Communication Tools Help Patients Know What to Expect Before and After Cancer Treatment

Effectively communicating with patients about what to expect before and after cancer treatment is an essential element of patient care. Several new patient education strategies which nurses may want to try in their own practices were spotlighted in studies presented by four nurse researchers at the 2014 ONS Congress.

Preparing Patients for Breast Biopsy

Amy Singer, MSN, RN, from the Ohio State University James Cancer Hospital and Solove Research Institute in Columbus, discussed a booklet that nurses there developed in collaboration with their patient education department, describing what patients scheduled for breast biopsy should expect. The motivation to create this educational tool came from patient feedback on how to improve existing one-on-one patient teaching sessions conducted by the nursing staff. Before launching the project, staff anticipated that use of the booklet would promote active engagement on the part of biopsy patients and bolster nurse—patient relationships.

After using the booklet for 3 months, a survey was conducted to evaluate its impact. Of 27 patients who responded, all indicated that it was an effective teaching tool for learning what to expect before, during, and after breast biopsy. Over three-fourths of respondents agreed strongly that the material in the booklet was easy to read and to understand, and over two-thirds approved of the way the material was organized. Patients made useful recommendations for the addition of section tabs in future versions of the booklet to facilitate searching for specific information.

Promoting Patient Compliance After Discharge

The patient education efforts of Molly Henneberry, RN, OCN, and colleagues at the Billings Clinic in Montana, focused on post-discharge follow-up of acute care patients to facilitate better patient compliance with discharge instructions and provide more effective identification of patient needs, improve patient care, and decrease readmission rates.

A review of the medical literature had revealed that telephoning patients post-discharge could both decrease anxiety and reinforce discharge instructions. Given that little was known regarding outcomes in the growing practice of post-discharge calls to patients with cancer, oncology nurses at the Billings Clinic developed guidelines for calling patients post-discharge. All phone conversations were documented in the electronic record.

Since initiation of the program, over 1000 patients with cancer have been called post-discharge and assessed regarding pain, nutrition, elimination, and medication adherence, as well as to confirm follow-up appointments and patient comprehension of discharge instructions. Henneberry stated that fewer readmissions and adverse events had occurred thanks to early recognition of uncontrolled symptoms, disease progression, or patients’ misunderstandings of discharge instructions.

Pretreatment Chemotherapy Education

Denise Fleming, RN, BSN, OCN, from the University of California Davis Health System, Comprehensive Cancer Center in Sacramento, presented on pretreatment education efforts there for patients soon to undergo chemotherapy treatment. Again, the communication medium for education was the telephone.

Nurses at the Cancer Center designed and implemented a nursing prechemotherapy education phone call conducted the day before treatment to better prepare patients by setting expectations appropriately and helping to relieve anticipation anxiety. Many details not routinely addressed in the previous physician visit occurring a week or more previously were covered in the call.

A survey was developed to assess patient responses to the pretreatment call and to provide feedback for amending the call template. All 19 of the patients responding to the survey over the initial month of the program reported that the call had increased their satisfaction with the subsequent therapy and reduced their anxiety. When asked about any planned follow-up surveys, Fleming said,

“We are going to wait for a year out. With a 100% satisfaction rate, I don’t think we were going to find out anything different than what we were learning already from that one month.”

Participating nurses, who had been using valuable chemotherapy teaching time resolving preventable problems and conflicts on the day of treatment, felt that benefits of the proactive phone call included the identification of treatment obstacles or scheduling conflicts.

“We have a very set schedule that we need to operate on, kind of like a plane,” said Fleming. “We have a limited amount of time to do really precious chemotherapy teaching and we were using a lot of that time to explain things to patients that could have been done preemptively.” Fleming added that, “It’s good to get information, but the really beautiful thing was that the patients were walking in with a preexisting relationship with a registered nurse.”

“Making the Calls That Matter Most”

Michelle Wasko, MS, BSN, RN, NE-BC, also from the Ohio State University James Cancer Hospital and Solove Research Institute, highlighted a post-discharge call and follow-up visit protocol established for blood and marrow transplant patients there. The purpose of the protocol was to address patient concerns and to decrease hospital readmission rates by calling patients within 24 to 48 hours of discharge to identify and address any issues before they became problems. Literature had suggested also that return visits can be instrumental in decreasing readmission rates.

An interdisciplinary team of nurses, physicians, nurse practitioners, and billing personnel analyzed each phone call and accompanying readmission information. Data were used to aid in determining how the facility might best incorporate new transitional care codes from the Center for Medicare and Medicaid Services (CMMS) for the fee schedules that allow for follow-up calls and clinic visits.

Over 2 months, the researchers found that readmission rates decreased an average of 6%, and patients reported satisfaction above national benchmarks.

Wasko and colleagues noted that the protocol is now being initiated with other patient populations, with the goal of implementing it throughout the entire cancer hospital.

“As outcome measures continue to drive future reimbursements, developing and implementing approaches to continuity of care for our transitional patients is paramount,” the research team noted, adding that the current protocol offers an innovative approach to impact overall readmissions and improve delivery of patient care.

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