Tagged: Communication skills
- This topic has 9 replies, 8 voices, and was last updated by mwoolphd.
January 20, 2020 at 4:25 pm #17074
I admit to not having as in depth of knowledge about egg retrieval as this fertility nurse. So I would have referred her to a specialist and sought patient support materials. Meanwhile my thoughts on this video – I’m assuming it’s implied that IF the patient had a significant other/partner, they would have been invited to this discussion? Also I would like to have seen some inclusion of who the patient will discuss the finances of this collection, procedure, and storage with.
I think this provider does a good job explaining what would naturally happen with the follicles, which to me makes it seem less scary since the injections are enhancing something the body goes through anyway [in the example, stimulating 10 follicles vs 1 in the hypothetical]. I know many of my patients are concerned about chemicals, hormones, etc so I feel this explanation worked well.
At the same time, it’s a lot of information to process for someone visibly wringing their hands. I think a pause midway would have been good, while I did appreciate the pause near the end to acknowledge the large amount of information. I also like that it gives her an expectation of length of time and monitoring. I do wish she would have addressed side effects of the injections [any pain, nausea? Etc] , even if it just to say that the nurses teaching her about the injections will discuss it with her. I also think it’s good they discussed recovery after the procedure. I think the provider did a good job explaining the limited but observed knowledge of the spike in estrogen for egg retrieval against potential risk to the patient’s breast cancer prognosis.January 21, 2020 at 12:21 am #17090
Wow! A ton of information. The patient appears understandably anxious. She is facing surgery and chemo, now another complicated procedure with its own set of caveats, side-effects, etc. I wonder if it would have been wise to ask the patient what she thought about all that she was hearing. I know we ask patients if they have any questions, but it is difficult to have questions about things of which they haven’t a clue.January 21, 2020 at 10:27 am #17096
I agree, Cullydog8. I think before beginning the conversation asking the patient what her preferred method of learning is and assessing whether she would like to discuss this today would have potentially given her a chance to prepare herself for another whole piece of the complicated sequence of breast cancer treatment. The patient did seem very nervous and while I thought the provider’s tone was therapeutic and information was delivered in clear and appropriate manner, as Pennchr said, I thought she could have paused sooner to make sure the patient did not need a break. I would hope that there would be some additional resources provided to the patient after this conversation in case she did not absorb all of this information today.January 21, 2020 at 10:28 am #17097
@cullydog8 “it is difficult to have questions about things of which they haven’t a clue” is definitely a great point! So often I’ll meet with a patient and they have a number of questions, some that require I go back to the provider to facilitate discussion. Sometimes a provider will look at me and say, ‘ Well I asked if they had any question?!’ It’s a lot to take in and needs time to digest!
January 21, 2020 at 10:32 am #17098
- This reply was modified 8 months, 1 week ago by pennchr.
@osflynn1 You bring up something I thought as well – I think some kind of visuals would have been helpful as the discussion went along, if it helped the patient’s learning style. Working in healthcare, we tend to have a good grasp of anatomy but I encounter many patients who have not had the same access to education we have. I, too, hope there would be printed materials to go home with the patient.
January 21, 2020 at 4:11 pm #17130
- This reply was modified 8 months, 1 week ago by pennchr.
I thought the information given was very thorough and well presented. It would have been a good idea for the patient to have had someone with her taking notes and at least asking other questions the patient wasn’t thinking of.
penchr, I agree it would have been nice to have pictures, diagrams or maybe a video to help give more background. Finally, I think discussing the financial cost should have been upfront because many patients are not able to afford these procedures and storage.January 23, 2020 at 5:29 pm #17266
The providers explanation of the egg retrieval procedure was very in depth. You could tell the pt was visibly nervous and anxious. I put myself in her shoes and I would be absolutely terrified of yet another procedure. Plus, the pt was visibly concerned re the estrogen injections she would be taking despite her hormone linked breast cancer. And to be given an answer of, “there currently aren’t any studies”, would make me cringe. You already have a lot on your plate in regards to the cancer diagnosis and finical concerns etc. Now, to be told that you will be getting injections that may or may not be detrimental to your cancer would be frightening. I do think that if there was a partner, they should be invited, however, it is ultimately up to the pt themselves. I think that an MSW in the room also would have been good to calm nerves.January 26, 2020 at 4:04 pm #17323
Agree with many of the responses. Understanding the patients learning style is very important and has a significant impact on how much of the information she will retain. We require someone to be present with our patients for some education. I truly feel it is extremely helpful and necessary for a support person to hear the same information the patient hears and for them to be provided the information in written form. We also assist the patient with making appointments which we have been told by patients is a huge relief to them. One less thing they need to worry about at a very overwhelming time.January 27, 2020 at 1:41 pm #17331
Our chemotherapy treatment plans include referral to cancer fertility specialist as part of the pre treatment plan. I am not sure of how often this is actually done throughout our facility.January 28, 2020 at 2:02 pm #17350
What struck me most was how long the educator spoke without stopping. She talked for 5 minutes, covering several different procedures within the overall process and only then asked the patient if she had any questions – with the preface that she had a lot more to tell her. I can only imagine she couldn’t really absorb and process all of these details. I like the idea of a “teach back,” inviting the patient to share her understanding and be sure that the educator had been clear. I’d include a chance for questions and teach back after each segment, such as before switching from the vaginal ultrasound to hyper-stimulation. She could also address the patient’s emotional state and ask how she’s taking it all in. She could ask if there are steps that the patient anticipates being particularly concerning or problematic. At one point she mentioned “complications” which I heard as a rather charged word. She did not explain what these might be, and give the patient an understanding of the seriousness of these issues.
All that said, the educator conveyed kindness, experience, and a wish to help the patient be well-informed to make the best choice in line with her goals and values. She was very likeable and seemed supportive.
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