In today's busy oncology practice, a physician often relies on an oncology nurse to reinforce the informed consent process education he or she has provided to newly diagnosed cancer patients. Oncologists place confidence in their nursing staff to provide comprehensive information on the treatment regimen, the oncolytic agents to be administered and the supportive care medications used for managing the treatment's side effects.
Oncology nurses have never been more challenged to budget adequate time for preparing these newly diagnosed cancer patients and caregivers with this information. The severe shortage of available experienced oncology nurses, rising labor costs and dwindling reimbursement from payers add to the challenge. Doing more with less has become the mantra of oncology nurses. They are expected to teach the patient about the cancer disease process, the action and side effects of each chemotherapy agent, administration techniques for drug delivery and symptom management self-care issues. They must also address when and whom to call for oncology emergencies.
Adding to this challenge is the knowledge base of the nurse who's providing the education. Patricia E. Benner's book, From Novice to Expert, identifies the five stages of skill acquisition. Because of their limited knowledge, novice nurses (those with fewer than one to two years of oncology experience) are not considered the best candidates for educating patients.
Literature on this topic emphasizes that the information presented to patients should be standardized so that important details are not missed or skimmed over as a result of time constraints. In light of this, we at The Oncology Group encourage you to establish a formal chemotherapy class for patients and their support system, who serve as an additional set of ears. The goal of this class is to impart general information on treatment, common side effects and clinic/infusion center protocols. This class can be for many patients or just those on similar regimens.
Your class would ideally be offered two to three times a week, preferably in the early morning, allowing patients who need to start chemotherapy to be scheduled for treatment after the class. Complete with slides and handouts of relevant material, the class would address topics including the cancer disease process, treatment modalities, side effects of treatment, oncologic emergencies and general tips on office/clinic procedures.
We suggest delaying the start of a patient's chemotherapy until he or she has attended the formal training session. This short waiting period allows your business office to verify coverage, obtain authorization when applicable and provide financial counseling to the patient and his support system.
A review of the literature reveals that patients comprehend and retain only a small percentage of information provided. Generally, seven new items of information are the maximum anyone can process at a time. Since more than 60 percent of information we process is visual, using a PowerPoint presentation will ideally help patients and their families decrease their apprehension about starting chemotherapy. A copy of the PowerPoint presentation along with materials from reputable health sources should be provided for patients to keep. The National Cancer Institute provides booklets on each cancer state, such as Chemotherapy and You and Eating Hints.
Once the patient has completed the class, the oncology nurse who is delivering the treatment can discuss individual drugs and their side effects with him and his support companions. The treating nurse may also give them a copy of information on each drug to be administered.
We recommend these broad topics for inclusion in the class curriculum (for a comprehensive list of recommended topics, please contact us at [email protected]):
- Hand washing technique
- Understanding your CBC
- Expected side effects and how to control
- Thrombocytopenic guidelines
- Low residue diet
- Neutropenic guidelines
- Oral hygiene guidelines
- Nausea and vomiting
- Emetogenic potential of drugs
- Pain and its management
Also, a handy quick-reference guide on whom to call at the office/clinic—and when to call—is essential for your patient and his support system. It should include office/clinic hours, how and when to leave messages or email office/clinic staff (if applicable), your physician on-call procedure and which emergencies require the patient to go directly to the emergency room.
Each visit your patient makes to the oncologist and the infusion suite offers opportunities for your nurse and other staff to reinforce his learning and answer questions. We suggest telling patients to bring to each visit all the medications they're taking, including herbs and alternative therapies, plus a list of questions for the oncologist and the nurse.
Preparing your patients for treatment is a key step in delivering the best care. The expert consultants at The Oncology Group can help you plan and implement a comprehensive yet streamlined education program that enables your nurses and other staff to provide essential information to your patients and those who support them. To learn more about The Oncology Group's services, please contact us at 512-583-8815 or by email at [email protected].