The words oncology nurses use when talking to patients and their loved ones can have a major impact on the quality of care. Using proper terminology for substance misuse disorders and being compassionate to parents whose child is facing a cancer diagnosis, for example, can set the tone for the patient-provider relationship.

In this issue’s cover story, we explore the tragic opioid crisis that is sweeping the nation and oncology nurses’ role in tackling the issue. “Nurses should have mindful social interactions with parents who have heard the dreaded words, Your child has cancer.”

 interviewed experts in the field about the stigma around opioid use, risk mitigation, and patient education strategies, as well as when it is—or isn’t&mdash;appropriate to use opioids. The article outlines key strategies for safe drug administration, which has great potential to affect patients whom nurses see day in and day out.

Although nurses should be cognizant of how they discuss opioid use with their patients, they should also have mindful social interactions with parents who have heard the dreaded words, Your child has cancer. In our feature story, we discuss the importance of compassionate care, not only with the child with a diagnosis but also with the family members and caregivers.

Nurses must be sympathetic to parents who are facing this difficult time and ensure they understand the ins and outs of their child’s diagnosis, as well as any care or consideration they should provide at home. This often requires patience, as many loved ones can have trouble digesting information after hearing the word cancer.

Also, in this issue, you’ll hear one oncology nurse discuss the reality of having cancer and how she finds motivation and inspiration from the amazing people she treats every day. And for Breast Cancer Awareness Month, we’re offering a continuing education (CE) section specific to the disease. Be sure to take the online quiz and earn 1 hour of CE credit. I hope you find this issue both enjoyable and informative. As always, thanks for reading!

Articles

From the Chairman

Here's what you can expect from the latest edition of Oncology Nursing News®!

Putting Compassionate Care at the Forefront of Oncology Nursing

Parents often become distressed or overwhelmed when their child receives a cancer diagnosis, especially if the prognosis is poor. Nurses must be sensitive to parents’ emotional needs when providing important information about the disease and safely caring for the child at home, and a number of strategies can help guide their interactions with parents.

In 2019, more than 11,000 children will be given a cancer diagnosis, and almost 1200 children are expected to die from the disease.

 Behind accidents, cancer is the second-leading cause of death for children aged 1 to 14 years, according to the American Cancer Society. But thanks to advances in cancer research and treatment, the survival rate for children has increased over the past 4 decades from 58% to more than 80%. The Children’s Oncology Group (COG) has played a pivotal role in improving outcomes for pediatric cancer through clinical trials, research, and education.

Wendy Landier, PhD, RN, CRNP, FAAN, an associate professor in the Division of Pediatric Hematology-Oncology and the School of Nursing at the University of Alabama at Birmingham, chairs the COG Nursing Discipline Committee and spoke to Oncology Nursing News® about a structured interventional approach to optimize parent and family education and increase nurses’ satisfaction.

The intervention, which a COG workgroup developed to educate parents after their child receives a diagnosis, follows an 18-item checklist to ensure essential information is taught prior to hospital discharge.

 This checklist addresses topics including diagnosis/treatment, access to care, treatment of adverse events, infection prevention, care of the child, and home medications. Some areas, such as handwashing and taking temperature, require return demonstration.

Education must be patient/family-centered, focused on essential information first, consistent, repeated, structured, paced, and delivered according to the family’s preferred style of learning.

“Early on,” Landier says, “parents tend to be anxious about the logistics of life following diagnosis. They want to know how they’ll handle working, telling the other children, paying the bills, and managing the appointments.” The impact of hearing their child has cancer makes retention of information difficult at this stage.

Posting the COG checklist in the child’s hospital room allows nurses to know at a glance what areas have been taught and to whom, how, and when they were addressed, as well as whether a topic’s final checkoff is complete. This provides transparency, with a list that is easy to use, accessible, and empowering for nurses, as they are always aware of what areas still need to be addressed. The checklist, along with the parent guide and handbook, is available through the COG.

“Nurses are pivotal when it comes to helping families cope,” Landier stated. “They bridge the gaps by providing essential education on complex information in a way the family can best understand. It means so much to families when nurses take the time to translate medical language for them and meet them where they are.”

