manage- ment of existing health problems. It is important to emphasize that timely information reduces uncer- tainty and provides wellbeing to favor self-care. CONCLUSION The findings found in the systematic review allow us to evidence that the authors of the articles agree that tele-nursing in the daily work of nurses offers advantages and incorporates professional care through their own care, administrative, research and educational functions in a virtual environment that contributes to improve nurse-patient health communication. In addition, targeted health educa- tion allows an adequate response to timely detec- tion to reduce post-chemotherapy adverse events, supports self-care and promotes the control and monitoring of the oncology patient’s health status through technological tools. At present, tele-nurs- ing in the face of social isolation has become an answer to continue offering nursing services to sup- port self-care at home, promote quality of life and provide wellbeing in the face of the disease, the implication of not having these means is an obstacle to providing timely and quality care. SUGGESTIONS It is necessary to implement a care guide to carry out this educational activity through tele-nurs- ing. It is also important to train nurses to achieve skills in the use of virtual platforms. 399Calle, Aquino, La-Riva, Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients REFERENCES Alcázar B, and Ambrosio L. 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