Abstract
Scope of Problem: Understanding care needs across the cancer trajectory requires sensitive communication about diagnosis, discussing factors influencing treatment decision-making, mediating family communication, and psychosocial counseling about difficult topics. Oncology nurses, especially Advanced Practice nurses (APRN), are expected to initiate shared decision-making with the patient and family; however there is little instruction available for nurses on how to communicate in a way that accomplishes this approach.
Purpose: To assist oncology nurses with discussions about care topics, we received funding from the National Cancer Institute to provide a two-day communication training course offered annually for four years to a cohort of 100 competitively selected oncology nurses. Methods: Participants in our first course (n = 82) completed a pre-course survey to report educational offerings at their institution, the perceived effectiveness of communication with patients at their institution across the cancer trajectory, and their own degree of difficulty with communication topics. Results: More than 75% of teams reported that their organization had not provided training on how to break bad news, talk about goals of care and care transitions, or talk about recurrence. Nurses rated communication with patients about survivorship (4.36), end of life (4.64), during bereavement (3.92) and time of death (4.72) as least effective at their institution (on a scale of 0 = not effective to 10 = very effective); and their own communication about hospice and palliative care (5.18), conflicts with patient/family (5.18), conflict with team members (4.87), and financial topics (4.08) as most difficult (on a scale of 0 = not difficult to 10 = very difficult). More than 50% of nurses surveyed are present when bad news or prognosis information is provided to the patient.
Implications for Practice: This nationwide training provides nurses with education to improve communication with patients and families across the cancer trajectory. Conclusion: This communication training curriculum focuses on understanding the patient narrative, including the family caregiver, and providing psychosocial and spiritual care. Care needs across the cancer trajectory communication training for oncology nurses is needed, especially given their strong impact on quality patient care and family support.