One of the best ways nurses can build a trusting relationship with parents is to hold space for them to feel how they feel. If they are angry or sad, hold space for that. Amy Haskamp, MSN, RN, PCNS-BC, CHPPN, CPON, clinical nurse specialist for the Pediatric Palliative Care Team at Riley Hospital for Children in Indianapolis, Indiana, and a pediatric faculty member of the End-of-Life Nursing Education Consortium, encourages nurses to align their conversations with parents’ hopes. This is particularly important when a child’s prognosis is poor.

“If the family says they just want their child to stay alive, responding with ‘I will hope for that too’ helps bridge the divide between what parents wish and what nurses know,” Haskamp told 

. She also encourages nurses to use the NURSES mnemonic, which represents “name (the emotion), understand, respect, support, explore, and silence.”

“Communicating with parents about their child’s cancer is not about explaining everything out. It’s about a family who’s experiencing an emotion. Giving more cognitive information is not going to be helpful until emotions are addressed,” Haskamp said.

Haskamp added that acknowledging what parents are experiencing helps them feel supported and respected, which in turn helps them cope with their emotions. “They want to be heard,” she said.

Nurses should tailor conversations with parents to the situation and the family’s communication preferences. If the child has always been involved in conversations about their cancer, abruptly changing this pattern may lead to worry about what is wrong.

Sometimes the family may want help talking to the child. Guiding the conversation by asking and exploring questions often opens the door to deeper communication. Haskamp said nurses must never undersell their role: “They are more valuable than they can imagine.”

1. Key statistics for childhood cancers. American Cancer Society website. 

https://www.cancer.org/cancer/cancer-in-children/key-statistics.html. Updated September 10

2. Withycombe J, Alonzo T, Wilkins-Sanchez M, Hetherington M, Adamson P, Landier W. The Children’s Oncology Group: organization structure, membership, and institutional characteristics. 

2019;36(1):24-34. doi: 10.1177/1043454218810141.

3. Rodgers C, Bertini V, Conway MA, et al. A standardized education checklist for parents of children newly diagnosed with cancer: a report from the Children’s Oncology Group. 

2018;35(4):235-246. doi: 10.1177/1043454218764889.

4. Rodgers CC, Stegenga, K, Withycombe JS, Sachse K, Patterson Kelly K. Processing information after a child’s cancer diagnosis—how parents learn: a report from the Children’s Oncology Group. 

2016;33(6):447-459. doi: 10.1177/1043454216668825.

Feature Story

Oncology nurses are a key part of the cancer care team, but they are also a crucial source of information for a patient's family. 

Providing Essential Education and Support for Parents of Pediatric Patients

As cancer survival rates increase, healthcare professionals may be treating more patients who are considered long-term survivors (5 years or more after treatment). The 5-year survival milestone is often a cause for celebration, but results from studies show that 20% to 30% of long-term survivors continue to have needs that nurses and other members of their healthcare team can address, at least in part.

Survivorship comes with its own set of physical, emotional, and financial challenges. To promote good quality of life and autonomy, long-term survivors will need ongoing support. Healthcare teams can provide this by implementing survivorship care plans, using telemedicine, or bringing on more support staff, such as patient navigators.

Even 5 years or more after treatment, patients can continue to experience the physical effects of cancer treatment, which may affect their ability to perform typical daily activities. These effects can include pain, neuropathy, sexual dysfunction, incontinence, and fatigue, among others. Some treatments lead to other health risks, such as damage to the heart, bones, or other organs, as well as an increased risk for other cancers.

Patients often feel as if they’ve been cut off from their healthcare team a few years after treatment and that they have been left to deal with these issues on their own. Once patients stop seeing their oncologist regularly, nurses are perhaps in the best position to let them know who can address these salient concerns. Providing patients with detailed guidance can help them recognize that they have support as they continue through survivorship. Nurses can encourage some to call their primary care physician or educate others on how to stay in touch with their oncologist.

Long-term cancer survivors often have similar psychosocial needs as patients who have recently completed treatment. Although anxiety is highest in the first year or two after treatment completion, long-term survivors often continue to experience anxiety related to fear of recurrence. Survivors also sometimes experience ongoing depression, post-traumatic stress disorder, and poor body image.

