Mentorship, Education, and Training at the Winship Cancer Institute of Emory University

Deborah Watkins Bruner, RN, PhD, FAAN, wears several hats at the Winship Cancer Institute of Emory University, Atlanta, GA. She is Robert W. Woodruff Professor of Nursing, Nell Hodgson Woodruff School of Nursing; Professor, Department of Radiation Oncology, Emory University School of Medicine; and Associate Director for Mentorship, Education and Training, Winship Cancer Institute of Emory University.

Dr Bruner has had a distinguished career, marked by many awards (most recently, induction into the National Academy of Medicine), the publication of more than 150 peer-reviewed journal articles, and the distinction of being the first and only nurse to lead a National Cancer Institute cooperative group—the Radiation Therapy Oncology Group’s Community Clinical Oncology Program. In addition, Dr Bruner heads the NRG Oncology National Cancer Institute Community Oncology Research Program.

The Oncology Nurse-APN/PA (TON) spoke with Dr Bruner about her various roles, main research interests, and concerns about the future of oncology research.

TON: What does your work as Director for Mentorship, Education and Training entail?
Deborah Watkins Bruner: I monitor junior faculty members and their mentorship under senior faculty members. I conduct gap analyses to assess priorities for mentorship, and how well we are meeting those priorities. I develop programs to assess the gaps and needs and to improve the quality of mentees’ scholarships.

We also educate mentors and mentees about how to have difficult conversations, including conversations on addressing a power differential (eg, a mentee not getting what he or she needs from a mentor), how mentors can be supportive to mentees, ethical conduct in research, and ethical conduct with patients.

My main focus is research, and clinical ethics training is mandatory in research. It is important to keep in mind that this is not just a box that gets checked—clinical ethics training requires a continual emphasis on the importance of the quality of information, health literacy of patients entering a clinical trial, whether there is a translator needed (and who that translator is), and the importance of rigorous scientific research, including the nitty-gritty of how you get from point A to point B when conducting a clinical trial.

TON: What are you excited about in the field of oncology right now?
Dr Bruner: Research and mentorship are what make me get up every day and go to work. There are exciting research opportunities in immunotherapy and precision medicine. As enthusiastic as I am about these new therapies, I am also concerned about all of the hype. Only approximately 20% of patients will have a genetic abnormality that makes them a match for targeted therapy, only 12% get into clinical trials, and only approximately 5% to 6% are exceptional responders. These new therapies will cure only a small number of patients, yet drug companies are advertising them on television as if they are good for all patients. With response rates <20%, these advertisements about immunotherapy and other targeted therapies can be misleading to patients.

As a nurse, I am less involved with curing cancer than I am with symptom management and ethical issues. If we do not find a match for a targeted therapy based on a genetic abnormality, that is stressful for patients, and nurses have to help them cope. On the other hand, if we do find a match and a patient receives one of the new precision medicines or immunotherapies, the side effects can be significant and severe.

We still do not know enough about the symptom profile of precision medicine and immunotherapies and the trajectory of that profile—patient adherence, financial toxicity, and drug toxicity are extremely concerning.

Despite the excitement about tumor control, there is a human being involved, and quality of life and symptom control are equally important.

TON: What is your biggest challenge as an oncology nurse professional?
Dr Bruner: Funding for research is the biggest challenge right now. The federal government does not seem to appreciate the importance of science and of training the next generation of nurse scientists. The proposed National Institutes of Health budget cut of approximately 20%, and suggestions to cap indirect costs of research—which are needed to turn on the lights and pay for office space and heat—could shut down research. Universities lose money conducting research, but they do it because it is important to advance evidence-based practice and improve patient survival and quality of life. We could lose a generation of scientists because of a lack of funding. Loss of science and scientists will mean fewer advances in patient care.

Another of my concerns is that, although the Doctor of Nursing Practice is a wonderful clinical degree, it creates a brain drain on the supply of nurses who have a Doctor of Philosophy (PhD) degree. We need PhDs to teach nursing research and to conduct rigorous, patient-centered research. Most nurses go into nursing for clinical practice; however, many of them are not exposed to evidence-based research during their nursing training. We need to get more nurses exposed to research earlier in their training and education.

TON: What is the biggest reward related to your job?
Dr Bruner: Mentorship is my biggest reward. Nurses can be involved in writing policy based on evidence-based research.

Seeing mentees involved in science that changes clinical practice is exciting. For example, research that I was involved in demonstrated that a single fraction of radiation for bone metastases provided equivalent pain relief of up to 30 fractions. Now, the American Society for Radiation Oncology guidelines state that you can use a single fraction of radiation, which saves patients multiple trips to the hospital and is less costly.

One of my mentees at the University of Pennsylvania helped update the pain guidelines for the National Academy of Medicine (formerly called the Institute of Medicine). Another mentee is working to establish guidelines for anal cancer screening in patients with HIV. Nursing research should lead to or influence evidence-based patient care guidelines.

TON: What has your career path been?
Dr Bruner: I received my nursing degree at a state college, and then earned 2 master’s degrees—one in oncology, and one in nursing administration. I worked as a clinical nurse specialist in gynecologic oncology, and became frustrated with the lack of evidence for managing symptoms of gynecologic cancer—this started my interest in research.

I worked in a number of nurse manager and program leader/researcher roles for 16 years at Fox Chase Cancer Center, Philadelphia, PA, where I earned my PhD. I then moved to the University of Pennsylvania as a Professor of Nursing; this was my first academic position, and it was unusual to bypass being an assistant and an associate professor. After my time at the University of Pennsylvania, I moved to the Winship Cancer Institute of Emory University.

TON: If you won the lottery, would you do something different?
Dr Bruner: Absolutely not. I love research, mentorship, and changing practice. I tell my colleagues that I want to turn to dust at my desk.