Oncology nurses are an integral part of patient care team. Sometimes, they are at the forefront of discussing difficult treatment- and diagnosis-related topics. Ann Katz, RN, PhD, a clinical nurse specialist at Cancer Care Manitoba, provided insight on how to talk to patients about “the elephant in the room” during a session at the 41st Annual Congress in San Antonio, TX.

Katz began by discussing a study published in Nursing Outlook that found oncology nurses “encounter barriers that impede the patient’s understanding of prognosis, delay transitions to end-of-life care, and contribute to non-beneficial treatments.” Interventions that empower nurses to engage in prognosis communications are needed, and education in interprofessional communication skills can be helpful.

When discussing sexuality, nurses may lack specific knowledge, which leads to a lack of confidence. Some of the barriers that impact a healthcare provider’s discussion of sexuality with the patient include conservation attitudes, fear of embarrassing oneself, fear of offending the patient, denial of responsibility, institutional issues, and a lack of awareness of guidelines on the topic. A data analysis published in Supportive Care in Cancer found that “although oncology nurses hold relatively liberal attitudes and recognize provision of sexual healthcare as an important nursing role, they possess limited sexual knowledge and communication skills, while often avoid or fail to effectively respond to patients’ sexual concerns.” 

Though infertility is a common side effect of oncology treatment, steps can be taken to preserve a patient’s fertility. This is another area of communication that can be lacking because of a provider’s belief of whether the topic is important, whether he or she has adequate knowledge, and barriers such as lack of time and resources, cost concerns, and no referral information. A study published in the Clinical Journal of Oncology Nursing found that only half of nurses discuss fertility preservation methods with patients, despite most believing that those discussions are part of their role. 

Factors associated with the discussion of fertility preservation among nurses included

  • Knowledge of procedures, fertility institutes and clinics, resources for patients, and practice guidelines
  • Attitudes, such as difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics
  • Behaviors, including patient initiation, physician behaviors, patient characteristics, and timing.

When counseling a patient who is overweight or obese, avoid contributing to the patient perception of judgement by sharing your own personal struggles with lifestyle change, Dr. Katz suggested. She noted that it is not necessary to provide patients with weight management counseling, but do alert them to the links between obesity and their cancer. Patients should be referred to the appropriate resources once the discussion has occurred.

Communication is a key element to discussing these topics. The patient’s accommodations, ability to adapt, family and caregiver relations and communication, health literacy, personal health goals, nonverbal messaging, and relational tension all impact patient−provider communication.

She provided a pneumonic device to help oncology nurses engage in these difficult conversations with SPIKES, which was originally published in the Clinical Journal of Oncology Nursing.

  • Get the Setting right
  • Gauge patient Perception
  • Invitation to discuss
  • Give Knowledge
  • Address Emotions
  • Provide a Summary/strategy

Katz concluded the session by noting the five A’s to focus on.

  • Ask
  • Assess
  • Advise
  • Assist
  • Arrange

Katz, A. (2016). The elephant in the room: Tackling tough topics with your patients. Session presented at the ONS 41st Annual Congress, San Antonio, TX, April 30, 2016. 

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