Facing Terminal Cancer with Honesty & Courage: Zones collaborate to ensure cancer patients understand their cancer treatment
What started as a quality improvement project at St. Martha’s Regional Hospital in Antigonish (Eastern Zone) has expanded into a collaborative research project based at the Aberdeen Hospital in New Glasgow (Northern Zone), involving Halifax-based researcher, Dr. Robin Urquhart (Central Zone).
The goal of the project is to see if a short survey can effectively guide oncologists in their discussions with cancer patients, so that patients truly understand the intended purpose of their chemotherapy regimen.
Confusion arises in patients with advanced cancer who are receiving “palliative chemotherapy.” These therapies are designed to reduce tumour load, minimize symptoms and extend life—for months or potentially several years—when a cure is not possible.
“Because they’re getting chemo, many patients mistakenly believe the purpose of the treatment is to cure their cancer,” notes Dr. Urquhart, who works extensively in the area of communication skills in cancer care. “This is not helpful to them or their families when the cancer has advanced past the possibility of cure. Our research clearly shows that patients and caregivers overwhelmingly want to know the truth about their situation, so they can prepare.”
Heather Brander, the cancer patient navigator who coordinated the project to improve communication with patients at St. Martha’s, shared her enthusiasm with her counterpart at the Aberdeen, Bonnie McCarron. The two approached Dr. Urquhart to help devise a research project that would allow them to further develop and validate the survey with the aim of eventually being rolled out across the province. Kelly Murray, health services manager responsible for oncology at the Aberdeen, came on board as colead with Dr. Urquhart on a successful TRIC grant application. Dr. Ron MacCormick, oncologist at the Cape Breton Cancer Centre, is advising the team.
“First we are going to survey patients to gauge their understanding of their treatment goals,” notes McCarron. “We will then introduce the intervention, a survey that patients and oncologists complete so we can see if they’re on the same page. At St. Martha’s they found that the survey prompted oncologists to be very clear in their discussions with patients, so patients understood the goals of care. We hope to see similar improvements.”
The researchers will also interview patients and oncologists after their goals-of-care discussions, to evaluate the quality of the conversations and explore what improvements could be made to ensure patients receive complete and honest information, with sensitivity and compassion.
“It’s a simple yet powerful project,” notes Urquhart. “Accurate awareness of prognosis is known to improve quality of life for both the patients and their caregivers. It doesn’t take their hope away… it changes where the hope lies.”