Oncology Nurse Champion: Sarah Donahue
Sarah Donahue, MPH, AOCNP, shares what drew her to oncology, the daily challenges she faces as a nurse practitioner, and her advice to new oncology nurses on how to overcome those barriers.
When it comes to comprehensive oncology care from the nurse practitioner’s perspective, the “excellence is in the details,” according to Sarah Donahue, MPH, AOCNP, a nurse practitioner on the breast team at University of California San Francisco Health. Donahue originally thought she wanted to go the geriatric route focusing on reducing cardiac risk factors when she was in school for her master’s, but after some clinical experience in an infusion center, she knew oncology was the perfect path for her career.
Bound for Oncology
Donahue fell in love with oncology when she was a student. Her mother, who is an oncologist, offered her some clinical experience by working at her infusion center during the summer.
She said she immediately felt comfortable chatting and caring for the older patients at the center, “I think I am an old soul or something,” she said, adding that she was also impressed by the science behind the treatments. “The science were fascinating to me. Then you put that together with the patient and all the social issues that come up around having cancer…it’s a lot more emotional, [but] it was also really exciting for me, and it brought together the science and social [components] perfectly.”
The Nurse as a Teacher
“I love to teach,” Donahue said. “I like to take something really complicated and make it as simple as possible.”
“She is committed to communicating the interpretation of scan and laboratory results to our patients, particularly now that results are released immediately to the patient, which can cause significant anxiety. She is very attentive to management of toxicity and pain, providing clear information and potential strategies,” said coworker Hope S. Rugo, MD, professor of medicine and director of breast oncology and clinical trials education at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center.
Donahue said she tries her best to imagine not having any sort of medical background when talking with patients. She will often ask her patients to repeat back her explanations so she can gather a sense of their understanding. She is also very thoughtful about her wording. She prefers words that are palpable and not scary.
“There’s a bit of finesse when you’re talking about scans in cancer. [You need] to give the patient the information they need but also not scare them,” Donahue said. For example, she prefers to use words like stable or maintain instead of not progressing because it allows the patient to feel calm, even though the cancer is still present.
The Different Angles of Supportive Care
As a nurse practitioner, Donahue is used to approaching supportive care from a variety of viewpoints. There are the “obvious” pillars of care, like ensuring patients arrive for treatments, monitoring for medication adherence, and actively managing adverse events, but cancer care also involves more complex assistance that needs to be managed. Donahue explained how she must constantly evaluate her patients, not just for symptoms but for psychological components, family stress, transportation issues, and more. “It is all interconnected,” she said.
She noted that, often, the role of a nurse practitioner in oncology is almost akin to that of a therapist because of the strong emotional and psychological component that accompanies the treatment journey. Often times patients don’t just offer up how they are coping mentally, so she makes sure to ask directly at every visit if they are anxious or depressed.” “I’ll go into a room to see a patient and usually take a quick look at their chart before I walk in. I’ll see a lot has happened since the last visit, and I must go in, gather all the information from them, get it noted in their chart, then go over all their symptoms and get their story. Because often, it doesn’t match exactly, so I have to go through a lot of information.”
She said there are days when it feels as if every patient requires high level of data collection, which is part of why the workload for nurse practitioners can feel overwhelming at times. However, the best thing a nurse can do in this situation is remain calm and focus on the details, she said. If a patient states they are experiencing diarrhea, she needs to ask when: First thing in the morning? In the afternoon? Exactly when are they taking their Imodium? She will tell them, “We’re going to figure it out together because I can’t help you unless I know exactly what’s going on.” She also added that her patients often learn to take notes between visits with her so they can explain to her exactly what they are experiencing.
A Final Message
Donahue acknowledged that supportive oncology care often feels as though it is nonstop. Between patient visits and coordinating care with other providers’ between visits, one of the biggest challenges is learning to “turn it off” when she is not in the clinic. She said she is grateful for her family and her 2 kids for helping her practice separating herself from work when she goes home.
“Her commitment to patient care is exemplary,” Rugo said. “Sarah is always willing to step in to see a patient manage an issue [even] when she is not in [the] clinic, and this commitment showed clearly throughout the pandemic despite her need to juggle the care of her 2 young children. Sarah is a true Oncology Nurse Champion.”
Donahue’s message to fellow oncology nurses is this: “As you get more experienced, you will get better. It’s an honor to care for these patients and to be a part of their cancer journey. The end result could be the same, but if you can make their journey better, make them feel heard, treat their symptoms, [and] improve their quality of life, that is 100% worth it and rewarding.”
Supported by G1 Therapeutics