CUTTING THROUGH THE FOG
Fear and lack of understanding are the two greatest barriers to receiving information, reports Melanie Carrow, RN, OCN, ACRN, a nurse with the Ambulatory Service, Infectious Disease Service at Memorial Sloan-Kettering Cancer Center in New York City.
“When patients are shocked to the core, they are not in a state of readiness to take in information, but they know they will need some help,” Ms Gilmore adds.
The nurse must determine the patient’s emotional state, says Ms Dein, adding that such an assessment requires the nurse to actively listen rather than formulating responses or trying to move the clinical agenda forward.
“Don’t run ahead by trying to offer ‘fixes,'” advises Mary Jean Houlahan, RN, manager of the oncology navigation program at Good Samaritan Medical Center in West Palm Beach, Florida. “Just hold it, physically, mentally, and clinically, until they feel more secure.”
Nurses must find out what is most important to patients, summarize that back to ensure correct understanding, and then validate it for the patient, Ms Dein says. Patients’ worries could be as serious as role changes and job loss fears or barriers to treatment, such as a lack of insurance, child care, or transportation. “What you think should be the priority isn’t necessarily going to be the patient’s priority,” Ms Dein explains.
Ms Dein closes her office door, turns off the telephone, takes care to project openness and relaxed body language, and gives the patient her undivided attention, making eye contact and perhaps holding the person’s hand. She acknowledges that often the conversation is uncomfortable, especially if the patient is crying. “They need to express that,” Ms Dein acknowledges. “But nurses often don’t have the time to give.”
Yet sitting attentively, as if you have all the time in the world, will mean a great deal to the patient. Begin by asking the patient what he or she has been told and determine the person’s understanding of what that means, Ms Houlahan suggests. “You have to assess quickly, with all of your senses—and with your heart, too,” advises Ms Houlahan.
Reinforce what the physician has said, Ms Henry adds. Never contradict the team director or greatly expand on what the patient has been told, especially about prognosis. When patients receive a diagnosis of cancer, they often assume they will die; although they might fear saying that to the doctor, they will often open up to the nurse.
“Answer their questions honestly,” Ms Henry recommends. “You can say, ‘There are so many different outcomes. It would be best to talk with your doctor because he knows your specific disease.'”
DEVELOPING A PLAN
The cancer diagnosis triggers a series of decisions the patient must make. It also often necessitates a diagnostic workup to stage the disease and provide information for the physician to make more informed recommendations.
It’s important to make sure that before patients leave the office, they have a plan, Ms. Carrow advises. If patients have a plan, they feel a little more secure. “That plan can be as basic as ‘I will call you tomorrow morning.’ You keep the lines open. Don’t put it in their hands because they will be quite overwhelmed.
At that follow-up call, Ms Carrow will review what has been discussed and may talk about the testing required, future appointments, and symptom management. She adds that good information gives power to the patient. “Our role, as nurses, is to make sure that happens,” Ms Carrow points out.
Jane Edelman, RN, OCN, breast health nurse at Southampton Hospital in Southampton, NY, tries to ensure that patients understand the pathology report on the first visit. She also gives them a handbook, so they can read more about breast cancer after they go home, and a special gown. “The education and support are the most important things for these patients, and realizing that they are not alone on this journey,” emphasizes Ms Edelman.
When coming up with a plan, Ms Houlahan asks patients what is most important to them during the next 24 to 72 hours. “Break it down into small, manageable parts,” she advises. “That can ease their anxiety.”
Often nurses find themselves in a position of dispelling myths about cancer. Ms Dein inquires about patients’ experience with cancer, either personally or with a family member or friend. “That can taint their concept of what they are facing,” argues Ms Dein, explaining that someone whose mother died quickly of cancer will have different expectations than someone whose loved one survived. “Their experience may make it easy to deal with them or very difficult.”
Nurse navigators provide accurate information from an experienced professional. For additional support, Ms Dunphy suggests referring patients to hospital or community cancer support programs.