Communication is key in delivering compassionate, patient-centered care. No one knows this better than Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG, a University Distinguished Service Professor of Breast Cancer at Johns Hopkins University School of Medicine, Baltimore, MD, cancer survivor, and Journal of Oncology Navigation & Survivorship (JONS) Editorial Board member. To help facilitate effective and empathetic conversations during one of the most challenging times in a patient’s journey, Ms Shockney has partnered with the Medical Learning Institute to offer a free continuing medical education (CME)-accredited series called “Oncology Communication Skills.”
By enhancing communication skills, healthcare providers can encourage patient engagement in decision-making, support improving quality of life, and empower patients through the complexities of end-of-life care. While this training is particularly valuable for those working with patients with metastatic breast cancer, the principles shared are universally applicable to any advanced cancer setting. Healthcare professionals who participate will earn CME credit while gaining practical tools to enhance their professional expertise and emotional resilience, ultimately improving the care they provide and reducing personal stress.
JONS had the pleasure of speaking with Ms Shockney about this series. What follows is our thoughtful exchange.
There is no situation more difficult for a patient than learning they have advanced cancer. The individual delivering this news may be an oncologist or even a nurse navigator. Although there may be limited time to devote to such conversations, our patients always deserve compassion and honesty from us.
The patient is far more than their pathology and scan results. They deserve patient-centered care. We must go beyond just treating the disease. We must get to know our patients and see them as someone who had a life before their diagnosis and still need to be living their life during treatment. We need to focus on their goals of care and not on treating the disease.
Giving treatment for treatment’s sake is bad care. I have heard from patients across the country who didn’t understand their options. They fear their oncology team isn’t being truthful with them.
Frankly, giving treatment for treatment’s sake is bad care. I have heard from patients across the country who didn’t understand their options. They fear their oncology team isn’t being truthful with them to avoid a difficult discussion that likely will lead to talking about planning for end of life.
I have been contacted by hundreds of patients with stage IV cancer across the country who want help understanding where things stand at this time regarding their longevity. They are receiving treatment that they say is doing nothing and are feeling very ill. They want to stop treatment, but their doctors want them to keep going. Clearly, there was no agreed-upon plan to engage in shared decision-making.
We must help a patient develop criteria that, when reached, mean they are ready to take a different path, a path that transitions them to hospice care. Oftentimes, hospice is explained poorly, and the patients (and sometimes even the doctor) see it as giving up or failing—but that is not what hospice is. It is giving back control to the patient over the remainder of their life and having them choose how they want to spend that time.
Ironically, once patients stop receiving toxic treatments, they start to feel better—a gift unto itself. Many patients with advanced diseases don’t even know that the goal of treatment is no longer to cure but instead to control the disease for as long as possible, while preserving quality of life. Approximately 20% of patients with cancer die in an intensive care setting, which signifies that there was no discussion about planning for end of life.
Asking the patient these key questions at the time of their first consultation (and every visit thereafter) is key to delivering the type of care they need from us:
To that last question, I have had patients respond, “Well, I have breast cancer, bone cancer, and lung cancer,” to which I respond, “Actually, that is not what your clinical situation is. You have breast cancer that has spread to the bones and lungs.”
All too often patients are still receiving cancer treatment within a month of their death, only getting to experience an average of 5 days without therapy—that is shameful, and usually only due to the patient being too ill to get another dose of chemotherapy.
No end-of-life planning was achieved. The family witnessed their loved one suffering. There is no time for effective closure. It makes me angry. A patient may still believe they can be cured when that wasn’t possible from the start.
Providers have been taught in school how to treat the disease instead of the patient who has advanced cancer. Patient surveys have validated that the most important thing to them is honesty from their providers. They also want to be able to understand their clinical situation and feel confident that they are receiving the right care.
Providers believe that if the patient is still alive, then they are doing their job; they consider hospice a sign of failure and see their patient’s death as their own failure. This is wrong. If they take the advice and teaching points I have included in these communication skill trainings, they can take pride in the care they have provided, lead the patient into end-of-life planning, have their patient fulfill the elements needed to achieve a peaceful death, and feel confident they have worked with the patient to enable effective, shared decision-making.
They will quickly see that the outcomes of adopting these new communication skills will result in feeling more fulfilled as a healthcare provider and no longer feeling like they have failed their patient. Our stress is oftentimes attached to seeing a patient getting sicker and sicker while they continue to receive toxic treatments destined to make them feel worse. I have witnessed providers who have adopted this new method of communication experience less compassion fatigue. When we move from feeling like a failure to being able to take pride in caring for our patients and seeing them through to end of life, we can recognize that this new way of conversing is what is needed for the patient and for the provider.
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