Patients should be screened for mental health and psychosocial needs on an ongoing basis. Ideally, this evaluation would be part of the conversation during follow-up visits and yearly checkups. Even if a patient is coping well during their first year in recovery, new issues may arise throughout their survivorship trajectory.

Although not all patients may be willing, or able, to seek formal mental health or counseling support, some may benefit from psychoeducation or peer support through groups or mentors.

Patients need information and tools to guide them in the right direction, and nurses are uniquely qualified to provide these resources. Patients want to get healthy, lose weight, and take action to prevent a recurrence. Information on diet, exercise, and lifestyle changes is an important part of cancer survivorship. This affords patients some control of their own and provides new ways to care for their health.

Nurses can steer patients toward excellent online and mobile resources for diet, such as Ina, the Intelligent Nutrition Assistant from Savor Health and CancerCare. This service provides patients and survivors with on-demand nutrition guidance through text messages, and many health insurance companies offer vouchers or reimbursement for gym memberships. 

Nurses can also help keep patients informed through survivorship care plans. Cancer survivors want to know what to expect once treatment is complete. After seeing their doctor frequently for months or years, patients may experience increased anxiety as they adjust to fewer visits. Survivorship care plans maintain the conversation about what the patient is experiencing throughout survivorship.

This tool assesses the patient as a whole person and can address many facets, including physical well-being, ongoing symptoms, mental and emotional health, financial needs, and reproductive or sexual concerns. These plans also allow providers, especially those outside the oncology team, to understand the specific needs of a patient.

Unfortunately, only about half of the top cancer centers in the United States use a survivorship care plan,4 even though they can access many versions of the tool online, such as the OncoLife Survivorship Care Plan from OncoLink (

Although many cancer survivors can move forward post-treatment with minimal psychological or physical distress, some need support 5 years or more after treatment.

 Healthcare providers, especially oncology nurses, are well-positioned to connect patients with the appropriate avenues of support for life after treatment.

Burg, MA, Adorno G, Lopez ED, et al. Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. 

2015;121(4):623-630. doi: 10.1002/cncr.2895

Foster C, Wright D, Hill H, Hopkinson J, Roffe L. Psychosocial implications of living 5 years or more following a cancer diagnosis: a systemic review of the research evidence. 

2009;18(3):223-247. doi: 10.1111/j.1365-2354.2008.01001.x.

Painter K. Life after cancer: more survivors live longer, face new health challenges. 

usatoday.com/in-depth/news/50-states/2019/02/13/life-after-cancer-survivors-oncology-survivorship-plans-long-term-health/2794121002/

Harrison SE, Watson EK, Ward AM, et al. Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. 

2011;29(15):2091-2098. doi: 10.1200/JCO.2010.32.5167.

Partner Perspectives

For patients with cancer, their journey does not end after treatment is over.

What Are the Needs of Cancer Survivors 5 Years or More After Treatment?

A flood of information about genetic tests for cancer risk is available outside the clinic—in the media and even in public places like senior centers, churches, and community fairs. If these promotions have caught your attention or that of your patients and their families, and they are considering DNA or genetic testing, you need to be armed with important information that you should first share with your patients. As an oncology nurse, you can be the first line of defense against fraudulent genetic tests and help steer patients and their family members to tests that are trustworthy and can provide reliable information to act on.

Genetic testing can provide important, potentially lifesaving information if performed in the right way. If a patient is considering genetic testing to learn more about their cancer risk, or if they have already received genetic test results, speaking with a genetic counselor, a doctor, or other healthcare provider who has advanced training in genetics is crucial. This is the most reliable way to obtain and understand information about their cancer.

With the growing interest and availability of genetic testing, the industry has witnessed a striking uptick in advertisements and sales representatives aggressively promoting genetic tests directly to consumers at community events, on Facebook, and in other nonmedical settings. The vast majority of these salespeople and “health advocates” have no medical background and little or no training in genetics.

These marketing representatives often target the Medicare population. Some are evasive about the lab performing the testing, and most provide misleading information, making false promises of “free” genetic testing to individuals who do not qualify. Ultimately, unwitting consumers may hand over sensitive information such as their health insurance ID number and Social Security number, enabling fraudulent billing of insurance companies—or worse.

