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The Acknowledge–Normalize–Partner (ANP) Framework: A novel empathic communication tool for oncology nurses

Published online by Cambridge University Press:  03 March 2022

Dana Kramer Open the ORCID record for Dana Kramer [Opens in a new window] ,
Kimberly Chow ,
Mary Elizabeth Davis ,
Judith E. Nelson ,
Kelley Anderson ,
Molly Okpako ,
Camila Bernal ,
Catherine E. Malisse  and
Jessica I. Goldberg Open the ORCID record for Jessica I. Goldberg [Opens in a new window]
Dana Kramer*
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
Kimberly Chow
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
Mary Elizabeth Davis
Affiliation:
Department of Evidence-Based Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
Judith E. Nelson
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
Kelley Anderson
Affiliation:
Center for Nursing Excellence, UCLA Health, Los Angeles, CA
Molly Okpako
Affiliation:
Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
Camila Bernal
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
Catherine E. Malisse
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
Jessica I. Goldberg
Affiliation:
Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Dana Kramer, Supportive Care Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 486, New York, NY 10065, USA. E-mail: kramerd@mskcc.org
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Abstract

Objective

To describe the development and implementation of a novel tool designed to enhance nurse–patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience.

Method

An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires.

Results

Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001).

Significance of results

Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.

Keywords

Communication skills trainingNurse–patient communicationPalliative care educationPrimary palliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 1 , February 2023 , pp. 12 - 19
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

