Understanding Your Patient: Keys to Outcomes Success
Understanding the specific characteristics that affect how patients interact with their treatment is crucial.
Oncology nurses have seen medical advances shift the prognosis of cancer from a death sentence to a chronic disease. If you have been on the front lines of cancer treatment long enough, you have seen the emphasis on surgery and radiation evolve into an emphasis on chemotherapy and, most recently, to new forms such as immunotherapies and targeted treatments. Some of the brightest minds in research are dedicating their time to the development and testing of medicinal compounds that could one day mean a cure for these now chronic diseases. Due to this paradigm shift, our roles as oncology nurses have changed as well.
When treatment was relegated to chemotherapy for all, understanding the needs and proclivities of each patient was not particularly important. We cared for them and tried to help them through their experiences, but in reality every patient was treated similarly.1-3 We simply needed to know the adverse effects of the chemotherapy agent and how to educate patients to manage those effects.
Today, understanding the specific characteristics that affect the way patients interact with their treatment is crucial.2,4 A patient on an oral regimen needs a totally different type of support than one on chemotherapy, just as a child may need different support than an adult.3 Oncology nurses have to think about how to ensure that patients understand their treatment, how to obtain their medications, how to manage the health system and its processes, and ultimately, how to persist with this complex and expensive treatment.2 We need to assess people's social situations, ie, who is available to help them, so they stay motivated and positive over the long term.2 We also need to learn about our patients' long term goals for their lives, not just the short term goals, because many cancer treatments, especially hematologic agents, are pills patients will take for the rest of their lives.
As an advanced practice nurse and clinical educator at a cancer center, I have seen patients respond differently to the same treatment based solely on factors we nurses can influence. Although some efforts go a long way toward promoting treatment success, such as ensuring our patients are taking their medication appropriately, assessing other medications they are currently taking, or closely monitoring new patients during the first few weeks of treatment, other practices require personalized attention to be effective.1,2,4 The most important part of our job as nurses is to identify individual patient factors that can influence adherence to treatment and adjust our care to meet the specific needs created by these unique characteristics.2
What does this look like in practice? In this article, I outline a few archetypal patient profiles, identified over the course of many years of working in oncology, and my suggestions for setting each patient up for treatment success.