Contrary to most health insurance policies, these businesses claim that the broad genetic test panels they offer are free to individuals

who have certain health insurance coverage. Although genetic counseling and testing for a BRCA mutation is considered an essential health benefit for certain women under the Affordable Care Act (ACA),

 the tests for hereditary cancer genes (CGX) and pharmacogenetic tests (PGX) offered by companies are rarely covered at 100%, if they are covered at all.

Importantly, the BRCA testing requirement under the ACA does not apply to Medicare or Medicaid. In fact, a Medicare policy imple- mented in late 2018 severely restricts genetic testing for hereditary cancer mutations. In most cases, it covers testing only for individ- uals with “recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer” who are seeking additional treatment. Even before this policy took effect, Medicare rarely covered multigene panel testing for cancer survivors, and it has never covered genetic testing for previvors (those with a strong predisposition to cancer who do not have a diagnosis of the disease).

Despite complaints filed with the Federal Trade Commission, the Office of Inspector General, and state attorneys general, the number of unscrupulous companies and concerns is growing. These companies take advantage of individuals by misinforming them about their need and eligibility for hereditary cancer genetic testing, providing a medical service without the expertise of qualified healthcare providers, and committing fraud by stealing personal information

and/or billing insurers for services not provided.

Reliable Genetic Testing is Still Important

National guidelines recommend genetic counseling with a qualified expert before and after genetic testing. Talking to a healthcare provider with expertise in cancer

genetics is important. This helps assure that the right test is performed (many are available) at a reliable, high-quality lab; that results are interpreted correctly; and that you or patients receive accurate infor- mation about what the results mean and the available medical options.

When genetic testing for cancer risk is performed outside a healthcare setting, the like- lihood of misinformation is high and could lead to harm, including misinterpretation or misuse of the results. This includes “recreational” genetic tests such as 23andMe, which are not comprehen- sive or reliable measures of disease risk.

All individuals can benefit from meeting with a qualified and trustworthy healthcare professional who has their best interests at heart. Former teachers, pyramid marketing representatives, and insurance salespeople should not be involved in genetic testing— even if it involves just taking a cheek swab. Too much rides on the results of these tests.

So please, talk to your patients’ family members and friends. Warn them about the bad actors and fraud that is taking place. If they are interested in genetic testing, encourage them to seek out trust- worthy medical professionals such as yourself, a trusted colleague, or their primary care provider for guidance and expertise.

Alternatively, the Facing Our Risk of Cancer Empowered website has information on finding a cancer genetics specialist.

Affordable Care Act implementation FAQs - set 12

Centers for Medicare & Medicaid Services website. cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html. Accessed August 19, 2019.

Genetic testing has come a long way in cancer care, but not all genetic tests are as defentive as some would have you or your patients beleive.

Protect Yourself and Your Patients From Fraud in Genetic Testing

Opioids are top of mind for many oncology nurses when it comes to managing patients’ cancer-related pain. However, as the opioid epidemic continues to sweep the nation—claiming an average of 130 American lives every day

— healthcare providers must be aware of the risks of these popular painkillers, knowing when to use them, when not to, and how to identify biases, as well as recognizing the warning signs of potential misuse. Armed with thorough documentation and patient communication tools, nurses can be key players in the safe administration of opioids and other analgesics to patients with cancer.

“It’s our moral obligation to treat pain, and suffering is not a desired response at all,” said Tonya Edwards, MSN, MS, RN, FNP-C, a palliative care nurse at The University of Texas MD Anderson Cancer Center in Houston, in an interview with 

. “But there is a cascade of issues out there, especially with so many opioid-related deaths.”

Many individuals have biases against opioids and the patients who use them, and oncology nurses certainly are not the exception to this rule. But Edwards stressed that healthcare workers need to put their patients’ pasts aside and always provide the best and most appropriate care.

“It’s unfortunate that patients might have had an addiction issue before, but now they have cancer. So it’s a double whammy,” she said. “We are not here to judge them on whatever happened in the past. They are human. They walk through the door with cancer, and we need to gain their trust and, of course, use our ethical concerns if we have to have an exit strategy and get them off the medicine later.”

