We are fortunate to have a collaborative oncology, palliative care team at St. Martha’s Regional Hospital. Working together, they have recognized an issue, did a study that corrected the issue, and are developing the study into a research project that may change communication strategies in cancer care throughout Nova Scotia.
The fourth floor of St. Martha’s Regional Hospital is a special place. The Community Based Cancer Clinic is there. Dr. Ron MacCormick is here from Sydney, Wednesdays and Thursdays, to see and supervise therapy for cancer patients and Drs. Mike MacKenzie and Maureen Allen and Dr. Phillip Cooper lead the Palliative Care services. Registered nurses like Jean Kennedy and cancer patient navigator Heather Brander are striving to provide the best possible care for their patients. This team has lead the development of a communication tool that is attracting a lot of attention, both provincially and nationally.
At St. Martha’s, the oncology and palliative care teams are combined and meet weekly to discuss “shared” patients. At one of these weekly meeting, two years ago, Dr. MacKenzie brought up his concern that a number of patients that he was seeing who were receiving palliative chemotherapy misunderstood the goal of their therapy. Similar to other patients in the medical literature, they thought their treatment would result in a cure, where in fact their treatment was aimed at providing an improved quality of life or to extend their remaining life, as a cure for their cancer was, regrettably, not possible.
Where was the communication breakdown? To solve this question, an “ad hoc” committee was struck and spent time to develop two surveys, using the same clear concise language. One would be filled out by Dr. MacCormick as he finished his initial consult, the other by Jeannie Kennedy RN with the patient immediately afterward, when treatment consent forms were being signed, appointments planned and educational sessions started and scheduled.
The results of the survey showed the patients had understood the doctor, so what was happening? Dr. MacCormick and Jeannie Kennedy both noticed the answer. Dr. MacCormick, a known excellent communicator with over 30 years as an oncologist, had started modifying his practise. As he was finishing his consult and preparing to fill out the survey, he went over things another time with the patient, using the clear language of the survey. As Jeannie filled out the survey with the patient, the information was re-enforced in the same clear format. As Dr. MacCormick said “…being a cancer specialist, it’s a whole life of giving bad news. And every once in a while, you may steer clear of really being totally straight forward with people. It (the survey/tool) kind of focuses you back at it. It’s a real good tool to have.” “…They (the patients) have got to know what’s happening…” ”It’s something we should be doing everywhere. And it’s being picked up in places, too”
Jeannie has found, that as she is filling out the survey with patients, it prompts talking about concerns the patient has and opens the door to a variety of difficult conversations and ensuring that truly informed decisions are being made by the patients.
The team, Dr. MacCormick, Dr. MacKenzie, Jeannie Kennedy RN, and Heather Brander RN have presented their work at a provincial conference, and a patient education conference last spring as a poster presentation. In October Heather and Jeannie presented the work at the national Canadian Association of Nurses in Oncology (CANO) conference in Quebec. They have recently submitted their abstract to the International Palliative Care Conference being held in Montreal this fall.
They have recently been awarded a TRIC (Translating Research Into Care) grant by NSHA. In conjunction with a researcher, the survey will be turned into a research project using the Aberdeen Hospital in New Glasgow as the research site. This time, they will conduct it as a research project with a control group, hoping to duplicate the results as a first step to having it included as standard care practise in Nova Scotia.
Jeannie Kennedy says “We have a wonderful hospital here. It’s a great place to work.” To illustrate the point, she speaks about the cooperation the oncology department receives from other departments in St. Martha’s, about being able to confer quickly with the other specialists, about getting patients seen, same day. The Tele-Health program is reducing the need for patients to travel to Sydney for radiation oncology consultants. On Tuesday mornings, the radiation oncologist in Sydney sees patients, assisted by Dr. Cooper at St. Martha’s, via the telehealth link. It’s about putting the patient first and that is important to Jeannie. She was nominated for the Boehringer Ingeheim Oncology Nurse of the Year last year, one of two from Nova Scotia and in a select group of about 20 from across Canada.
It has been said that St. Martha’s Regional Hospital has a special atmosphere. It is small enough that the staff and patients often know each other from the community, so they are caring for friends and neighbours not “just” patients but large enough to have the specialist services needed to treat a wide variety of conditions. We are fortunate to have these highly trained specialists. And fortunate to have caring staff, concerned for their patients, and their understanding of their condition. They have gone the “extra mile” and have developed the tool to cross the bridge the communication gap.