Cancer Patients example essay topic

Cancer patients often report psychological distress at the time of diagnosis and treatment (Del Mastro et al., 2002; Jacobsen & Holland, 1991). Patients' distress is highly correlated with the frequency of side effects from chemotherapy and radiation (Leventhal, Easterling, Coons, & Luchterhand, 1986). Studies report that up to 50% of people report lingering anxiety and depression as long as three years after completing their treatment (Redd et al., 2001). Other researchers have found that subclinical levels of psychological distress persist five years or more after diagnosis for breast cancer (Saleeba, Weitzner, & Meyers, 1996). Even eight years after diagnosis, 50% of patients believe themselves to be more at risk for becoming depressed than they were before diagnosis (Halttunen, Hietanen, Jallinoja, & Lonnqvist, 1992). Sometimes it happens that one partner becomes a nurse for another (e.g. during breast cancer husbands often take care of their wives).

In such cases, it is common that partners experience many memories of and emotions about the cancer experience as aversive. These negative associations often lead to the avoidance of situations or conversation that might evoke the memories and emotions. It should be noted, that avoidance of thinking or talking about the cancer experience disrupts patients' and their partners' abilities to communicate effectively and process the cancer experience cognitively and emotionally. Several studies have shown that patients who engage in active cognitive and emotional processing of the cancer experience report lower distress (Lepore, 2001; Stanton et al., 2000). It may be concluded, therefore, that one of the purposes of nursing for cancer patients is to create a favorable environment, in which patients and partners feel safe to talk about the cancer experience and develop new understandings of its meaning for their lives. The principle underlying this guess is similar to that for treating phobias or obsessions (Steketee & Ellis, 1999): expose patients and partners to the aversive stimuli (memories of the cancer experience), help them remain calm, and encourage them to discuss their cognition's and emotions about it.

By exposing and sharing patients' and partners' thoughts and feelings to the "light of day", they become less frightening and more manageable. Both patients and their partners are able to put the cancer in its place (Gonzalez, Steinglass, & Reiss, 1989) and move on with their lives. It is remarkably difficult to talk about death and its meaning. Cancer patients may have their own personal fears and a death anxiety.

They may lack training, knowledge, and experience in giving bad news. Formal training communication skills and increasing availability of a wide variety of resources on communication can enhance the clinician's ability to relay difficult information. This can be done without increasing the patient's emotional distress and without lengthening the patient visit (Lepore, 2001; Stanton et al., 2000). The patient should be encouraged to make appropriate arrangements for personal matters. These include updating his or her will, thinking about end-of-life care and advance directives, and discussing these with an appropriate surrogate. All of these discussions should be both compassionate and culturally sensitive.

Even something as simple as an extra 40's of compassion on an educational videotape about breast cancer has been shown to reduce anxiety in 123 breast cancer survivors and 87 women without breast cancer, although it did not improve recall of the educational information. (Saleeba, Weitzner, & Meyers, 1996) Above all, the patient should be allowed to express their reaction to the situation. If there will be a day-to-day contact person who will coordinate care for the patient with all of the different consultants and resources, that person should be present at these discussions to facilitate congruence between patient preferences and care delivered. These conversations should be open minded and nonjudgmental; we must make sure that our own prejudices and beliefs do not overly color this joint discussion-making process.

(Saleeba, Weitzner, & Meyers, 1996) Giving bad news is a difficult task and requires physician competence and facility with communication under stressful circumstances. Nurse should avail themselves of the increasing body of educational resources to improve communication at the end of life. Strategies for facilitating a transition of focus of care to palliative and comfort measures include the following (Del Mastro et al., 2002; Jacobsen & Holland, 1991): (1) developing rapport; (2) finding out what the patient and family already know; (3) identifying preferences for receipt of information (amount and complexity); (4) giving the information in a sensitive but straight-forward manner; (5) responding to emotions; (6) establishing the overall goals of treatment given the patient's personal goals, the medical facts, and the available technology; (7) and finalizing the care plan, selecting elements based on goals of treatment. Involving the patient and family in decision making enables them to have as much control as possible over the dying process. Death is the ultimate outcome for every life.

In general, people meet their deaths the same way they approach life; if they have time before their death, then they need to have the tools to help them use this time wisely. We need to do our best to give them both the time and the tools.

Bibliography

Del Mastro, L., Costantini, M., Morass o, G., Boni, F., Bergaglio, M., & Banducci, S. et al. (2002).
Impact of two different dose-intensity chemotherapy regimens on psychological distress in early breast cancer patients. European Journal of Cancer, 38,359-366. Gonzalez, S., Steinglass, P., & Reiss, D. (1989).
Putting the illness in its place: Discussion groups for families with chronic medical illnesses. Family Process, 28, 69-87. Halttunen, A., Hietanen, P., Jallinoja, P., & Lonnqvist, J. (1992).
Getting free of breast cancer. An eight-year perspective of the relapse-free patients. Acta Oncologic a, 31,307-310. Leventhal, H., Easterling, F., Coons, H.L., & Luchterhand, C.M. (1986).
Adaptation to chemotherapy treatments. In B.L. Andersen (Ed. ), Women with cancer. Psychological perspectives (pp. 172-203). New York: Springer-Verlag. Saleeba, A.K., Weitzner, M.A., & Meyers, C.A. (1996).
Subclinical psychological distress in long term survivors of breast cancer: A preliminary communication. Journal of Psychosocial Oncology, 14, 83-93. Steketee, G., & Ellis, A.W. (1999).