Edwards noted that if patients have a history of opioid misuse, healthcare providers will not treat them with opioids in the cancer setting. But regardless of an individual’s history, each patient deserves to be treated with compassionate care, she explained.

Gretchen McNally, PhD, ANP-BC, AOCNP, agrees and says that the language oncology nurses use can have a major impact on perceptions as well as patient care. “For example, someone with an opioid use disorder, is the correct terminology, versus ‘an addict’ or ‘a junkie,’” said McNally, a nurse practitioner at Arthur G. James Cancer Hospital, part of The Ohio State University Comprehensive Cancer Center, in Columbus, in an interview with 

. “The first step is just recognizing and [trying] to use different terminology that is more respectful. Try to reframe your perception, which will then influence your practices.”

Improved education is also key in caring for this patient population. “Healthcare providers know that substance use disorders are a medical diagnosis, but I really don’t know that we all understand how much of a chronic brain disease it is,” McNally said. “People can’t really control that at all. So that [recognition] is the first step.”

Oncology nurses can look for specific signs of drug misuse, Edwards said. These include asking for more opioids before a prescription is finished, repetitively stating that opioids were stolen or lost, not attending oncology visits, and calling the clinic or heading to the emergency department only for more opioids.

The majority of opioid misuse starts with a prescription, “either that a doctor gave patients or that wound up in the wrong hands,” Patrick I. Borgen, MD, chair of the Department of Surgery and director of the Breast Center Program at Maimonides Medical Center in Brooklyn, New York, said in an interview with 

. “So the healthcare profession is directly at the center of this.”

Edwards said that she and her team at MD Anderson tell all their patients to lock up their medications to reduce the risk that another individual will take them. Additionally, providers at the institution make it a point to educate patients and their caregivers about proper opioid use and even host annual Opioid Crisis Seminar events to spread the goal of safe use. “Opioid education is one of the most powerful lessons that anyone can always share and build upon in their own clinic or inpatient area,” Edwards said. “Everyone in the community is welcome to come. We have people coming from all over the United States, and we are more than happy to let them see the system that we have.”

McNally’s team focuses on harm reduction for at-risk patients. She established a multidisciplinary committee within the lymphoma department of her hospital, comprising inpatient and outpatient nurse practitioners, pharmacists, patient care resource managers, social workers, and other nurses. After reviewing literature on the topic, they realized that harm reduction would be the best strategy to address opioid misuse in the cancer clinic.

Harm reduction does not treat addiction or disease. Rather, as its name suggests, the strategy focuses on minimizing harm and is not abstinence-based. “We can use safer prescribing practices or maybe be more aware of red flags that may come up—for example, patients losing their prescription, having it stolen, asking for early refills, and things like that,” McNally said, echoing Edwards’ advice. “We’re providing education to patients for different strategies to minimize their use or their risk.”

Harm reduction strategies at Wexner Medical Center, also part of The Ohio State University, included safer prescribing practices, such as asking every patient about their current or past substance use or addiction; consideration of complementary or nonopioid therapy; using the Prescription Drug Monitoring Program and employing a controlled medicine management form; pain diaries for patients; urine toxicology screenings; pill quantity limits; and other initiatives.

Many patients with cancer may not even need opioids, especially because safer alternatives with similar efficacy are available, explained Borgen. After witnessing a growing number of opioid-related hospitalizations and deaths at its institution, Maimonides formed a group to determine how the healthcare staff could decrease the amount of opioids prescribed.

The group created the Enhanced Recovery After Surgery protocol, which it initially employed in the colorectal surgery space but then altered and applied to other areas of the

hospital, including breast cancer surgery. The protocol is focused on mitigating opioid use but still effectively treating patients’ pain.

“We did a pilot study. We had some surgeons who were naysayers, and they stayed out of it, but that gave us a control group. We were able to show dramatically better pain scores and really [use] zero opioids,” Borgen said. “So if you fast-forward now to 2019, we’ve just submitted a paper tracking 700 women who we’ve treated consecutively for their breast cancer without a single milligram of opioids being dispensed. I’m incredibly proud of that accomplishment." Borgen has found alternatives to opioids for his patients, such as liposomal bupivacaine (Exparel), which he describes as a “workhorse of a local anesthetic.” The bupivacaine is encased in liposomal microspheres that break over time, resulting in an operative field that is bathed in local anesthetic over days instead of just hours, giving patients who underwent breast cancer surgery about 72 hours of pain relief.

