Kristen Sismilich created a patient education tool for veterans undergoing chemotherapy at the Baypines VA Hematology/Oncology Clinic. The tool provides pictures and descriptions of common chemotherapy side effects and signs/symptoms that require immediate medical attention. Nurses and patients responded positively to the tool. While the tool still needs approval from the VA, its goal is to improve patient health outcomes and appropriate use of healthcare services by enhancing health literacy as outlined in Healthy People 2020 objectives. Low health literacy is associated with poorer health outcomes and healthcare utilization according to research.

1. Service Learning
Project
Kristen Sismilich, B.A.
University of South Florida

2. Clinical Agency
 Baypines VA: Hematology/Oncology Clinic
 Services provided: chemotherapy, transfusions, lab
work, biotherapy, broad spectrum antibiotics
 Partnerships: American Cancer Society, Oncology
Nursing Society
 Preceptor: Cindy Bowman, RN, MSN/Nursing
Education, OCN
 national oncology educator

4. Client Population
 Veterans with cancer receiving outpatient
chemotherapy
 Demographics
 WWII, Korean Conflict, Vietman Era, Gulf War
Era, Operation Enduring Freedom (Iraq, Afghanistan)
 Race: majority are white; 11% black, 6% hispanic, 4%
other (American Indian/Alaska Native, Asian, Pacific
Islander)
 Gender: 10% female (Veteran Population Projections:
FY2010 to FY2040)

5. Health Needs of Population
 Major health problems: cancer, co-morbidities
 Appropriate education tools regarding chemotherapy
side effects and when to seek medical attention
 Goal of SLP: Veterans undergoing chemotherapy will
be aware of the signs and symptoms that require
immediate medical attention

6. Rationale
 Life threatening side effects
 New patients
 Receive ample amounts of information all at one time
 Overwhelming
 Create a tool that is easy to access, read, understand
and remember
 Pictures, description of side effects, numbers to call

7. Healthy People 2020
 Objective: Improve the health literacy of the population
 Increase the proportion of persons who report their
health care provider always gave them easy-to-
understand instructions about what to do to take care of
their illness or health condition (Healthy People 2020)
 Relationship to SLP: development of tool

8. Description of SLP
 Goal: nurses to understand the rationale for tool
 Objectives: By the end of the lesson chemo nurses will
be able to
 Demonstrate patient teaching at the beginning of
chemotherapy (application)
 Classify signs and symptoms in order of their severity
(analysis)
 Justify the necessity of monitoring for specific signs and
symptoms during chemotherapy (evaluation)

9. Presentation
 Poster
 Healthy People 2020 Objectives
 Chemotherapy related side effects
 Damage to rapidly dividing stem cells
 Drug toxicity
 Symptoms
 Fever (neutropenia)
 Nausea/Vomiting (dehydration, noncompliance)
 Dyspnea/SOB (anemia, cardiovascular, pulmonary toxicity)
 Burning (UTI, dehydration, cellulitis)
 Bleeding (thrombocytopenia)
 Pain (IV infiltration or infection)
 Oral mucositis (Gates & Fink, 2008, & Polovich, Whitford, &
Olsen, 2009)
 Tool

11. When To Contact Your Doctor
Blood Mouth Sores
FEVER
Burning Pain
Shortness of Nausea and
Breath Vomiting

12. Call the Hematology/Oncology Clinic
#727-398-6661 OR #888-820-0230 ext. 5125
Monday - Friday 7:30 to 4:30
(if clinic is not open, go to the emergency room)
FEVER: If you have shaking, chills, or a fever greater than 100.4, go to the
emergency room.
Vomiting: If you have you have vomiting for more than 24 hours or if you are unable
to eat or drink.
Blood: If you have black stools, blood in the stools, or any other unusual bleeding or
bruising.
Shortness of Breath: If you have an unusual cough, sore throat, lung congestion, or
shortness of breath.
Pain: If you have intense pain in a new place, or pain that does not get better after
taking pain medicine.
Burning: If you have burning when you urinate or blood in the urine, or if you have
burning at your IV site.
Mouth Sores: If you cannot eat because of mouth sores or if you have white patches
or red areas.
Any new or unusual symptom that lasts more than 1 day.

13. Modifications During Planning
 Patient feedback
 Are they aware of side effects
 Do they know when to contact providers
 Are their caregivers aware
 More beneficial for new patients vs “veteran” patients
 Added days and hours of clinic

14. Participant Response
 Nurses
 appreciated and valued development of tool
 Patients
 Responded positively
 Thought tool would be useful and beneficial
 To achieve goal in future: implementation of tool

15. Implementation
 Tool has to be submitted and approved by the VA
 Include in welcome packet
 Evaluate
 Number of calls to chemo clinic
 Number of patients reporting to emergency room

16. Impact of Health Policy
 Patient Protection and Affordable Care Act
 Health literacy: degree to which an individual has the
capacity to obtain, communicate, process, and
understand basic health information and services to make
appropriate health decisions
 Research: health information is presented in ways that
are not usable by most adults
 CDC: every organization involved in health information
and services needs its own health literacy plan to improve
its organizational practices
 Create health information and services that truly make a
positive difference in people’s lives

17. Low Health Literacy and Health Outcomes:
An Updated Systematic Review
 80 million Americans have limited health literacy
 Greater risk for poorer access to care and poorer health outcomes
 Update 2004 systematic review
 Determine if low health literacy related to poorer use of health
care, outcomes, costs, disparities in health outcomes
 Low health literacy associated with poorer health outcomes and
poorer use of health care services
 Finding ways to reduce effects of low health literacy on health
outcomes justifies the attention of policymakers, clinicians, and
other stakeholders (Berkman, Sheridan, Donahue, Halpern, &
Crotty, 2011)

18. References
Berkman, N., Sheridan, S., Donahue, K., Halpern, D., & Crotty, K. (2011). Low
Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of
Internal Medicine. Vol 155(2), 97-107.
Centers for Disease Control and Prevention. (2011). Health Literacy. Retrieved
from http://www.cdc.gov/healthliteracy/learn/index.html
Gates, R. & Fink, R. (2008). Oncology Nursing Secrets. St. Louis, MI: Mosby Inc.
Healthy People 2020. (2013). Retrieved from www.healthypeople.gov/2020
Polovich, M., Whitford, J., & Olsen, M. (2009). Chemotherapy and Biotherapy
Guidelines and Recommendations for Practice. Pittsburgh, PA: Oncology Nursing
Society.
Veteran Population Projections: FY2010 to FY2040 (n.d). Retrieved from
http://www.va.gov/vetdata/docs/QuickFacts/Population_quickfacts.pdf