SpeakSooner and Adirondack Health’s oncology department team up to improve healthcare communication

SpeakSooner and Adirondack Health’s oncology department team up to improve healthcare communication

By Brittany Proulx

           Adirondack Health oncology providers are utilizing the SpeakSooner initiative to communicate quickly and efficiently with patients. It goes beyond diagnosis and treatment, encouraging patients to voice their questions and concerns earlier in their care. It also helps ease patients into discussions about difficult choices like advanced directives and end-of-life care.

           Oncology Nurse Practitioner Sara Ames began working with the Center for Communication in Medicine on its SpeakSooner initiative several years ago. During this time, Ames and the oncology team began re-evaluating their entire process of caring for new cancer patients – from the first time they came in the door. Ultimately, the oncology team developed a method to integrate the SpeakSooner guide into their patient care.

           “I felt like I finally found people who really understood how important it was to initiate these conversations early and thread them throughout a patient’s care and continue it,” Ames said. “My approach to prompting the patients and having them be a part of SpeakSooner is that I am essentially the guide,” Ames said. “The guide is incorporated into my everyday questions.”

           Around the same time, oncology welcomed a social worker to its team, Kristina Hybicki, and a nurse coordinator, Jennifer Marshall.

           “SpeakSooner is also an opportunity to teach new people who are coming into a close-knit department,” Ames said. “It helps you teach these values.”

           “It’s actually having the patient tell you how they feel and how they’re working through the emotional part of a difficult diagnosis,” Hybicki said.

            The Center for Communication in Medicine (CCM) is the education division of the Institute of Medical Humanism, a Bennington, Vermont-based nonprofit organization. Since 2001, CCM's educational programs and tools have helped patients and loved ones prepare for conversations with healthcare providers, leading to improved communication about treatment options, quality of life considerations, and supportive care needs. Dr. Bernard Bandman, a founder and the executive director of CCM, established the psychological services program at the cancer center in Bennington in 1988. 

           Oncologist David Mastrianni said that amazing new treatments bring increased complexity to the conversations clinicians need to have with patients about every aspect of their illness, and SpeakSooner helps facilitate that. 

           As a registered nurse who received oncology care at Adirondack Health, Mary Smith said that when someone first learns they have cancer, “all you hear is you have cancer.” But then the patient goes home and the questions begin to manifest.

“With the SpeakSooner book, all of that information is there,” Smith said. “As a cancer patient, it’s easier [for you] to go through it than it is for your family to go through it. I want to have all the answers before I tell my family.”

           Adirondack Health cardiology PA Jessica Garnsey and Director of Business Development and Provider Relations Luke Meissner were both part of the initial SpeakSooner committee at Adirondack Health.

           “We’re creating a model so that we’re using the same script,” Garnsey said. “So we’re all on the same page about how we communicate and how we listen, and that is going to improve patient outcomes.”

           Meissner said when utilized correctly and early in treatment, SpeakSooner can also help to define a patient’s wishes.

           “Sometimes those communications can be difficult and scary. We [as clinicians] can have our personal feelings mixed in, so having a guide for how to have these conversations in a way that doesn’t take into account these personal feelings and let them get in the way, is valuable,” Meissner said.

           Ames said the oncology team has embraced the SpeakSooner guide and conducts a monthly meeting where everyone gets to be involved with each patient’s care.

           “It also has a benefit internally for our recruitment and retention,” Meissner said. “Ethical dilemmas and moral stress are huge challenges for healthcare workers, impacting their ability to continue working in the healthcare environment. I think a big part of the ethical dilemmas healthcare workers face is when they feel they’re not doing a service for the patient.”

           “It has given them a forum to express these things and given them validation that what they’re seeing and what they’re observing is important,” Dr. Mastrianni said. “The guide has given them a way to do it, and it’s been an incredible tool for us.”

           The entire oncology team now meets monthly to present complex patient cases, using a framework of questions prompted by the SpeakSooner guide. The meeting is an opportunity to re-evaluate every step of a patient’s care.

           “The first question asked by Dr. Mastrianni at each meeting is ‘Did we do the right thing medically?’” Ames said. “And he educates all the staff on the decisions that went into a patient’s treatment plan. People love to learn. We go through these sets of questions that mimic the guide and we’re all learning from each other from the different conversations and experiences we’ve all had with these patients. At the very end, the last question is, ‘Is there anything we can do better?’ We always come away with an improved understanding of the complicated cases. It better prepares everyone.”

           Ames hopes other Adirondack Health teams will take an interest in utilizing the SpeakSooner guide in their departments and welcomes questions at ext. 2548 or by email at sames@adirondackhealth.org.

           “Now that we’ve gone through a lot of the trials and tribulations, we can help others who are interested in learning about how SpeakSooner can work best for them,” Ames said. “The guide is very adaptable.”