Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care

"I think the key in effective communication is building trust, because without trust, patients are not likely to engage in their care as effectively, which can influence patient well-being and their overall health outcomes. Building trust is, I think, crucial," Deb Christensen, MSN, APRN, AGCNS-BC, AOCNS®, founder and chief patient officer at the Cancer Help Desk, a nonprofit that provides personalized cancer treatment resources, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about strategies oncology nurses can use when approaching difficult conversations with patients across all populations. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to difficult conversations in cancer care. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Deb Christensen's ONS Voice articles about communication Oncology Nursing Podcast: Episode 14: Having Difficult Conversations in Oncology Practice Episode 208: How to Have Fertility Preservation Conversations With Your Patients Episode 235: Self-Advocacy Skills for Patients Episode 253: The Ethics of Caring for People You Know Personally Clinical Journal of Oncology Nursing articles: Tools for Communication: Novel Infrastructure to Address Patient-Perceived Gaps in Oncology Care Breaking Bad News: An Evidence-Based Review of Communication Models for Oncology Nurses ONS Resources: Palliative Care Communication Strategies Shared Decision Making in Prostate Cancer Journal of Oncology Practice article: Role of Kindness in Cancer Care SPIKES: A Framework for Breaking Bad News to Patients With Cancer Ask-Tell-Ask method City of Hope: The Interprofessional Communication Curriculum Center to Advance Palliative Care Agency for Healthcare Research and Quality's Health Literacy Universal Precautions 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 Today's Episode "Patients tend to be less anxious when they have a trusting relationship with their providers, with their oncology team on a whole, and they tend to follow through better on their treatment plan because they trust what you're saying. It's not easy to establish a trusting relationship when you first meet someone. But what I found in my practice is that anticipating their needs and really listening to their story has made a world of difference in establishing that trusting relationship—and admitting if I don't know the answer to something or if perhaps I've gotten something wrong." TS 2:32 "Intellectual empathy asks you to imagine yourself in that person's place. And we've all had challenging experiences; we just don't get through life without them. And as a result, we can generally think of a time when we might have been in a similar situation, maybe not exactly the same, but a similar situation, and garner that empathy for the patient and, importantly, for the caregiver, too. Because we genuinely, genuinely want to understand somebody. Intellectual empathy really comes from listening carefully to what's being said and what's not being said, analyzing different people's perspective, knowing your own bias, and asking open-ended questions." TS 4:41 "I think that the first thing that an oncology nurse needs to do is recognize that patients have their own autonomy to make their own decisions and not go into a conversation expecting a specific outcome. So going in with the intention to do your best, but also be open to what the patient wants to do." TS 8:30 "Our biggest foe in all of this communication, these communication strategies, really is time. We just do not have the amount of time. I mean, we love the luxury of time to be able to sit and really get into these kind of deeper conversations with people, but we may only have 30 minutes. We may only have 15. So, how do we do that? That is still a question that's out there that there's a lot of investigating. Are there techniques that can help? And there are." TS 13:47 "All of these points in the continuum have one thing in common, and that's uncertainty. That's really a whirlpool—uncertainty—for people. One of the communication strategies that I've used with people is letting them know that this is a very common emotion to experience—a sense of loss of control, uncertainty—and that in my experience, that people generally, once they have a plan, the anxiety settles. So, giving them kind of a guidepost, hope in the future, that the anxiety will settle. Because I would say 98% of the time it does, once people gain a sense of control, because they have a plan of action to move forward." TS 16:10 "The setting is really, really important, especially when you're having these challenging conversations. Always checking for understanding: What is that perception? What is the patient perceiving? What is the caregiver family perceiving? Are they understanding you correctly? And being respectful of what people want to know, because sometimes they don't want to know specific things." TS 21:57 "Oncology nurses need to be aware of their own biases and their own emotional state when they're going into these emotional conversations, these difficult conversations they really need to be in. You might not always be the right one for the conversation. I think that's an important thing to note too, and be able to admit that you may have had a personal life experience that just is not going to allow you to get around a bias or an emotional reaction to the conversation, and so you might not be the right one." TS 23:11 "I've always felt like if you can help someone find joy and peace in the moment, then that moment was made better. Life is a series of moments. That's kind of how I get through that piece of it." TS 26:20