In cancer rehab, saying “I don’t know” can feel uncomfortable…
BUT it can also beapowerfultool when paired with the right communication strategies.
In this TCRCC2025 preview episode, Dr. Alex Eilers shares how to navigate uncertainty with patients, build trust, and elevate your practice even when answers aren’t clear.
Get a sneak peek of her session, “Navigating Uncertainty in Oncology Rehabilitation: Communication Strategies to Elevate Your Practice When ‘I Don’t Know’ is the Answer,” and learn practical tips to handle the unknown with confidence and professionalism.
Want to watch the episode instead?
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
About Dr. Alex Eilers, PT
Alex Eilers is a Doctor of Physical Therapy currently practicing in the Oncology Unit at Madonna Rehabilitation Hospital-Omaha, an institution accredited by the Commission on Accreditation of Rehabilitation Facilities. With over 2,000 hours of hands-on experience, Alex is dedicated to providing compassionate, evidence-based care to oncology patients, expertly managing their treatment plans.
Transcript
Elise Cantu (00:19)
Hey Onco PT, welcome back to this episode of the Onco PT podcast. Today I am so thrilled to bring you an outstanding interview from Dr. Alex Eilers, but I have to be upfront. When I recorded this episode with Alex, actually back over the summer, my audio was completely messed up. Alex was perfect. It was amazing, incredible interview, ⁓ but I goofed up.
my audio totally messed up. And so what I’m doing today is I’m actually, because my audio wasn’t even recorded for half of the interview, I am going back and I am re-recording myself asking Alex those questions because otherwise it just takes away from the magic of the interview that I did with Alex. And so if you’re listening to this and you’re like, man, this is kind of choppy. This is kind of weird, like Elise cutting in and out. That’s why. And I want to, first of all, take
full ownership of that. Like I said, it was nothing that Alex did. It was entirely the tech on my end. And I want to apologize for that because I like to deliver really high quality episodes and this one did not make the cut. So what we’re doing is we’re just, doing the best we can with what we have, but I can guarantee you that is not going to happen ⁓ for the rest of our episodes for this year. And it’s also definitely not going to happen at the conference because I’m using entirely different software.
So tech issues aside, like I said, I just wanted to be upfront about that. We have an amazing interview from one of our ⁓ speakers at our upcoming, the Cancer Rehab Community Conference 2025, Dr. Alex Eilers. And she is talking about her session, which is titled, Navigating Uncertainty in Oncology Rehabilitation, Communication Strategies to Elevate Your Practice, when I don’t know is the answer.
And if that is not one of the most iconic conference session titles I have ever seen, I don’t know what is. This interview was so good. And one of the things that I really appreciated about Alex and this session and what I know she’s going to bring to the conference is that this is really embracing and stepping into the unknown, which as we know, working in oncology rehabilitation comes with a lot of unknowns. It comes with a territory where
Uncertainty is common. Sometimes we don’t have all of the information. Sometimes we don’t even know what’s going to happen next. And that’s not necessarily even just us. Sometimes the entire oncology team may not know what is quite coming ⁓ down the road for this patient and what they’re experiencing. So how do we navigate that professionally, ethically, and still respecting our patients and ultimately being honest with, I don’t know.
I’m not sure of that. I don’t have the answer for that. And so I’m so thrilled to bring you this interview. You are absolutely going to love it. Alex knocks it out of the park. And like I said, this is just a preview of the magic that she is bringing to the cancer rehab community conference. And I cannot wait for you to see that.
So I’m gonna take a step back now and let Alex introduce herself. Let’s get into this interview.
Elise Cantu (03:29)
Yes, thank you for having me. I’m really excited to be here.
my name is Alex Eilers. I’m a physical therapist and I work at an inpatient rehab hospital. And so we get the opportunity to work with ⁓ people for a high intensity program, but they usually are pretty debilitated. And a lot of times we see patients where they’re freshly off their diagnosis and they have been hospitalized ⁓ because of secondary complications with their treatments and with the disease itself. ⁓
I work in a CARF accredited program. And so that’s the commission on accreditation of rehab facilities for our cancer
Elise Cantu (04:10)
And so we are able to take on some of these patients with these challenging diagnoses and see really good results.
