Shared Decision-Making and Self-Management of Cancer Through Patient Empowerment and Education

A cancer diagnosis can be overwhelming and distributing educational resources to patients with newly diagnosed multiple myeloma (NDMM) is crucial to providing comprehensive cancer care, as patients may lack understanding and retaining information can be difficult. In addition to counseling patients verbally, nurses should provide written or electronic information from reliable sources to engage patients and families. Some examples of reliable sources include the National Cancer Institute, American Cancer Society, International Myeloma Foundation, and Leukemia & Lymphoma Society. Shared decision-making can also improve patients’ experience with care. Seeking patients’ participation and understanding their values and preferences can improve the quality of care delivered and improve patient adherence to treatment recommendations. The SHARE approach builds a trusted relationship between healthcare professionals and patients; free education and training materials are available online (Table 1).

Table 1. The SHARE Approach

Step 1 Seek your patient’s participation
Step 2 Help your patient explore and compare treatment options
Step 3 Assess your patient’s values and preferences
Step 4 Reach a decision with your patient
Step 5 Evaluate your patient’s decision

In patients with NDMM, there are important considerations that may require education by nurses. Infection prevention is important in these patients, and nurses should encourage handwashing and proper hygiene. Growth factor, such as filgrastim, and IV immunoglobulin for hypogammaglobulinemia may be required. Nurses should ensure patients are receiving all vaccines, although no live vaccines, including COVID-19 vaccine and booster, pneumococcal 20-valent, seasonal flu vaccine, and shingles. COVID-19 prevention can include monitoring of antibody levels and tixagevimab copackaged with cilgavimab. Kidney health is also crucial in patients with NDMM and active MM and high calcium. Nurses can educate patients on avoiding certain medications, such as contrast dye and NSAIDs, and ensure adequate hydration. Dose adjustments may be necessary for reduced kidney function, and healthcare teams should address underlying myeloma causing kidney dysfunction. Bone health is also important for patients as myeloma cells may cause bone damage; about 85% of patients with MM develop bone disease. Nurses should monitor patients and report any new or worsening bone pain. Serum calcium levels should be monitored along with imaging depending on type and location of pain. Bone-strengthening agents should be administered for at least 12 months to all patients with NDMM, with or without bone disease.

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