The team at Maimonides sets the expectation with patients that their pain will be managed but without the use of opioids. To put patients at ease—because this notion can make some appre- hensive, said Borgen&mdash;clinical staff members are available for patients by phone 24 hours a day, 7 days a week, if they need better pain manage- ment. But they almost never call. “I do think that these patients need peace of mind knowing that these pills are just a phone call away if they’re in pain. But it’s much better than our old mind-set, which was ‘Here are 50 pills. I hope you don’t need them,’” Borgen noted.

Edwards also cited alternatives to opioid use for pain management, such as referring patients to integrative medicine. “[The rehab team] can teach them certainexercises, or maybe they even need to  walk in a different way to take the pressure off a painful area,” Edwards said. “They have tricks and aids in their field that are able to help them minimize pain or discomfort and be more functional. That’s the whole point of it: restoring functional recovery for everyone to continue on and be able to fight their cancer, go to their kid’s soccer game, or just have a good night’s sleep.”

McNally added that pain is not only physical but can be emotional, too, so having a psychol- ogist, in addition to physical and occupational therapists, on the treatment team can be helpful.

“Really before the whole ‘pain is the fifth vital sign’ campaign, they were looking at these multimodality clinics to treat pain, but those are expensive. Then they started coming out with opioids, and it was much easier to take a pill, and it cost less. Going back to that [kind of care] isn’t easy, but things like psychosocial therapy, phys- ical therapy, and occupational therapy can really help,” McNally said.

The courts are beginning to push back against manufacturers of these painkillers, too. In August, Johnson & Johnson and its subsidiaries were ordered by an Oklahoma judge to pay $572 million for their contributions to the opioid crisis in the state. This is after 2 other rulings stating that Purdue Pharma and Teva Pharmaceutical Industries Ltd. were ordered to pay $270 million and $85 million, respectively.

Appropriate Opioid Use And The Future Of Care

Despite promising alternatives, some patients ultimately will need opioids. “I think that there are going to be times, maybe for trauma patients or patients under- going large, radical surgery, when we do have to use opioids. But our choice of opioid matters,” Borgen said.

Borgen noted an underused opioid called buprenorphine that controls pain but does not elicit the same euphoric feeling that other drugs such as oxycodone and morphine do, making it less likely to lead to addiction. Overall, he expressed optimism that through patient and provider education, the opioid crisis can improve. “We’ve got to change the mind-set, and I think that’s happening,” Borgen said. “I think being honest and transparent about these drugs, offering alternatives, is what is going to make a change.”  

Understanding the epidemic. Centers for Disease Control and Prevention website. cdc.gov/drugoverdose/epidemic/index.html. Updated December 19, 2018. Accessed June 26, 2019

McNally GA. Harm reduction: reframing perceptions and informing practices of hematology/oncology advance practice providers. Presented at: Oncology Nursing Society 44th Annual Congress; April 11-14, 2019. Anaheim, CA. 

Cover Story

Opioids are the go-to treatment for cancer-related pain. But is this mainstay poised to change as the opioid crisis continues to grow?

Nurses Can Change The Direction of The Opioid Crisis

I have recently been reading a lot about compassion. I’m not sure whether it’s triggered by a specific event or due to a long-standing interest in the interpersonal domain of oncology nursing. I have always wondered about the varying degrees of compassion I have observed at the bedside over the decades. Why are some of us so virtuous in our caring and others so distant and disconnected? Where does compassion come from anyway? Was a family member a role model for it for us when we were young or was it a profound reaction to some event we observed? And what, exactly, is compassion?

In 2017, Canadian colleagues published the results of a study in which they interviewed 53 patients with advanced cancer and asked them about their perceptions of sympathy, empathy, and compassion.

They also asked the patients what these constructs looked like in healthcare providers. Sympathy was depicted as an unwanted, pity-based response.

