MY LIFE Matters - Health Literacy - 34

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BY JENNIFER MCKENNA, RN, MSN, AOCNP,
NURSE PRACTITIONER, BREAST ONCOLOGY
CENTER, DANA FARBER CANCER INSTITUTE
34
MY LIFE MATTERS
HEALTH LITERACY ISSUE | SUMMER 2023
ne of the most difficult parts of my job as an oncology nurse practitioner is
delivering bad news. When a patient initially recurs or presents with incurable
metastatic breast cancer, the information is nothing short of life changing
and often devastating. Other difficult conversations entail reviewing scan
results that show a treatment is not working or discussing that we have limited
treatment options left to offer. Discussing the transition of care from anti-cancer therapy
to hospice care can be a frightening and disheartening time for patients. There are times
when I am giving this news to a patient I do not know well and other times to a patient I
have taken care of for years-both situations have distinct challenges.
For any difficult conversation, it is critical to have a private place to talk and not
to be rushed. With patients I have recently met, I will often start by asking what
they have already been told about their cancer. This allows me to get a sense of
their understanding of cancer and their own particular situation. I strongly believe
that being direct and honest while maintaining hope is extremely important. If
the initial conversation is anything less than honest, there will be a lack of trust
moving forward. Even in the most dire situation, there is always room for hope,
and helping patients maintain hope must be included in these conversations. This
is a skill and an art that takes years to develop. Fortunately (or unfortunately), in
the oncology setting we have no shortage of practice. Tailoring the conversation to
meet the needs of the patient is critical-it cannot be a " one-size-fits-all " approach.
Every person and their situation are unique, and how people process information
can be quite different. Some patients want every detail and even want to look at

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