REFERENCES

Back, AL, Arnold, RM, Baile, WF, et al. (2005) Approaching difficult communication tasks in oncology. CA: A Cancer Journal for Clinicians 55(3), 164–177. doi:10.3322/canjclin.55.3.164Google ScholarPubMed
Baer, L and Weinstein, E (2013) Improving oncology nurses' communication skills for difficulty conversations. Clinical Journal of Oncology Nursing 17(3), E45–E51. doi:10.1188/13.cjon.E45-E51CrossRefGoogle Scholar
Baile, WF, Buckman, R, Lenzi, R, et al. (2000) SPIKES — A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist 5(4), 302–311. doi:10.1634/theoncologist.5-4-302CrossRefGoogle Scholar
Bakitas, M, Lyons, KD, Hegel, MT, et al. (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. Journal of the American Medical Association 302(7), 741–749. doi:10.1001/jama.2009.1198CrossRefGoogle Scholar
Banerjee, SC, Manna, R, Coyle, N, et al. (2016) Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse Education in Practice 16(1), 193–201. doi:10.1016/j.nepr.2015.07.007CrossRefGoogle ScholarPubMed
Bickel, KE, McNiff, K, Buss, MK, et al. (2016) Defining high-quality palliative care in oncology practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement. Journal of Oncology Practice 12(9), e821–e837. doi:10.1200/JOP.2016.010686CrossRefGoogle Scholar
Bishop, CT, Mazanec, P, Bullington, J, et al. (2019) Online End-of-Life Nursing Education Consortium Core Curriculum for staff nurses: An education strategy to improve clinical practice. Journal of Hospice & Palliative Nursing 21(6), 531–539. doi:10.1097/njh.0000000000000593CrossRefGoogle ScholarPubMed
Buller, H, Virani, R, Malloy, P, et al. (2019) End-of-life nursing and education consortium communication curriculum for nurses. Journal of Hospice & Palliative Nursing 21(2), e5–e12. doi:10.1097/njh.0000000000000540CrossRefGoogle ScholarPubMed
Bumb, M, Keefe, J, Miller, L, et al. (2018) Breaking bad news: An evidence-based review of communication models for oncology nurses. Clinical Journal of Oncology Nursing 21(5), 573–580. doi:10.1188/17.cjon.573-580CrossRefGoogle Scholar
Chen, CH and Raingruber, B (2014) Educational needs of inpatient oncology nurses in providing psychosocial care. Clinical Journal of Oncology Nursing 18(1), E1–E5. 10.1188/14.cjon.e1-e5.CrossRefGoogle ScholarPubMed
Coyle, N, Manna, R, Shen, MJ, et al. (2015) Discussing death, dying, and end-of-life goals of care: A communication skills training module for oncology nurses. Clinical Journal of Oncology Nursing 19(6), 697–702. doi:10.1188/15.cjon.697-702CrossRefGoogle ScholarPubMed
Curtis, JR, Downey, L, Back, AL, et al. (2018) Effect of a patient and clinician communication-priming intervention on patient-reported goals of care discussions between patients with serious illness and clinicians: A randomized clinical trial. JAMA Internal Medicine 178(7), 930–940. doi:10.1001/jamainternmed.2018.2317CrossRefGoogle ScholarPubMed
Desai, AV, Klimek, VM, Chow, K, et al. (2018) 1-2-3 project: A quality improvement initiative to normalize and systematize palliative care for all patients with cancer in the outpatient clinic setting. Journal of Oncology Practice 14(12), e775–e785. doi:10.1200/jop.18.00346CrossRefGoogle Scholar
El-Jawahri, A, LeBlanc, T, VanDusen, H, et al. (2016) Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: A randomized clinical trial. Journal of the American Medical Association 316(20), 2094–2103. doi:10.1001/jama.2016.16786CrossRefGoogle ScholarPubMed
Engelberg, R, Downey, L and Curtis, JR (2006) Psychometric characteristics of a quality of communication questionnaire assessing communication about end-of-life care. Journal of Palliative Medicine 9(5), 1086–1098. doi:10.1089/jpm.2006.9.1086CrossRefGoogle ScholarPubMed
Epstein, AS, Desai, AV, Bernal, C, et al. (2019) Giving voice to patient values throughout cancer: A novel nurse-led intervention. Journal of Pain and Symptom Management 58(1), 72–79.e2. doi:10.1016/j.jpainsymman.2019.04.028CrossRefGoogle Scholar
Ferrell, B, Malloy, P and Virani, R (2015) The end of life nursing education nursing consortium project. Annals of Palliative Medicine 4(2), 61–69. doi:10.3978/j.issn.2224-5820.2015.04.05Google ScholarPubMed
Ferrell, B, Buller, H, Paice, J, et al. (2019) End of life nursing and education consortium communication curriculum for interdisciplinary palliative care teams. Journal of Palliative Medicine 22(9), 1082–1091. doi:10.1089/jpm.2018.0645CrossRefGoogle ScholarPubMed
Fuoto, A and Turner, KM (2019) Palliative care nursing communication: An evaluation of the COMFORT model. Journal of Hospice & Palliative Nursing 21(2), 124–130. doi:10.1097/njh.0000000000000493CrossRefGoogle ScholarPubMed
Greer, JA, Pirl, WF, Jackson, VA, et al. (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. Journal of Clinical Oncology 30(4), 394–400. doi:10.1200/jco.2011.35.7996CrossRefGoogle ScholarPubMed
