The Quiet Ones

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Some patients respond to a cancer diagnosis by shutting out the world. They may feel as if they have been given a death sentence and are now no longer a part of the world, or they might be distancing themselves from the diagnosis (“this is not really happening to me, and I am going to step aside and watch from the outside”). The quiet patient appears to listen to what you are saying, but the nurse as a health care professional dealing with this patient can see that the information is not being absorbed.2 Patients who do not have a caregiver to ask questions on their behalf may have difficulty articulating their thoughts and may miss the opportunity to fully understand their disease and treatment.4

Oftentimes the quiet patient is misinterpreted as being apathetic, angry, confused, or even disinterested. This patient may require psychosocial support before he or she can cope with the diagnosis and treatment plan.2 The first objective here would be to assess how the person handled/overcame other crises in their lives and how effective those tactics were. If this is a person who has always closed themselves off in time of crisis, then the health care team would need to determine how to support this patient while providing the information necessary for self-care during treatment.2

Educated, or Over-Educated

A number of years ago, I worked at a facility where patients thoroughly researched their diagnoses, and we would review all the information they brought to us. I currently tend to see patients with blood cancers that do not manifest until later in life and who are not as savvy on the Internet as younger generations; therefore, I do not see a large number of patients who are well-educated about their disease in my current environment. Many times the patient’s child or younger caregiver is the one who arrives for an appointment with printouts from medical websites detailing the symptoms or prognosis for the patient’s disease.

Not only has medicine itself changed over the years, but our immediate access to information about medicine has also changed.1,2 As medical professionals, we need to educate patients about their condition, and in some cases, we need to uneducate patients and their caregivers, explaining why information they heard or read may not apply to them.1

My first reaction is to advise the people involved what many of us probably tell our patients: “Take everything you read with a grain of salt.” Although the information they are getting is not necessarily wrong, it may not apply directly to their situation. We also have a responsibility to direct people to appropriate and reliable websites.  It is our responsibility to encourage patients to be advocates for their own health, while still trusting in the training and experience of their health care team.1


One certainty of medicine is that it will continue to evolve, thereby continuing to shift the job descriptions for oncology nurses.2 The more we understand about our patients, their unique needs, wants, goals, and concerns, the better we can guide them to ensure treatment success, regardless of their treatment type.2,4 I encourage my fellow oncology nurses to spend time getting to know their patients to determine what type of care they need. Is your patient returning to treatment after a period of remission and in need of emotional support? Or is your patient having trouble sticking to the oral medication regimen and needs someone to create a calendar or fill their pill box?

The profiles described here are just a starting point. I hope they encourage you to recognize and appreciate the individualized nature of modern cancer care, as well as the need for nurses to take on the challenge of oral regimen adherence.

Carol Blecher specializes in hematology/oncology at Trinitas Regional Medical Center, Trinitas Comprehensive Cancer Center in Elizabeth, New Jersey. 


1. Blecher CS, Ireland AM, Watson JL, Conrad KJ. Standards of Oncology Education: Patient/Significant Other and Public. Pittsburgh, PA: Oncology Nursing Society; 2016.

2. Bastable SB, ed. Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. Burlington, MA: Jones & Bartlett Learning; 2014.

3. Neuss MN, Gilmore TR, Belderson KM, et al. 2016 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards, including standards for pediatric oncology. J Oncol Pract. 2016;12(12):1262-1271. doi: 10.1200/jop.2016.017905

4. Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health Literacy Universal Precautions Toolkit. 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Publication No. 15-0023-EF.

5. Schwartzberg JG, Cowett A, VanGeest J, Wolf MS. Communication techniques for patients with low health literacy: a survey of physicians, nurses, and pharmacists. Am J Health Behav2007;31(suppl 1):S96-S104.

6. Spoelstra S, Rittenberg CN. Assessment and measurement of medication adherence: oral agents for cancer.Clin J Oncol Nurs. 2015;19(3 suppl):47-52. doi: 10.1188/15.s1.cjon.47-52

7. Health Literacy: A Linchpin in Achieving National Goals for Health and Healthcare. Washington, DC: National Quality Forum; March 2009. Issue Brief No. 13.