Molly Stoddart, RN, BSN, is a clinical research nurse on the multiple myeloma (MM) team at the Winship Cancer Institute at Emory University in Atlanta, Georgia. Stoddart works with Blood Cancers Today Editor-in-Chief Sagar Lonial, MD, FACP, and is responsible for managing his patients who are enrolled in clinical trials.
How did you become a clinical research nurse? I graduated from Emory’s School of Nursing in 2011, and I’ve been a nurse for 12 years. My background is in orthopedics, and I worked at Hospital for Special Surgery when I lived in New York. I was there for almost 10 years doing inpatient orthopedics. When I moved back to Atlanta, I returned to Emory and worked in outpatient orthopedics, but I was looking for something different. I connected with a nursing school friend for this job I am in now. When I went to the interview, I knew it was for clinical trials, but I didn’t know the details. During the interview, they told me the position was for the MM team. I said, “Wow, that really is interesting because my grandmother was a patient with MM here on clinical trials for 16 years.” She passed in 2015, but Dr. Lonial remembered her. I feel like the job was not a coincidence, so I switched specialties, and I’ve been so, so happy here.
How many clinical trials are you responsible for currently? Walk us through your week. I’m currently working on six phase I clinical trials. I have on average eight to 10 patient visits per week, and I structure my week around those visits. The patients are scheduled based on the trial’s requirements, so whether they come weekly or biweekly, that’s up to the study’s protocol. We have a dedicated unit where the patients go for phase I trials at Emory.
I make sure that all the research duties are organized, that the patient treatment plan is accurate, and that any research labs that need to be drawn are there for the nurses. I visit with patients to see if anything new is going on and to find out how they’re doing. Then I work with the providers and the nurse practitioners in the clinic on any issues and to make sure we’re good to proceed with treatment for that day.
I’m able to build a personal relationship with my patients in a way that I never was able to in my previous jobs because you don’t see them over an extended period as an inpatient nurse. There’s also a lot of behind-the-scenes research tasks to do related to data, compiling information, and screening new patients for trials.
How do you build a relationship of trust with patients? What kind of challenges and barriers do you face in your role? For the first part of the question, I would say these patients come to us for clinical trials in a very vulnerable state. All the standard-of-care or on-the-market treatments have failed or are not available to these patients for some reason. It’s an interesting place of giving hope but also not [offering] a guarantee. Nothing in medicine is a guarantee, but [that’s true for] clinical trials especially. It’s a unique position, but then I get to see these patients every week and guide them through this process. I talk to them in between visits most weeks. I know what’s going on in their lives – I know about their kids, about their grandkids, their cats, and vacations they’re taking, so it is a more personal nursing relationship. Whereas before, when I worked in hospitals, people were in and out and that’s it. You never saw them after.
As far as barriers, time is always a barrier. Not to providing care, but just to being able to get everything done. These are complicated protocols. The learning curve was steep when I started this job, in terms of learning both MM and then learning research, starting with the basics of how to read a protocol and building from there. The other barrier is more of an emotional barrier for me personally. You can’t magically fix patients, unfortunately. It’s emotional when patients’ disease progresses no matter the circumstance.
How do you help ease patients’ apprehensions about enrolling in clinical trials? The way it works here at Emory is the physicians identify a patient who they think would be a good candidate for a trial, and then I look through their chart and make sure that they are eligible. Then I’ll meet them in the clinic with the physician, and we’ll go over the consent form, which has all the basic information about the trial. I also send it to them ahead of time so they can read it alone, or with their family, or whoever else might be helping them decide. [Some patients] will absolutely come in with tons of questions, but some people don’t. Some people are like, “This is what Dr. Lonial suggested, so let’s do it,” and some people are hesitant.
There’s a lot of hesitancy among patients that I had not encountered before this job. Patients have told me, “I don’t want to be a guinea pig.” Reassuring them that everyone here has their best interests at heart and using the data and research that is available for those drugs is important. I believe a lot of it comes down to their trust in the medical system, our physicians, and Emory. Most patients have a very long-standing relationship with the Winship Cancer Institute by the time they get to clinical trials, and they do have that trust.
I like it when patients have questions. It means that they are interested in their care, that they read the consent form that we sent them, and are an active participant in making their decisions. I think that’s important for a clinical trial because it’s not easy, necessarily, for the patients. It might not necessarily require more appointments but longer appointments. They have surveys, blood draws, sometimes imaging tests on a frequent basis. There isn’t much flexibility for the patients because we’re bound by the requirements of the protocol. It can be a big commitment for the patient. You want them to buy in and be active participants.
Your position has a steep learning curve. How do you stay current in your skills? I immediately did a deep dive into myeloma when I onboarded. I certainly wouldn’t say that I know everything there is to know about myeloma, but between reading and studying I have learned a lot. Our physicians and team members are wonderful educators. Dr. Lonial is a phenomenal educator and resource. I’ve gone to him many times with questions related to patients.
Our team does a great job of this by sending out current publications, doing grand rounds in our weekly meetings, and keeping us up to date on anything that might impact patient care. A lot of our studies are novel in the myeloma world. One of our drugs, teclistamab, was approved by the U.S. Food and Drug Administration (FDA) recently, which was phenomenal.
What is one thing that other people would be surprised to learn about in your profession? I think people would be surprised by the variety of skills I use daily in this job.
What is something that you would like clinicians to know? They put a lot of trust in us (and the nurse practitioners) in the phase I clinic to manage the day-to-day care of their patients. They trust me to tell them if there’s anything that they need to know regarding our trial participants. I would love for the clinicians to know that I as a research nurse care so much about our patients and their outcomes. It’s an interesting relationship because I feel like we work closely with them, but I see them weekly, not daily.
Can you describe what it is like working at an institution like Emory, where these emerging therapies are front and center? It is personally rewarding. Dr. Lonial always tells us that Emory has been a part of many FDA-approved myeloma drug trials over the years. I think that’s incredible. For me personally, I think about how my grandmother was on clinical trials here and how that gave her so much more life than she would’ve had somewhere else. It’s amazing to be able to help be a part of that with the patients I work with now.
Burnout is notorious in the nursing profession. How do you stave off burnout and leave work at work, especially while caring for patients? I think preventing and dealing with burnout are skills that nursing school should teach instead of having to pick it up on your own and figure out what does or doesn’t work. As I’ve gotten older, I have gotten better at compartmentalizing. I find myself thinking about my patients (and about work) even when I’m not actively working—it’s always there in the back of my mind, even on the weekends. I work hard while I’m at work, but I also have a family and my time with them outside of work is just as important to me. My weekends are sacred, and I really do my best to be present. I have two young children, a two-year-old and a four-year-old, and my husband and I make a conscious effort to keep work out of our family time as much as possible, so that we can recharge, relax, and combat those feelings of burnout. I also try to dedicate just a few minutes to myself every day, like escaping into a fiction book.
Molly Stoddart, RN, BSN, is a clinical research nurse on the MM team at the Winship Cancer Institute at Emory University.