Hill, H, Evans, JM and Forbat, L (2015) Nurses respond to patients’ psychosocial needs by dealing, ducking, diverting and deferring: An observational study of a hospice ward. BMC Nursing 14, 60. doi:10.1186/s12912-015-0112-8CrossRefGoogle ScholarPubMed
Hui, D and Bruera, E (2015) Models of integration of oncology and palliative care. Annals of Palliative Medicine 4(3), 89–98. doi:10.3978/j.issn.2224-5820.2015.04.01Google ScholarPubMed
Jackson, VA and Back, AL (2011) Teaching communication skills using role-play: An experience-based guide for educators. Journal of Palliative Medicine 14(6), 775–780. doi:10.1089/jpm.2010.0493CrossRefGoogle ScholarPubMed
Kissane, DW, Bylund, CL, Banerjee, SC, et al. (2012) Communication skills training for oncology professionals. Journal of Clinical Oncology 30(11), 1242–1247. doi:10.1200/JCO.2011.39.6184CrossRefGoogle ScholarPubMed
Krimshtein, NS, Luhrs, CA, Puntillo, KA, et al. (2011) Training nurses for interdisciplinary communication with families in the intensive care unit: An intervention. Journal of Palliative Medicine 14(12), 1325–1332. doi:10.1089/jpm.2011.0225CrossRefGoogle ScholarPubMed
Lindley, LC, Herr, KA and Norton, SA (2017) The role of hospice and palliative care nurses in quality improvement. Journal of Hospice & Palliative Nursing 19(2), 160–165. doi:1097/NJH.0000000000000324CrossRefGoogle Scholar
Nardi, TJ and Keefe-Cooperman, K (2006) Communicating bad news: A model for emergency mental health helpers. International Journal of Emergency Mental Health 8(3), 203–207.Google Scholar
Oncology Nursing Society (2019). Palliative Care for People with Cancer [Position statement]. Available at: https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/palliative-care-people.Google Scholar
Paladino, J, Kilpatrick, L, O'Connor, N, et al. (2019) Training clinicians in serious illness communication using a structured guide: Evaluation of a training program in three health systems. Journal of Palliative Medicine 23(3), 337–345. doi:10.1089/jpm.2019.0334CrossRefGoogle ScholarPubMed
Pehrson, C, Banerjee, SC, Manna, R, et al. (2016) Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses. Patient Education and Counseling 99(4), 610–616. doi:10.1016/j.pec.2015.11.021CrossRefGoogle ScholarPubMed
Pollak, KI, Arnold, RM, Jeffreys, AS, et al. (2007) Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology 25(26), 5748–5752. doi:10.1200/JCO.2007.12.4180CrossRefGoogle ScholarPubMed
Pulsford, D, Jackson, G, O'Brien, T, et al. (2013) Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: A systematic review. Palliative Medicine 27(3), 221–235. doi:10.1177/0269216311429496CrossRefGoogle ScholarPubMed
Rask, MT, Jensen, ML, Andersen, J, et al. (2009) Effects of an intervention aimed at improving nurse-patient communication in an oncology outpatient clinic. Cancer Nursing 32(1), E1–E11. doi:10.1097/01.NCC.0000343365.13871.12CrossRefGoogle Scholar
Rosa, WE, Dahlin, C, Battista, V, et al. (2021) Primary palliative care clinical implications: Oncology nursing during the COVID-19 pandemic. Clinical Journal of Oncology Nursing 25(2), 119–125. doi:10.1188/21.CJON.119-125CrossRefGoogle ScholarPubMed
Selman, LE, Brighton, LJ, Hawkins, A, et al. (2017) The effect of communication skills training for generalist palliative care providers on patient-reported outcomes and clinician behaviors: A systematic review and meta-analysis. Journal of Pain and Symptom Management 54(3), 404–416. doi:10.1016/j.jpainsymman.2017.04.007CrossRefGoogle ScholarPubMed
Spetz, J, Dudley, N, Trupin, L, et al. (2016) Few hospital palliative care programs meet national staffing recommendations. Health Affairs 35(9), 1690–1697. doi:10.1377/hlthaff.2016.0113CrossRefGoogle ScholarPubMed
Temel, JS, Greer, JA, Muzikansky, A, et al. (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine 363(8), 733–742. doi:10.1056/NEJMoa1000678CrossRefGoogle ScholarPubMed
Walling, AM, Tisnado, D, Ettner, SL, et al. (2016) Palliative care specialist consultation is associated with supportive care quality in advanced cancer. Journal of Pain and Symptom Management 52(4), 507–514. doi:10.1016/j.jpainsymman.2016.04.005CrossRefGoogle ScholarPubMed
Wittenberg, E, Ferrell, B, Goldsmith, J, et al. (2016) Assessment of a statewide palliative care team training course: COMFORT communication for palliative care teams. Journal of Palliative Medicine 19(7), 746–752. doi:10.1089/jpm.2015.0552CrossRefGoogle ScholarPubMed
Wittenberg-Lyles, E, Goldsmith, J, Ferrell, B, et al. (2014) Assessment of an interprofessional online curriculum for palliative care communication training. Journal of Palliative Medicine 17(4), 400–406. doi:10.1089/jpm.2013.0270CrossRefGoogle ScholarPubMed