Chemotherapy education is intensive and ongoing
Patients overwhelmed when bombarded with facts
Chemotherapy requires intensive patient education that is ongoing. Patients can’t be taught everything they want to know and need to know in one sitting, says Kerry Harwood, RN, MSN, director of the Cancer Patient Education Program at Duke University Medical Center in Durham, NC.
Education often starts when patients come to the treatment center for their first chemotherapy session because there is little time between the physician’s recommended treatment regimen and the start of chemotherapy.
"Patients have told us that they would like a separate teaching session so we are in the process of designing classes that would allow them to come for a separate visit for that education," says Harwood.
Patients can feel overwhelmed with all the information they are given, says Sheryl Stewart, RN, MS, AOCN, CNS, a senior oncology clinical nurse specialist at Ohio Health Cancer Services in Columbus. Therefore, health care professionals need to reinforce what has been taught throughout the treatment regimen.
To make sure that patients aren’t overloaded with facts, Harwood uses a three-tiered educational approach for chemotherapy that provides need-to-know information first. This information covers safety issues and self-care. "I consider the first step what you need to know to get through today and to get through the next three days at home safely," she says.
Patients are given a three-page handout on the basic side effects of chemotherapy, what to do and what not to do, and when to call the doctor. They not only receive teaching sheets on the individual drugs they will be given but they also receive information on their regimen as well. It’s an overview of chemotherapy when drugs are combined as well as information on the other agents that are used.
In addition to medical facts, patients are given information about the demands of therapy. For example, how long they will be in the clinic, how many times they will need blood drawn between treatment cycles, and when they may expect to return to work.
Patients also watch a video the first day of treatment so that they not only hear the information verbally from the nurse and read it in the materials given but see it as well. "They have three different opportunities to hear the same basic information because it is overwhelming," says Harwood.
Cover the basics
Stewart always begins her initial teaching on chemotherapy by asking patients what they know about the cancer treatment that they will undergo. This is important because many patients research their cancer and treatment on the Internet and may have gotten incorrect information, she says.
She explains that chemotherapy is simply the use of drugs to treat disease just as insulin is used to treat diabetes. All medications have side effects, including chemotherapy, and patients need to know the potential side effects for the drugs they will be receiving as well as information on how to manage them.
For example, a patient may experience nausea and vomiting, but they should know that medications called antiemetics could be prescribed to prevent or control the nausea. They may also try drinking clear, cool liquids, such as ginger ale; eating dry food such as toast and crackers; eating smaller, more frequent meals; and eating cool foods or those served at room temperature.
It’s important that they understand that there are ways to manage the side effects, says Stewart. Complementary therapies, such as guided imagery, music therapy, and yoga, also can be helpful in managing side effects.
Knowing when to contact the doctor is critical. Such symptoms that would warrant a physician visit include a temperature higher than 100.4° F, uncontrolled nausea and vomiting, uncontrolled pain, unexplained bruising or bleeding, and excessive fatigue.
It’s important that patients know how to use the information they are given to make good decisions, says Harwood. Therefore educators should not simply evaluate the patients’ knowledge but evaluate their ability to make good decisions with the information at hand. For example, ask what they would do if they had a fever of 101° at 2 a.m., she adds.
Patients are given a binder of information during their first treatment visit at Duke University Medical Center. During their orientation to the notebook, they are told that it contains information that they will need over the next six months, then they are shown the sections that contain the information they need at the moment.
A treatment protocol is used by the nurse in the clinic to guide and track education as patients return for treatments. In that way, the nurse will know that the patient learned about nausea and vomiting and acute reactions to chemotherapy the first week, about low blood counts the second week, and fatigue was covered during the third week. Harwood considers this the second tier of her chemotherapy education program.
"We decided to give patients lots of information up front and then focus on what they need at different periods of time," says Harwood. As a result, patients have the information should they need to look up something.
The third tier in the educational program is providing information that people can access about such issues as intimate relations for cancer patients on chemotherapy. It is resource materials that patients can access when they need the information. For example, the notebook has information on the resources they will find in the patient library. Also, many of the waiting rooms have racks with trifold brochures that provide some information and referrals to other resources.
Harwood divides the chemotherapy program into essential and elective resources. The essentials are the things she can predict that someone will need to know and when they will need to know it. The elective resources are things that a lot of people are going to need but she can’t always predict exactly when.
Sources
For more information about chemotherapy education, contact:
• Kerry Harwood, RN, MSN, Director, Cancer Patient Education Program, Duke University Medical Center, DUMC Box 3677, Durham, NC 27710. Telephone: (919) 681-5288. E-mail: [email protected].
• Sheryl Stewart, RN, MS, AOCN, CNS, Senior Oncology Clinical Nurse Specialist, Ohio Health Cancer Services, Riverside Methodist Hospital, 3555 Olentangy River Road, Suite 511, Columbus, OH 43214. Telephone: (614) 566-5067. E-mail: [email protected].
Chemotherapy requires intensive patient education that is ongoing. Patients cant be taught everything they want to know and need to know in one sitting, says Kerry Harwood, RN, MSN, director of the Cancer Patient Education Program at Duke University Medical Center in Durham, NC.
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