After the cancer diagnosis: What do you say—and do—next?

VALUING CULTURAL DIFFERENCES

Although nurses should never stereotype a patient on the basis of ethnicity or religion, they should remain mind­ful that in certain cultures, accepted practices, such as eye contact, may make the patient uncomfortable and adjust accordingly.

“Nurses use a lot of touch, and it’s appropriate,” Ms Henry says. “But if you put your hand on the person’s shoulder and he or she recoils—do not touch the person again, at least not at that moment. A lot of it is intuition.”

Ms Henry adds that nurses should always identify themselves and ask how the person would like to be addressed. When working with an interpreter, Ms Dein recommends that the nurse face the person and direct the conversation to the patient, not the translator.

HEARING THE NEWS BY TELEPHONE

In some cases, nurses follow up by telephone after a physician, sometimes a radiologist the patient does not know, has informed the patient by telephone about the cancer diagnosis.

“Hearing the message on the phone is rather cold; I’d much rather do it face-to-face,” emphasizes Maureen Lockwood, RN, BS, OCN, clinical coordinator at the Women’s Health Center at Saint Clare’s Health System in Dover, NJ. But logistically, that doesn’t usually happen. Radiologists call as soon as the pathology report comes in, and then Ms Lockwood follows up.

“Compassion, patience, listening are the things I use,” Ms Lockwood says. “A lot of it is instinct and awareness that no two women accept the diagnosis in the same way.”

Telephone consults present additional challenges to good communication. “You can imagine how hard it is over the telephone to get a feel for this person,” Ms Gilmore suggests. “I cannot see them. They cannot see me. I use a lot of silence and reflecting.”

Ms Gilmore may have access to the medical record but no personal knowledge about the patient. She starts by asking if it is a good time for the person to discuss the “difficult news,” and then she just pauses. She finds most people want to talk.

Yet patients often try to dismiss Ms Gilmore’s concerns, telling her they are fine. Even on the telephone, the experienced nurse can pick up subtle clues indicating that may not be the case. She might repeat, “It must be hard news to take,” and let that hang in the air.

Ms Gilmore notes that patients will often tell her they are fine and then suddenly they start to cry. Then, she says, “we will talk about what it feels like to get that phone call.”

Sometimes all Ms Gilmore can accomplish during the first interaction is to set up a second meeting, preferably in person, with a goal of providing more information about the diagnosis so the patient can better discuss options with the physician. “If they understand the diagnosis well, they are better able to choose than if they are still at the point where they don’t know what’s wrong,” Ms Gilmore maintains. “I try to help each patient be ready to get the most out of time with the specialist.”

CARING FOR CHILDREN AND THEIR PARENTS

When the patient is a child, the provider must inform both the patient and the parent. At The Children’s Hospital at Montefiore Medical Center in Bronx, NY, nurses are in the room with the family as the attending physician gives the news. This approach reinforces the team concept, and all the clinicians know what has transpired. Often a child-life specialist will stay with the child while the providers talk separately with the parents.

“The parents can be a little more open with how they are feeling and with questions they wouldn’t want to ask in front of the child,” offers Joan O’Hanlon Curry, ANM, CPNP, CPON, administrative nurse manager of outpatient pediatric hematology/oncology at Montefiore. Parents more than children, she says, get that “deer-in-the-headlights” look. At that point, Ms Curry will schedule another visit to discuss testing, treatment, and “softer issues,” such as symptom management, school, and treatment logistics.

“The most important thing is to reassure them that they are not alone,” Ms Curry says. “That’s your biggest job as a nurse—to make this as tolerable as possible, for the family and the patient.”

DISPENSING HOPE

Nurses often encourage patients to call them with questions and allow them to serve as a resource. For many patients, just knowing the nurse is there and can offer guidance throughout testing and treatment is reassuring.

Cancer patients “are alive and need to be treated like they are alive and going to have a life,” Ms Houlahan says. “Give them hope. It may not be hope for long-term survival, but it can be hope for control or comfort care and that they will never be abandoned.” ONA

Debra Wood is a medical writer in Orlando, Florida.

From the May 01, 2010 Issue of Oncology Nurse Advisor