While talking to an old friend about her experience with cancer and chemotherapy, we discussed the important factors that affected her recovery.
In many instances, the delivery of cancer care is fraught with deficiencies in communication, coordination, and accountability. In addition, patients with cancer tend to be vulnerable, older, and have multiple comorbidities and unique psychosocial needs. Patients may be exposed to conflicting information, duplicate procedures, confusion about treatment plans, and unanswered questions.
The concept of patient-centered care has gained increasing attention in recent years as a goal of the US healthcare system. In the paper "Patient Centered Care: What does it take?" Shaler (2007) identifies the key attributes of patient-centered care. These include:
- Education and shared knowledge
- Involvement of friends and family
- Collaboration and team management
- Sensitivity to nonmedical and spiritual dimensions of care
- Respect for patient needs and preferences
- Free flow and accessibility of information
Our challenge as clinicians is to incorporate these attributes into our daily practice. We need to forge a partnership with patients, showing respect for their wants, needs, and preferences while providing support and education to encourage participation in their care.
This involves a change from the paternalistic approach where we talk at patients and tell them what they should not do and what they need to do. We must find out what is important to the patient. Our focus must be on shared decision making with patients, and to do that we must realize that communication is a two-way street.
Do we provide a supportive, safe, and trusting environment? Are our patients able to discuss secrets without fear or judgment? Is our practice environment arranged for the benefit of the patient?
Suggested strategies, noted both in the literature as well as identified by patients, include the following:
- Personalized handouts with information on when to call the MD with what signs, symptoms, and emergency contact information.
- Checklists emphasizing nutrition, exercise, questions regarding support, comorbidities, health maintenance such as using sunscreen, and tips for reducing the risk of infection during chemotherapy treatments.
- Frequent reports to a patient's primary care physician in order to promote seamless care.
- Friendly and supportive office staff. Patients should have no fear to call the office with questions. Patients can overhear tone of conversations with other patients. Are questions encouraged and clear explanations given?
- A specific chemotherapy area with pleasant, soothing music; available snacks; comfortable chairs; reading material; family encouraged to stay, if desired; and written sample patient education materials. From my personal perspective, I plan to explore the possibility of massage therapy and relaxation breathing exercises as a possible resource for patients during chemotherapy.
How does your practice compare with the above mentioned attributes of patient-centered care? Are there opportunities for improvement? Can we as nurses lead the way to transform the cancer care provided to our patients? Can you share some successful strategies that you have implemented?
Shaler, D. (2007) Patient Centered Care: What does it take? The Picker Institute, Inc.
Available at Picker Institute.