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A team empowers a patient, and an empowered patient inspires the team
Editor’s note: HemOnc Today’s regular columns for advanced practice providers (APPs) tackle common issues APPs face, discuss day-to-day practice and regulatory concerns, and share research advances. To contribute to this column, contact Alexandra Todak at stodak@healio.com.
There can be few experiences more frightening than when the word “cancer” and your name are uttered in the same sentence.
As a physician assistant (PA) in thoracic surgery, I am part of a team consisting of APPs, surgeons, nurses and others. The malignancies of the chest we see every day are difficult and are only becoming more sophisticated to manage. I have found myself in the “you have cancer” conversation many times in my career. It is humbling to see how, in those first moments, the weight of the news falls onto a patient’s shoulders and a struggle for focus ensues.
Like each health care provider communicates differently, patients also have a unique way in how they wrap their head around such devastating news. I constantly find myself inspired and in awe of how, ultimately, they are successful in receiving and incorporating information in such a way as to be able to move forward.
Creating space
As a PA on the team, I have the opportunity to bond with patients in the ways I interact with them: from the first moments in a clinical encounter as I obtain their history of present illness, in educating them about a surgical treatment plan, and through postoperative follow-up care and long-term surveillance.
In this role, it is important for me to communicate information — which is most often technically sophisticated and can seem abstract to someone who is not familiar with medical terminology — and I must do this in a way that is clear and understandable. I need to respond to questions with answers and explanations in ways that make the complex sound or seem less complex, while remaining accurate with the information.
Working in thoracic surgical oncology, I frequently deliver difficult or seemingly devastating news, and it is important to engage with a patient in these moments with an eye toward pace, space and being present in the moment. In general, I prefer to create a sense of team by using inclusive speech such as “we,” “us” and “our” as opposed to “me,” “I” or “my.” I find that patients feel a greater sense of comfort when I approach them wherever they are, both emotionally and in terms of their understanding of their diagnosis.
Speaking slowly in an intentional but nonpatronizing way seems obvious, yet providing space can sometimes feel awkward. However, it is important to let the patient have as much time as they need to hear difficult information. There are moments in the conversation when I need to pause and let the previous statement hang in the air so that it can be digested.
I remember the time as a newly trained PA when I first heard my supervising physician deliver the news of a diagnosis of cancer. I remember the moment he described a positive lymph node biopsy. He used clear language that the patient understood, and then he paused ... not just for a few seconds, but for an appreciable length of time such that, in my inexperience, I was tempted to interrupt the deafening silence with something that I thought would have provided comfort.
But, if I had broken those moments of silence, I would have only distracted the patient, not helped them. The technique was very effective as the news itself, no matter how clearly communicated, was like trying to drink water from a fire hydrant. But, the pause created space for the patient to catch up and let the information settle in so that the discussion could move forward to next steps.
Addressing stigma
It also is important to recognize that some patients come to us carrying guilt or stigma.
Cigarette smoking is commonly associated with many — but not all — of the new patients with lung cancer we meet each year. With each patient we meet, we have to either cross the bridge to smoking cessation if they are currently smoking or help them overcome their feelings associated with their smoking history. No matter on which end of the spectrum the patient exists, it is critical to communicate in a nonjudgmental way. It is important for the patient to get a sense that you are not an adversary, but are with them in their efforts to stop smoking.
Smoking cessation is extremely difficult and, for some, a seemingly insurmountable task, but cessation is attainable if you can coach the patient to access their internal fortitude. There are other patients who no longer smoke but have feelings of guilt that they have brought the malignancy on themselves, which is not a productive perspective to endorse.
Lastly, there are patients who never smoked a cigarette but are diagnosed with lung cancer, a fact less well known to the public but nevertheless a frequent occurrence. These are the patients who deal with the stigma from society that assumes that, because they were diagnosed with lung cancer, they must have smoked. Battling cancer is difficult enough, and neither guilt nor stigma should be carried on the patient’s shoulders. I find that focusing on the present is the most helpful perspective in assisting patients to release themselves from any shroud of guilt or stigma.
Leader of the team
Ultimately, my goal is to help the patient navigate the troubled waters of their diagnosis, and the rapport created in how we communicate can yield a greater level of confidence in the treatment plan.
Communication that creates trust and confidence can then build a foundation from which the patient can develop an understanding that they are part of a team, blanketed by those surrounding them and caring for them. And, most importantly, they become empowered to know that they are the leader of the team.
As a leader, there is great opportunity for personal growth, such as when a patient comes to the realization that guilt, stigma or societal misconceptions either are not brought on or created by themselves, and they can empower themselves to ignore or look beyond them.
Arming a patient with what we are doing, why we are doing it, when we are going to do it, and what we hope to gain from it, are tools that help give the patient a sense that they are the leader of their own team, because nothing happens unless they agree to the plan.
The true inspiration comes from the dynamic in which a patient is thrust into one of the worst and darkest moments of their life and yet they ultimately endure and persevere in ways far greater than what they ever would have imagined of themselves.
For more information:
S. Scott Balderson PA-C, is a cardiovascular and thoracic surgical physician assistant at Duke University Medical Center. He also is a partner with Your Cancer Game Plan, a national awareness effort between Merck and the cancer advocacy community to help people with cancer and their loved ones take an active role in developing a “game plan” to support the emotional, health and communication challenges of living with cancer. He can be reached at stafford.balderson@duke.edu.
Disclosure: Balderson reports no relevant financial disclosures.
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