TINA: Before we move on -- tell me Joe, what are the three main steps you'll take to help avoid infection during treatment?
JOE: Uhh... the flu shot, which I got. I need to... wash my hands more often, sing two Happy Birthdays, which is definitely a lot longer than I take now. And... uhhh...
TINA: Someone's... coughing?
JOE: Ah! And stay away from anyone sick.
TINA: You got it!
TINA: Let's talk about the signs to look for that could mean you have an infection. Even if you follow all the precautions, there's still the risk you could get sick, so I want to make sure you know what to look for.
JOE: Alright…
TINA: So - you know those symptoms you feel when you have a cold or flu?
JOE: Ugh, yes.
TINA: Exactly - those. You'll want to be on the lookout for fever, chills, sweats, sore throat, cough, nasal congestion, diarrhea, and vomiting --even other unusual signs like a stiff neck, shortness of breath, or new pain, any of these could be a sign of a serious infection. If you notice anything like that during your treatment, let us know right away.
JOE: Yeah. I just... I dunno... I don't want to be a bother or anything…
TINA: Infections can cause a fever, and sometimes a low fever - maybe one you don't even realize you have -can be the first sign of infection. So you need to take your temperature at least once a day during your nadir period. And, even if you're not in your nadir, you should check your temperature if you're ever feeling... not-so-great.
JOE: Alright.
TINA: And if your temperature is 100.4 or higher? That's an emergency -- you'd need to call and let us know immediately.
JOE: Y'all are always so busy... would hate to interrupt…
TINA: Your medical team is always here for you, day and night. If you get a fever or sign of infection during chemo, it's an emergency. We need to know and want to help. That's what we're here for. 24/7.
JOE: Yeah, alright…
TINA: It's our job! And it could be your LIFE, so it's something we're all invested in. And if, for any reason, you're not able to reach us, head to the closest ER. Let them know you're on chemo and are experiencing signs of infection.
FEEDBACK: Good job! It's important that patients feel comfortable contacting their medical team at any time about anything.
TINA: So, before we move on, tell me -- what signs could mean an infection?
JOE: A fever. I should check every day and if I'm ever, uhh... not feeling well.
JOE: Yeah, uhh... things like I'd feel if I got the flu or something. The aches and chills and sweats and stuff. Anything... unpleasant.
TINA: Right.
TINA: Do you have questions about anything else?
JOE: Yeh, uhh... you said stay away from sick people... so does that mean I shouldn't go out? Like, in public?
TINA: If you're feeling up to it, going out is generally fine as long as you take some precautions.
JOE: Oh. Great!
TINA: Still - you'll want to avoid really crowded places whenever you can...be extra mindful to wash your hands when you're out --say, at a restaurant or something -- and when you get back home.And if you notice someone coughing or sneezing? Steer clear.
TINA: Before you leave, I'll give you some information on what we've talked about today. I'll also write down the link to a CDC website that has a lot of information about staying safe during chemo.
JOE: Good. Definitely won't remember all of this! Memory isn't what it used to be…
TINA: I know it's a lot to remember--
JOE: --a whole lot.
TINA: And that's why we have handouts! You can have them at home and reference them whenever you'd like. You also may want to make sure your wife and daughter read through them too, so they can help you stay on top of it all.
TINA: Alright, Joe - if any new questions come up or you want to double check anything we talked about, please don't hesitate to call.
JOE: Okay. I feel like I understand all this a bit better, so - thank you.
TINA: Of course! We're here for you any time and are more than happy to help. There are no questions or concerns that are too small and no "bad time" to reach out to us - seriously.
JOE: Okay - I'll hold you to that!
TINA: I hope you do.
Let’s see why that conversation was much more successful.
Tina did a great job helping Joe to understand neutropenia and the associated risks. As a result, he is likely to adhere to recommendations and lower his risk for infection.
Tina explained neutropenia, nadir, ways to avoid infection, and signs of infection using plain language. She also used frequent checks for understanding to ensure Joe was following the conversation. This made it easier for Joe to understand and retain information.
Tina reinforced the importance of Joe reaching out to his medical team. Telling Joe to reach out at any time made him comfortable reaching out with any question. This increases the chance that Joe will reach out if he has any concerns.
Tina did a good job of avoiding showing frustration and using empathetic statements. This made Joe feel supported and more willing to ask questions.