The fine line between cancer as an acute versus a chronic illness has blurred, thanks to early diagnosis and better treatment.
Almost 12 million people in the U.S. have had a cancer diagnosis, completed therapy, may or may not be cured, and are ready to move on, says Shirley Stagner, RN, ONP, nurse practitioner, Lawrence Hospital Center, Bronxville, N.Y. The CDC has identified this group as a public health concern, because these individuals often are left with problems or concerns related to the cancer diagnosis or treatment, she says.
Nurses are in a key position to help patients manage cancer as a chronic illness and maintain a good quality of life. The challenge is to use creative strategies that engage patients before, during, and after their care.Shirley Stagner, RN
Knowing Is Just the First Step
Knowledge helps patients promote wellness and live with cancer as a chronic illness. Through educational programs, patients learn skills that help them to cope and to communicate better with their healthcare providers. The days of the traditional lectures are over, says Leah Scaramuzzo, RN, MSN, AOCN, interim associate director of Intra- and Extramural Nursing Education, The Cancer Institute of New Jersey, New Brunswick. For educational programs to be effective, they must be interactive, short, relevant, and engage patients in their care, she says.Leah Scaramuzzo, RN
At the CINJ, Scaramuzzo and Jayne Camporeale, RN, MSN, APN-C, nurse practitioner, designed a new Orientation to Radiation Program to inform patients, decrease their anxiety, and provide self-management through preventive healthcare strategies. We want patients to interact with us and learn how to prevent and avoid adverse effects of the treatment regimen that could lead to hospitalization, Scaramuzzo says. By implementing this new program, we aimed to increase patient satisfaction and adherence to treatment regimens and positively affect outcomes, she says.
Studies show that educational programs that emphasize self-management and prevention are effective in increasing patients self-efficacy and health status and reducing rates of hospitalization and trips to the ED.
Studies also show that patients report fatigue as a common radiation side effect, but say that they didnt realize this would occur, says Camporeale. It isnt that nurses arent doing their jobs [educating patients]; anxiety may be the culprit that blocks information that has already been presented, she adds.
The self-learning module, created by Camporeale and Scaramuzzo and read at the patients leisure, decreases anxiety and reinforces information. Patients can view the new 30-minute, self-learning module online, via DVD or iPod, a number of times and at their convenience.
The module consists of an automated PowerPoint Slide presentation with audio and a narrative below each slide. Patients and family members learn about the process of receiving radiation, what to expect, and what resources and services to call on if a problem occurs.
Patients can walk through a virtual tour of the Radiation Department, which also shows the logistics of parking and registration, as well as steps for treatment and follow-up visits. Patients can watch the tutorial and write down questions to ask their healthcare providers later.Kathy Andersen, RN
A Therapeutic Learning Environment
Education calls for a personal touch, making patients feel that someone is stepping into their space and sharing their burdens, says Kathy Andersen, RN, MPA, OCN, clinical educator, Oncology, IV Team, Med/Surg, Lawrence Hospital Center. When patients get to know the nurses, they feel assured that they have someone they can call on for help at any time, she says.
Mindful that the initial days of cancer treatment are overwhelming, nurses ease patients anxieties by engaging them in conversation about their cancer stories and providing them with basic educational material, says Andersen. Patients can turn to handouts for reference.
Andersen registers patients on the American Cancer Society Clinicians Portal, which supplies them with a packet of information; it offers specifics about local benefits, such as support groups, smoking cessation programs, and volunteer transportation assistance.
More Support on Its Way
To complement the National Action Plan led by the CDC and the Lance Armstrong Foundation, Lawrence Hospital Center is launching a Cancer Survivorship Program. Lawrence will be joining a select group of community hospitals in the country that have developed this outpatient service, which typically exists only in major cancer centers, says Stagner, who will lead the program.
The new program will offer a myriad of services. During the initial visit, Stagner will develop a care plan with each patient to identify and address his or her needs. To help navigate the healthcare system, the program will offer patients a care summary of all cancer-related treatments they have received, to take with them and share with healthcare professionals, as needed.
As patients complete treatments and see their oncologists less frequently, they rely more on their primary care physicians or APNs for general medical care. The program will supplement this care on issues related to cancer diagnosis and treatment. For example, a patient previously treated for breast cancer who has developed lymphedema may choose the services of one of the on-staff lymphedema-certified physical therapists.
Should a patient complain of fatigue, the program will work with the hospital Rehabilitation Department to offer such services as physical and occupational therapies to help individuals get back into shape. Although the concept isnt well understood, we believe that some fatigue patients experience may be caused by deconditioning, says Stagner.
For patients with insurance problems, the program will provide social workers or will refer them to organizations such as the National Coalition for Cancer Survivorship.
An important part of the program involves education and guidance to help patients learn how to advocate for their needs, says Stagner. We will continue to steer and guide them to places of support and help. Andersen looks forward to continuing the connection she made with patients during their inhospital treatments. Its good for patients to know that there is someone who cares, she says.
Lorraine Steefel, RN, DNP, CTN, is a senior staff writer for Nursing Spectrum.
To view the CINJ Treatment Patient Orientation Program log on to http://www.cinj.org/ treatment/CINJTreatmentOrientation.html.