Hepatocellular Carcinoma Competencies

2. Nursing Assessment Competencies

2.1. Describe the importance of income and social status in HCC prevention, access to care, and treatment.

• The role of income security e.g., employed, social assistance, retired
  • Higher socioeconomic status is an indicator of increased likelihood of receiving curative therapy. 4
• Types of income assistance available
• The impact of barriers such as lack of or unsafe shelter, lack of nutrition and lack of affordable transportation
• Strategies clients can use to access services e.g., addiction programs, travel support, and nutrition supplements
• Regional/geographical differences in accessing care and treatment

2.2. Describe the importance and impact of the client’s social support network

• Quality of life; living with uncertainty
• Access and retention in care
• Emotional and practical (e.g., transportation to appointments) support from family and friends
• Patient fatigue
• Caregiver burden and burnout

2.3. Explain how the client’s level of education and literacy can impact health

• Assess client’s understanding of information e.g., reading, writing, expression, and comprehension
• Use of adult learning principles e.g., language that is appropriate to the client’s education, literacy level, and ethnocultural context
• Facilitate client access to information e.g., peer support groups, internet
• Impact of language barrier
• Use of language interpretation services as needed

2.4. Explain the impact of employment/working conditions

• Individual’s rights to confidentiality
• Planning for work interruption
• Financial impact from missed work

2.5. Understand the influence of social environments

• Importance and impact of social networks e.g., community groups
• Access to community resources
• Access to cancer support agencies e.g., volunteer drivers, peer support, etc.
• Impact of the stigma associated with cancer on health behavior and human rights
• Impact of media influence

2.6. Understand the importance of physical environments

• Community safety
• Importance of a safe home environment e.g., location, fall prevention, assistive devices
• Contribution of the physical environment e.g., air/ground/water quality and chemical/biological exposure
• Assess client’s need for home care visits to ensure safety

2.7. Understand the importance of personal health practices and coping skills

• Optimize liver health e.g., balanced nutrition, physical activity, harm reduction practices re: alcohol and substance use
• Factors influencing patients’ choices e.g. psychosocial, financial, cultural and health literacy
• Use of complementary and alternative (CAM) medicine e.g., acupuncture, massage therapy, Chinese herbs, traditional indigenous practices

2.8. Explain the importance of healthy child development

• Adverse childhood experiences (ACEs) and their impact on lifestyle choices and behaviours in adulthood e.g., childhood obesity, physical abuse and family alcohol use

2.9. Describe the role of biology and genetic endowment

• Role of genetics in the underlying disease
• Importance of family history
• Identification of at-risk individuals or groups e.g., family screening

2.10. Describe the impact of health services on HCC

• Client advocacy: self-advocacy, family and nurse’s role
• Understand different treatment modalities and access to options
• Local referral and follow-up process for accessing HCC management
• Effect of stigma and discrimination on service access and utilization
• Role of remote community health services
• Palliative care services

2.11. Understand the role of gender

• Recognize biological gender differences in cancer risk, natural history of disease and disease progression

2.12. Understand the impact of culture

• Implications related to HCC e.g., alcohol as part of lifestyle, ethnicity
• Need to be culturally sensitive e.g., avoid actions that diminish, demean or disempower the cultural identity and well-being of an individual
• Spiritual and religious beliefs impact decisions e.g., traditional healing beliefs, Jehovah’s Witness
• Impact of provider’s values on relationships and client decision-making