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Preparing Patients for Hard Conversations

March 22, 2021 | AONN+ Blog
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Professor of Surgery, Johns Hopkins University School of Medicine; Co-Developer, Work Stride-Managing Cancer at Work, Johns Hopkins Healthcare Solutions

Hard conversations are a part of working in oncology. There are many situations that can occur during a patient’s treatment journey where you will have to deliver bad news. In some cases, the cancer has returned in the form of advanced metastatic disease, in others, the amount of options for treatment become fewer.

It’s becoming a common practice to bring oncology nurse navigators into these difficult conversations to address questions and concerns after the doctor has left the room. In this 3-part series, I will be addressing ways oncology navigators should be approaching these conversations.

There is great value in creating and maintaining an honest relationship between the patient and their treatment team. From the beginning, oncology nurse navigators and patient navigators should assess their patient’s treatment goals and gauge their level of understanding of current and future clinical outcomes.

To understand your patient better, ask them the following questions:

  • How much do you want to know about your cancer?
  • Can you explain what you currently know about your cancer?
  • Who do you want to include in discussions about your cancer and treatment options?
  • Do you want me to write down information regarding your cancer?
  • What is important to you?
  • What are you hoping for?
  • What is your understanding of your clinical situation?
  • What are 3 things that bring you joy?

Through these questions and throughout treatment, you should become familiar with your patient to better understand their life and what their future will hold. You should be able to answer questions like:

  • Where did your patient grow up?
  • What is your patient’s career path?
  • Is your patient married? How long? Children? Grandchildren?
  • What is the patient most proud of?
  • How does your patient enjoy spending their free time?
  • Does your patient currently have financial worries?
  • At this current moment in time, what does your patient consider to be their legacy?

Having in-depth conversations early on will give the patient a better understanding down the line and allow you to identify ways to give patients control over their lives by discussing what is important to them, how to determine when to stop treatment, and planning for survivorship or end of life. We have learned from evidence-based research that patients want to know the truth, and being honest does not take away their hope or cause depression.

To gauge your patient’s understanding of their care, ask them to repeat back to you what the doctor has told them. The beginning of care is also a great time to debunk myths surrounding palliative and hospice care. Before a patient has advanced symptoms, bring a palliative care specialist on board to serve as a “quality-of-life” coach. The goal of the palliative care specialist is to preserve quality of life or restore quality of life through effective symptom management. Determining when a patient may want to transition to hospice care before they reach that stage will allow them to better understand that hospice care isn’t giving up, but reaching the end of life on the patient’s own terms.

By learning the goals of care early on, we can continue to incorporate these goals into treatment and help the patient gain control during a time of uncertainty. These conversations will help guide any deliverance of bad news that may occur throughout treatment. In the next part of this series, I will be addressing why these conversations are difficult for healthcare providers and providing some tips to help.

Take the time to look at these short videos to use as teaching tools and resources:

  1. Metastatic Cancer Part 1
  2. Metastatic Cancer Part 2
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We should encourage patients with advanced cancers to rethink the timing of doing things that bring them joy.
Young Patients with Breast Cancer Living with Regret
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Oncology navigators need to make sure that patients with breast cancer actively participate in the decision-making about their care and treatment.
Mental Health and Cancer
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Navigators need to be aware of the mental health issues that patients with cancer may face during and after their treatment.

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