And that is one reason ⁓ I’m in this role primarily on the oncology team. We see a variety of patients throughout the hospital, but ⁓ my position is one that people have kind of avoided in the past. And ⁓ it’s the position that I’ve been in since I started and have stuck with. ⁓ Don’t know if it was something that I would necessarily sign up for when I was being hired, if they said market it as the oncology physical therapy team lead. ⁓
but have found that we are able to help our patients a lot and make a huge difference ⁓ with treating this population and ⁓ in our skills that we have as ⁓ even starting as physical therapy new grads, we have the skills to treat these patients. So ⁓ the title I don’t know is in there and I thought that was important to include because that was my mantra forever. And it’s still, I still say that.
daily, if not weekly. And being able to use that and, you know, yes, it’s still part of our lives. We’re not going to know all the answers, especially in this area where, you know, physicians and oncologists still say, I don’t know, we can have all the statistics in the world, but are you going to end on the high, the 90 % side or are you going to end on the 10 % side? We don’t know that looking at that specific person.
⁓ And so even if the stats are good, you still may have ⁓ a poor outcome or a better outcome. ⁓ And so that is kind of where this ⁓ has come up with. ⁓ We are also able to work with our palliative care team pretty closely. And so looking at my other ⁓ colleagues, ⁓ I have a pretty, ⁓ I have a good support system with our internal medicine doctor that heads our unit as well.
and watching how they manage these questions has really ⁓ brought a lot of insight to my practice and I think ⁓ can help people feel comfortable saying the words I don’t know, ⁓ but also providing your expertise despite, you know, feeling that ⁓ uncertainty.
Elise Cantu (06:35)
So Alex, do you remember the first time that you answered a patient question with, don’t know? And how did you get more comfortable answering with, I don’t know?
Elise Cantu (06:50)
that’s a good question. I don’t remember the first time, ⁓ cause it was, you know, sometimes that it depends on the level of the question. Sometimes there is something that’s like completely out of your scope and it’s easy to say, I don’t know that I, need to speak to someone else is probably, ⁓ the first step in that, ⁓ you know, pointing to your resources is probably one of the first steps to follow up with that. don’t know.
⁓ And then there’s other things you can do as far as ⁓ when you can reframe it to get it into where you do know stuff and try to direct the question that way. ⁓ I think we sought out a lot of these resources ⁓ because ⁓ it’s interesting. There’s some literature on having difficult conversations, but it’s usually directed at medical students.
or residents of some sort. And so it’s a lot of it’s around breaking bad news. And as far as my role, ⁓ that is not my role to say things. I can speak about your potential progress functionally and physically, but I cannot say anything as far as prognosis from a cancer perspective.
⁓ even the medical drugs and stuff. Maybe I can look into some potential side effects that we can address, but I can’t speak about your specific situation and what side effects you’re going to have with your treatment. And you don’t want me to because I don’t, I’m not the expert in that area. And if I try to answer some of those questions, I might just cause some more confusion then ⁓ or fear because there are, you maybe I give the worst scenario when it’s not necessarily appropriate.
⁓ And so I think that is kind learning some of those things about when it is appropriate to say, I’m going to step back and know that I could do more harm than good by trying to answer this question because my limited knowledge ⁓ will just ⁓ maybe create some anxiety that doesn’t isn’t necessarily ⁓ appropriate. ⁓ But as far as the first time, I don’t know, I think.
I think a lot of this came out again with that frustration piece of saying, like, I’m not going to be breaking bad news. ⁓ I need to help manage someone’s emotions following this realization. ⁓ And so how do I do that is a different skill.
Elise Cantu (09:33)
Do you feel like being in a multidisciplinary facility equips you with more resources to better have these difficult conversations, in which I don’t know is often the answer.
Elise Cantu (09:46)
Yes, to some extent I do have a little bit more resources like available right next to me as far as like counselors and social workers and palliative care providers that are able to really like are very, very equipped to have these conversations and discussions and make really solid recommendations on how to manage them. I think we do spend a lot of time with our patients. So then these things come up, which is a double edged sword because they trust us.
They want our opinions, but we may not be the correct person to be asking these questions. do have some things in my presentation on what can you do to kind of steer away from that. I do feel like being a task-oriented profession can help in some ways, in that we can be doing something while we’re talking about it, or can kind of switch the focus onto the task we’re trying to complete.
because of ⁓ our other functional goals. ⁓ And then also, ⁓ people start talking when they’re doing that and other stuff comes up. But being an active listener is another piece of our ⁓ profession. And so using those skills as well can ⁓ just comfort them as well as ⁓ give them an outlet to voice them and kind of organize them. Because another thing, ⁓
especially in other areas, ⁓ you know, this is kind of leading into the counseling role, but ⁓ people need to say their story and they need to speak it out loud and process verbally sometimes. So maybe you can just be that person for them at that time.