Empathy was perceived as an affective reaction whereby the professional attempts to understand the patient’s suffering. Compassion was the most preferred response. It was perceived to have empathy embedded in it and was distinguished by 2 unique characteristics, both relating to action rather than just feelings.

Compassionate professionals had a desire to relieve suffering rather than merely understand it. They acted on their feelings. There was an altruistic nature to their demonstrations of kindness, which were identified as going above and beyond the expected. Thus, if compassion is highly desired by patients who are suffering, we need to consider whether we can teach compassion as a necessary competency.

Contemporary neuroscientific research has identified a link between the mental and emotional foundations of compassion with brain functioning. Another study described that our brains don’t remain fixed over our lifetime and that by engaging in activities that foster connectivity and sensitivity at the bedside, we can enhance our capacity to read others’ cues and empathically respond.

A growing body of work posits that our interactions can have physiologic effects that influence healing, improve functional impairment, and relieve psychological pain.

 In the context of compassionate exchanges, we can trigger immunologic, hormonal, and neurologic processes, not just by what we say but by how we say it. Decades ago, in championing the modern hospice movement, Cicely Saunders, OM, DBE, FRCS, FRCP, FRCN, shared her insight that the power of listening and the ability to embody a compassionate presence in the face of suffering might be as important as any medical intervention.

In the book Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference, the authors speak of a “compassion crisis in healthcare.”

 In physicians, this can be characterized by brief, clinical interactions devoid of compassion, poor listening skills, and depersonalization, or the inability to connect with patients. Unfortunately, especially in teaching facilities, these behaviors may be exemplified in physician leaders and are emulated by those in training. How can we change this current problematic paradigm?

First and foremost, we must solicit more feedback from patients and families about their experiences, and we need to share these results. Years ago, as part of a grief group I cofacilitated, we asked family caregivers what it was like to be in the hospital setting when their loved one was dying. Results revealed that the nursing staff was perceived as extremely compassionate and concerned about the family’s well-being. In describing their loved one’s physicians, however, this was not the case.

The majority of comments were negative. Families felt abandoned. Their interactions with the physicians were void of compassion. They sensed the oncologists’ discomfort and saw this linked to their limited conversations, brief visits, or staying away altogether. In a subsequent cancer committee meeting, I shared this feedback with the predominantly physician group. I quoted the responses verbatim, making it hard to refute the accurateness of the comments. Little was said following my presentation, and the next item on the agenda was quickly brought forth. Despite this, I felt I had accomplished my goal, namely, to be the voice of our families and advocate on their behalf.

In a time of crisis, no one wants to be cared for by a healthcare professional devoid of compassion. I believe compassion can be taught and that this topic needs to be part of all healthcare professionals’ basic education. Subsequent skill enhancement should also be a component of ongoing education in the work setting.

I have been the recipient of non-compassionate and compassionate care by healthcare providers, over the years, mostly as a family caregiver. I can tell you that the difference between the two is palpable. Marketing the positive aspects of exemplary compassion might be a strategy to consider in motivating colleagues to embrace and learn this competency.

With compassion comes reciprocity. Personally, the extension of myself to suffer with a patient leaves me with the sense that I showed up and made a difference. What a gift. Mark Twain said that kindness is the language which the deaf can hear and the blind can see. True compassion has no limits.

Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. 

. 2017;31(5):437-447. doi: 10.1177/0269216316663499.

Contemplative Caregiving: Finding Healing, Compassion, and Spiritual Growth Through End-of-Life Care

. Boulder, CO: Shambhala Publications; 2019.

Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference

The Compassion Connection: The Healing Power of Empathy and Mindful Listening

. New York, NY: Oxford University Press; 2018.

Nurse's Notes

Providing compassion to your patients won’t just help their day-to-day care, it can also change their treatment journey for the better.

October 2019

Putting Compassionate Care at the Forefront of Oncology Nursing

Providing Essential Education and Support for Parents of Pediatric Patients

What Are the Needs of Cancer Survivors 5 Years or More After Treatment?

Protect Yourself and Your Patients From Fraud in Genetic Testing

Nurses Can Change The Direction of The Opioid Crisis

The Compassion Connection in Cancer Care