LOS ANGELESTo better manage fatigue, cancer patients need clear,
concise information about what to expect and how to deal with reduced
energy, memory, and other cognitive functions. The challenge for oncology
nurses and physicians, noted Patricia Jakel, RN, MN, AOCN, is to provide
this information in a manner that is sensitive to the individual patient’s
changing attitudes toward treatment and need for information at each visit.
"We need to know what the patients feel and what the patients want us
to communicate to them," Ms. Jakel said. She is a clinical nurse
specialist at University of California Medical Center, and associate
professor, University of California School of Nursing, Los Angeles.
Adult learning theory reminds us that adult learners forget much of what
they have learned, Ms. Jakel noted. Because adult learners forget about 40%
of what they have learned by 30 minutes, 60% by the end of the day, and 90%
by the end of the week, it is imperative that the 10% of the message
patients will retain is "really important."
Cancer patients are motivated to learn how to manage their symptoms, but
may also be overwhelmed by emotions. "So the information that they
retain is going to be very minimal," Ms. Jakel said. "After the
first cycle of chemotherapy, the patient may be more open to recommendations
for symptom managementbecause they’ve been through the
Motivation and Deterrence
A small study (Leydon, et al, 2000) conducted at an oncology outpatient
clinic in London looked at cancer patients’ information needs and
behaviors. The 17 patients, who had been diagnosed with cancer within the
past 6 months, all wanted basic information at the time that they were
diagnosed and treated. Not all patients, however, wanted further information
at every stage of their illness.
The researchers also found three predominant attitudes that effect
patients’ quest for information about their cancer and its treatment, Ms.
Jakel reported. Those three common attitudes were faith, hope, and charity.
Faith is the belief that the doctor knows best. Marina Lawson, a breast
cancer survivor, vouched for the argument that faith could deter a patient
from seeking more information. She was treated by John A. Glaspy, MD, MPH,
medical director of the Boyer Oncology Clinic at UCLA and co-chair of the
Fifth Quality of Life in Oncology Symposium. "I thought too much
information was going to cloud my judgment," she said. "So I went
by faith that what he was going to do for me was going to make me