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Preparing for Patient Reactions After Delivering Bad News

May 7, 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, Administrative Director, The Johns Hopkins Breast Center; Director, Johns Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

Patient reactions can greatly differ when receiving news of recurrence or disappointing test results. It’s the job of the oncology nurse navigator or oncology patient navigator to meet them where they are emotionally and always be honest with them.

In part 1 of this 3-part series, I discussed how the oncology care team can prepare for these conversations by preparing themselves and the patient at the beginning of treatment. In part 2, I provided advice for oncology professionals who fear these conversations and how they can make a patient more comfortable. In this installment, I will discuss the different reactions patients can have and how navigators can help.

If there is a situation where a member of the care team isn’t adequately prepared to give bad news and delays deliverance, this can negatively affect the patient in the following ways:

  • The patient may assume they are doing better.
  • The patient may be under the assumption they have more time left than they really do.
  • The patient still believes a miracle is possible.
  • The patient is given false hope.
  • The patient is further delayed in hearing the truth and facts and, in the end, lacks time to get closure that is needed.

Patients need your support, education, advocacy, honesty, and you serving as their touchstone as they begin a difficult journey that lies ahead. Some of the most common reactions from a patient receiving bad news are:

Anger – “I did all the treatments you told me to do, and it was all for nothing.”

Guilt – “You told me to take chemotherapy and I refused because I didn’t want to lose my hair. Now I am going to die instead.”

Control – “You have to fix this; this is why I chose you as my clinician.”

Disbelief – “I will find a doctor who will give me a better answer than you are giving me.”

Confusion – “I don’t understand. They are saying on TV every day that there are drugs to cure this. Right?”

Denial – A patient may have been keeping some health issues a secret because it likely means their cancer is advancing. They may smile and lie to the doctor and say they’re feeling fine. In this instance, a navigator needs to step in and say, “You look good! But do you feel as good as you look?”

As oncology navigators, we can guide our patients through these emotions by reminding them of their care goals and connecting with them through all the things we’ve learned about them through our time together. You can support them by having conversations about:

  • What treatment options exist and how decisions will be made WITH them regarding what treatments to consider.
  • Explaining to them how many treatments are left to help them formulate a timeline in their mind and determine how much time they have to get affairs in order, spend time with family, etc.
  • Initial treatment goals and how we can pivot. Treatment for treatment’s sake should never be a goal—yet there are many patients still today getting chemotherapy within 3 weeks of their death.

When the news is really bad, there isn’t a need to rush to treatment, and patients will be emotionally overwhelmed and unable to function until they have met with the medical oncologist and other multidisciplinary team members to put a plan into motion. If this is a diagnosis of distant recurrence, for example, and they recall that treatment got underway swiftly when they were first diagnosed, the patient may feel that the treatment team doesn’t care anymore since they appear to be dragging their heels. It is important to explain that additional studies, bloodwork, and scans are likely needed before a comprehensive plan can be created to take care of the patient now.

Bad news can be very confusing to patients and their families. The mission is control of the disease while preserving quality of life. These conversations can be a tough pill to swallow, but must be handled with care, confidence, and a plan in mind to ensure the patient fully understands their prognosis and next steps.

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