Elise Cantu (11:34)
Alex, one of the things that really wowed us and impressed us when we got your application was really the title and being so forward with this concept of like, I don’t know is common and it’s an okay answer. And it’s also sometimes a really acceptable answer, especially when we live in such a world where that can be, like not knowing can be seen as like a weakness or a deficit.
especially when we’re trying to be, you know, like the best Anko-PT we can be. So what inspired this title and this session idea for you?
Elise Cantu (12:13)
⁓ inspired is that’s the question I get at work is how do you deal with poor diagnoses? Never, I shouldn’t say never. Usually it’s not on how do treat this person appropriately. It’s how do you manage when someone’s crying in the room? How do you manage, ⁓ you know, trying to, you know, people are coming at you with these questions that nobody can answer, you know, like what do I do next?
Is it all worth it? You there’s some, there’s big stuff that goes on with a cancer diagnosis and people are processing ⁓ in real time. Sometimes we actually receive diagnostic information ⁓ while they’re in our care. And so we don’t have any oncologists on staff. We do have physicians that are taking care of the medical portion, but that can be a frustration because they come in
thinking one thing and then all of a sudden you get this like brick wall information and it’s it’s it’s hard for anyone to process. ⁓ I think in a hospital setting, most people are ⁓ caring individuals that are compassionate and want to help and it seems like ⁓ these are difficult questions to answer and to help people find a suitable ⁓ realization to. And so.
You know, I’ve gotten some research, ⁓ I’ve done some self reflection along with ⁓ some continued resources that have kind of helped me answer this question. ⁓ And so I just wanted to share it with other people. I also think that ⁓ it can be a deterrent for people to want to do this work. And on the flip side, I’ve just seen the benefits. ⁓
We work with people who can’t access their homes. And so that’s the major goal for most of them is to return home and be functioning and return to their daily lives. And so we make that happen even despite, ⁓ you know, maybe they don’t have a good diagnosis or they might not have a good outcome in the future. We still see functional gains. And so they should, this is, I think it’s just like the perfect area for physical therapy because
a trainer cannot do this. Like there’s no way they have the physiological background to be able to ⁓ provide the appropriate level of care. And so, you know, trying to get other people saying this is a barrier for
it shouldn’t be.
Elise Cantu (14:55)
Alex, I really appreciate you saying that because this is such an important conversation to have, especially because, as we’ve talked about, oncology rehab is such a dynamic place with lots of moving parts and lots of changes that our patients are dealing with.
Elise Cantu (15:12)
Yeah, Elise, and I do just wanna make one comment on, ⁓ you know, saying how dealing ⁓ with some people that have a poor prognosis, sometimes it’s just the trying piece that’s also really important. ⁓ Kind of that patients can take away that I did everything I could to beat this cancer and to fight. you know, therapy can be a huge role in that. ⁓
And people can come to peace with it even sometimes if they don’t meet their goals. That they did everything they could to meet their goals.
Elise Cantu (15:47)
So what are you most excited about for your session at the Cancer Rehab Community Conference 2025?
Elise Cantu (15:56)
Well, I’m going to end with a challenge. And my challenge will be to provide some reflection and being able to put some parameters and ⁓ some ideas of what is my expertise and how can I direct the conversation or identify where my expertise can help this patient, ⁓ even if I don’t know all of the answers. And so I think hopefully that is. ⁓
the challenge people will respond to and feel more comfortable in dealing with the unknown. Because I think you said it in your introduction, are going to live this cancer rehab is a world of unknowns. And ⁓ managing and setting expectations for what we do and what we don’t know can help provide some insight to patients and also provide the best care.
Elise Cantu (16:48)
Without giving everything away, what is one mic drop moment or surprising insight that you’ll be sharing at your session?
Elise Cantu (16:58)
Well, I’m also, I can share a quote with you. I’m gonna bring in quite a few qualitative analysis papers because they, ⁓ I mean, we’re talking about an experience, right? And so it is hard to even qualify or quantify what’s going on. And so ⁓ have a quote from the, ⁓ let me see the title.
