I was rounding at a hospital and received an update on a 67-year-old female patient from our physician before going to see her. Mrs. B had a history of stage IA endometrial cancer about a decade earlier. She had a total hysterectomy and was cleared of cancer at that time.
Recently, she came to the hospital for abdominal pain. She presented to the ED where a large mass was identified in her lower abdomen via CT scan that was pressing on her femoral vein. This mass was biopsied and she was now waiting for the results.
Mrs. B was not in our usual oncology unit due to overcrowding. Our physician had seen this patient the day prior and in her progress note shared that a recurrence of her Stage IA endometrial cancer would be unlikely since she had 10 years of follow-up and no symptoms or evidence of recurrence of the disease.
The morning I was to see Mrs. B, the pathology results were available and the physician and I discussed them before I went to see Mrs. B. Unfortunately, the pathology showed adenocarcinoma with the likely source being endometrial.
While the oncologist and I were discussing this on a different unit, the attending physician gave Mrs. B the bad news that her cancer had returned. Shocked and dismayed, Mrs. B and her husband did not have much of a response. The attending physician left. Enter the staff nurse.
As we all know, staff nurses get so many of the questions that many patients do not have the opportunity to ask the physicians. Mrs. B had so many questions about what the attending physician had just shared. The nurse tried to reassure them, and in doing so, looked up the last note from the oncologist from the day prior. The nurse then told Mrs. B, “According to what your oncologist said, you likely don’t have cancer. It must be something else.”
As the oncology nurse practitioner, I was next on the scene. While I was introducing myself and sharing with her the next step of the GYN oncologist coming to see her, Mrs. B stopped me. She was very puzzled and distraught and said, “I am so confused! Every time someone comes in here they are either telling me I do have cancer or I don’t! Please explain what is going on!”
I asked her to explain who had been telling her this information and she recounted to me the events described above.
I realized the staff nurse was last in their room and read a note from our oncologist that no longer was the situation now that pathology results were in. I explained this and apologized on behalf of our staff.
I left the room satisfied that they understood the situation, but inside I was furious! I remembered from my nursing training and education that we, as registered nurses, were not supposed to interpret for or diagnose a patient because it was outside of our scope of practice and could lead to issues such as this one.
The staff nurse was waiting for me outside Mrs. B’s room. She told me the attending physician wanted to send Mrs. B home. I answered by letting her know that Mrs. B was very upset because she was told she did not have cancer when she actually did. I knew her intentions were good, but she also did not realize what torture she had just put this woman through. The staff nurse leaned against the wall for support and said, “But all I did was read to them what your doctor said yesterday.”
“Did you see the pathology report that resulted today?” I asked. Her face quickly turning colors, she replied, “No.” I responded, “Unfortunately for Mrs. B, it appears her endometrial cancer did return. I explained all of this to her and apologized to her that she was told otherwise.”
I left it at that. I could tell the staff nurse was experiencing a very profound and uncomfortable dilemma. And I pray she never makes that mistake again. But it made me realize how delicate communication is. In oncology, there is a delicate nature to our conversations with patients. And most times, I encourage the patient to talk with the physician if they ask me about a new result that has not been shared with them yet. If they insist, I stop and go get the physician.
It is important for us to be cautious with our words and know that it's OK to say, “I don’t know” or “Let me find someone that can better explain that to you.” These are rules we must uphold in our profession.
Has anything like this ever happened to you? If so, what was the cause? How was it addressed?