Episode 368: Best Practices for Challenging Patient Conversations in Metastatic Breast Cancer

"That's what metastatic breast cancer looks like now—patients can live an extended period of time. And sometimes I think we forget to cheer for stable disease. I tell patients they can live with weeds in their garden; they just can't let the weeds take over their garden. And today we don't have a cure. We live in a rapidly changing time in oncology, and so there's just so much hope right now that we can offer patients," ONS member Kristi Orbaugh, MSN, NP, AOCN®, AOCNP®, nurse practitioner at Community Hospital North Cancer Center in Indianapolis, IN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about patient communication in the metastatic breast cancer setting. This podcast episode was developed by ONS through a sponsorship from Lilly. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes This episode is not eligible for NCPD. ONS Podcast ™ episodes: Episode 354: Breast Cancer Survivorship Considerations for Nurses Episode 350: Breast Cancer Treatment Considerations for Nurses Episode 345: Breast Cancer Screening, Detection, and Disparities ONS Voice articles: Black Patients With Metastatic Breast Cancer Are Less Informed About Their Clinical Trial Options What Is HER2-Low Breast Cancer? ONS books: Guide to Breast Care for Oncology Nurses ONS course: Breast Cancer Bundle Oncology Nursing Forum article: Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers ONS Biomarker Database American Cancer Society breast cancer resources METAvivor National Cancer Institute resources: Breast cancer—Patient version To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From This Episode "I think the most important and vital piece of having those conversations is making sure that we know—really know—that patient, because if we know them, that helps guide what they're needing right then, helps guide our verbiage, helps guide disciplines that we bring in." TS 2:04 "What do they want to hear? I've been in practice a really, really long time, and I've had the entire spectrum. I've had patients say, 'Tell me every single detail.' I mean, they want pictures. They want graphs. They want me to draw things. I've even had patients that want me to take markers and mark their body parts. … And then I've had patients that say, 'I don't want to know anything. I trust my healthcare team. I'm going to proceed with treatment, but I really don't want to know anything.'" TS 3:40 "Remember to make things as simple as possible until we really know what the patient knows. We don't send our children to school and start them out in eighth grade; we send them to kindergarten for a reason. So we get basic information, and then we build on that. And I think we need to remember that when we're doing our patient education, whether it's regarding new chemotherapy or treatment plans or palliative care, we've got to remember to start simple. And maybe we build on that very quickly, or maybe it takes a bit more time. Number one—I actually think it helps with adherence because patients understand what we're asking of them and why we're asking that of them." TS 12:00 "I think what's really kind of key to keep in mind is that patients are going to seek information. And so, we need to make sure that we're giving them really good, reliable, durable information because if we are not giving them good websites, if we're not giving them good written material, if we're not giving them good verbal information and education, they're going to contact 'Dr. Google.' Dr. Google is good for a lot of things, but sometimes patients can go down a rabbit hole that's not appropriate or not accurate. That's not a good place for them to be." TS 14:35 "If we find biomarkers that we call actionable, meaning that we find this mutation and we have a drug that blocks that mutation, that is what is going to guide and drive our treatment. Sometimes that can take a bit of time, right? And if we have a patient and they just find out they have metastatic disease, will they want treatment yesterday. And I understand that. … But frequently there is a very important period of waiting and allowing us to learn that enemy better by reviewing genomic testing, looking at that next-generation sequencing, looking at any positive biomarkers in breast cancer. They may have started out ER/PR positive. Are they still ER/PR positive?" TS 23:46 "I think when we're talking about goals of care, first of all, we need to make sure that the patient understands, when we're talking about metastatic disease today…, this is not a disease that we can cure, but hopefully it's a disease that we can manage for years to come. With that in mind, what's important to that patient? What is important to that patient in terms of life goals? What's important to that patient in terms of toxicities that they will allow and toxicities that they won't allow? TS 29:22 "If don't have a lot of medical knowledge, taking a pill seems less important than getting an IV. It seems like a bigger deal if I would miss getting my IV therapy. 'Oh, whoops, I forgot to take a pill. Maybe it's not such a big, important piece of my treatment.' So education—when we set that patient down, helping them understand how this drug works, mechanism of action in a simple term, why it's important to take it as scheduled, why it's important to take it with food or without food, why it's important to take it consistently." TS 34:41