Oncologist communication about uncertain information and second opinion consultations, a focused qualitative analysis by Van Sumeren is one article we’re going to be discussing. And then one of the quotes from the oncologists in there is that, ⁓ I’m just going to share it with you. I think it demonstrates that, you know, we’re not the only people that don’t have all the answers. It comes from ⁓
the oncologists, it comes from people seeking second opinions. ⁓ It comes from, ⁓ you know, and people share that ⁓ uncertainty and how to ⁓ explain it in different ways. And so this is a quote from that paper from an oncologist in that study. ⁓ They said, that side effect at end of life varies widely. I mean, anything can happen. It is impossible to predict how things will turn out. You really can’t make a meaningful statement.
That is of no use to you. I just don’t know. We cannot predict how it will go for you. I just don’t know. I just don’t have that answer. And so, you know, he said, don’t know, like four times in that little statement. And so I think there’s also, you know, some.
some solace in knowing that it’s not just you that doesn’t know the answer, but it’s also the people you’re kind of pointing to to have the answers ⁓ have a hard time discerning it. ⁓ And I think it also just demonstrates that we are living in an unknown area, but that doesn’t limit that we can’t, ⁓ that doesn’t mean we can’t help.
Elise Cantu (19:07)
And then what are you most excited about when it comes to the Cancer Rehab Community Conference 2025?
Elise Cantu (19:14)
I’m excited to participate, ⁓ to do a presentation. I’m also excited to learn from other people. ⁓ I really do think that this is such a, ⁓ you know, place for growth and place where physical therapists and therapy in general needs to be. ⁓ Everything that is coming out is just like confirming that over and over and over again to the point where it’s just like, exercise is the answer.
And we have the tools, the thing that sets us apart is the physiology background that other professions in exercise don’t have that is really, really valuable in this area. And so I just, think there’s a lot of growth for the profession and it’s a really exciting place to be.
I’m just also excited about it because I do feel like this is a barrier where people avoid this area ⁓ because of the complexity, because of the possible ⁓ negative outcomes as far as like, ⁓ you know, not meeting goals and not, ⁓ you know, getting to the point that you ⁓ would hope to be. And that is very different in different settings where it’s pretty, you know, you had an event and
you’re probably gonna get better. Whereas this is the case where it’s like, okay, you had an event and you ultimately we are faced with life and death, you know, complexes and discussions. And that can shy people away and it doesn’t have to, you know.
Elise Cantu (20:52)
So Alex, what would you tell someone who is on the fence considering registering for the Cancer Rehab Community Conference 2025?
Elise Cantu (21:01)
I would say that, you I see the people that are putting it on are very engaged and excited about the content. And so that ⁓ just demonstrate that it’s going to be good. You you have invested people that are leading it, Elise and everyone behind the scenes ⁓ and just are passionate about the topic. ⁓ And so that is going to be your gateway into ⁓ this world that ⁓
will just improve your skills and hopefully give you some of that fire to continue.
Elise Cantu (21:36)
Fantastic. And how can listeners connect with you and continue this conversation, Alex?
Elise Cantu (21:41)
Yeah, you can email me. My email is aeilers4@gmail.com And that’s probably the best way to get a hold of me.
Elise Cantu (21:51)
Once again, thank you so much to Dr. Alex Eilers for coming on the podcast, for giving us the sneak peek, the behind the scenes of her upcoming session at the Cancer Rehab Community Conference. One more time, that title is, Navigating Uncertainty in Oncology Rehabilitation. Communication Strategies to Elevate Your Practice, when I don’t know is the answer. I know that we are so, so excited for her session. We cannot wait to see all of the amazing clinical pearls and strategies that
she is going to share with us and then also give us to ultimately take back to our practices, to your patients in your community on Monday morning so you can better show up and work with your patients, especially like we said in this interview, when we do have those complicated, those nuance, those uncertain situations in which you may not have all the answer but can still show up with honesty and compassion.
in order to best treat your patient even when you maybe don’t know all the answers. And as Alex mentioned, it’s okay that we don’t know all the answers, but here’s how we move forward with that in mind. So once again, thank you so much, Alex. Thank you, dear listener. I really, really appreciate you joining us for today’s episode, and I cannot wait to see you in the next one. But until then, this is Elise with Onco PT, and remember, you.
are exactly the physical therapist that your patients with cancer need. So let’s get to work.