Physician, nurse and patient: Equal partners in care
Patient care is not simply about diagnosing and treating a disease with the best-available medications and therapies. It is imperative that health care professionals remember the person at the other end of the needle. One of the easiest and yet most forgotten ways of accomplishing well-rounded patient care is through enhanced communication with all members of the health care triad — physician, nurse and patient.
According to an online Harris Interactive survey of hematologists/oncologists and patients with indolent non-Hodgkin’s lymphoma, there is a disconnect between providers and patients about patients’ major concerns.1 The survey, commissioned by Cancer Support Community (CSC) and Cephalon Inc., showed that although side effects of treatment and the potential loss of life are major concerns for everyone, providers should understand that patients have other worries as well. Of the patients surveyed, 48% indicated they were concerned about the chronic nature of their disease, but only 15% of physicians understood that to be a significant concern. Also, 60% of patients were concerned about their treatment options compared with 31% of physicians.
Programs such as Framing Life With Lymphoma, a web-based program sponsored by CSC, can help patients, physicians and nurses effectively communicate with one another to realize the best possible outcomes. Framing Life With Lymphoma encourages increased synergistic communication with tips and tools for all parties involved, especially in initial conversations about the diagnosis, the disease itself and treatment options, as well as in conversations during and after treatment.
When a patient is first diagnosed with cancer, the news is life altering. At this point, when patients are overwhelmed by thoughts of prognosis and how treatments will impact their lives, it is the role of the health care provider to step in as teacher to decrease anxiety and effectively communicate the exact information that patients need to know. During initial consults, health care providers can teach patients about the disease and what to expect by providing a timeline of planned treatments and when side effects may occur. Afterward, providers can offer packets of information that enable patients to become better educated about their disease and also encourage patients to do their own research to better understand their diagnosis.
Health care providers can offer guidelines about preparing for treatment, what foods to avoid, what to expect during chemotherapy and when to call the office if a problem arises. In our practice, providers go a few steps further by calling patients before treatment to address their concerns and to make sure they are fully prepared. Also, we recommend patients write down any questions they would like to discuss prior to receiving treatment. We instruct our patients to bring a list of their current medications and to complete a questionnaire on their medical and family histories. It can also be helpful to take patients on a tour of the chemotherapy area so they are assured it is not an intimidating place. Thorough guidance and education from the health care team helps patients live their lives as best they can within the parameters of their particular disease and side effects.
Health care providers rarely have the time necessary to effectively communicate with patients in a single appointment. It is important patients understand that appointments and consultations are an ongoing process, which include the initial diagnosis and discussion of the disease and possible side effects, follow-up appointments and treatment appointments.
Framing Life With Lymphoma emphasizes to patients the importance of knowing their health care team and building a plan that puts them in touch with staff members day and night, whether it is to voice general concerns or to reach out in cases of emergency. In our practice, we give patients a business card that provides the direct line to our “pod” that comprises a secretary, physician and nurse practitioner. Our open-door mindset allows patients to feel comfortable to call, come in, or email us to ask questions or discuss an issue that may be bothering them. The team is mindful to provide a supportive environment by welcoming patients, remembering their names and the details of their lives, celebrating with them during important life events and helping out during hardships, all in an effort to connect in ways that remind them they are important to us and the details of their lives matter.
Over the years, health care providers have improved the way they communicate with patients regarding treatment options. In the past, it was common to speak with the patient’s family members only. That pendulum then swung the other way to speaking with the patient only, leaving family members uninformed. Health care providers now appreciate the significance of open communication, so discussions are often a family affair. The entire support team shares the responsibility, thereby, making everyone part of the plan. Family support can also positively impact a patient’s treatment experience. The Harris Interactive survey showed that 68% of patients recognized support from family and friends as having had a major impact on the treatment experience.1
Support goes beyond family and friends, though, and it is important to make myriad services and groups available to patients seeking additional assistance. In our practice, if we notice a patient struggling with any of the mental, psychological or even financial aspects of the disease, we have counselors on hand willing to help. Also, we offer additional support by way of massage therapy, nutritional counseling, educational programs and pastoral services. Framing Life With Lymphoma also suggests patients try self support, by maintaining a healthy diet and or keeping a journal about the physical and emotional side effects of treatment. Such complementary, holistic care helps patients feel like they are not alone in dealing with their disease.
The involved patient
According to ASCO and the National Comprehensive Cancer Network clinical guidelines for therapy,2,3 there are times when more than one treatment option may be considered for a patient. In these cases, patients should be informed of their alternatives, including any available clinical trials in which they can participate or even exercise their rights to refuse treatment. Many times, treatment depends on patients’ unique life situations, such as how far they must drive to the health care facility, which may determine the frequency at which they are treated. Therefore, effective communication through patient involvement in critical decisions negates them having to put their lives on hold in order to properly treat the disease.
A health care team’s approach can mean the difference between a positive and negative experience, both at diagnosis and throughout the treatment process. It is often true that the patient’s concerns and priorities are not necessarily the same as those of the health care team; thus, effective communication is critical to ensure the patient is heard. By assuring the patient that his or her thoughts are important, you will take a sizable step toward creating a comfortable, nurturing space that maximizes communication and sharing, and reduces the confusion and vulnerability that often accompanies silence.
- Framing Life with Lymphoma survey fact sheet. Cancer Support Community. http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Types-of-Cancer/Non-Hodgkin/Framing-Life-with-Lymphoma/National-Survey-Results.pdf. Accessed Oct. 12, 2011.
- Clinical Practice Guidelines. ASCO. http://www.asco.org/ascov2/Practice+&+Guidelines/Guidelines/Clinical+Practice+Guidelines. Accessed Oct. 31, 2011.
- The NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Oct. 31, 2011.
Nancy Zieber, RN, MSN, CRNP, is in collaborative practice with David Henry, MD, at Pennsylvania Hospital in Philadelphia. Disclosure: Ms. Zieber reports no relevant financial disclosures.