Psychosocial aspects of nursing in caring a patient with a cancer

Relevant statistic Cancer pts are three times more likely to suffer from anxiety or depression than the general population, twice as likely as other medical pts. Between a quarter and a third of cancer pts experience significant psychological distress

Factors related to severity of psychosocial problems Disease Environment Individual

Stages triggering distress Initial investigation Diagnosis Treatments End of treatment Recurrence Palliative care Bereavement

Impact on sense of identity Personality changes Ability to work/function normality Role in family Body image Sexuality Fertility

Mediating factors Stage in life cycle Social support Cultural issues Beliefs about illness Personality factors- life event, history of psychological difficulties

Adaptation to cancer Stimulus for coping: cancer Primary appraisal: how threatening? Secondary appraisal: options? Coping response Primary coping efficacy: demand met? Secondary efficacy: impact on the mental and physical health?

Factors promoting well-being Able to view demand as challenge rather than treat or loss Belief in own ability to do something about situation Ability to define priorities, set goals and solve problems

Issues of uncertainty Questions: Guidelines: Can I be treated? Can it be cured? What are the side effects? Will it come back? Acknowledge, uncertainty, empathy Be honest about what can’t be answered Be aware of distancing techniques Discuss what would help them deal with the uncertainty

The dreaded questions......... Is it cancer? Am I dying? How long have I got? How will I die? What happens after I die? How do I tell......? How will they cope without me?

Fears Fear of being blamed Fear of the unknown/ untaught Fear of unleashing a reaction Fear of expressing emotion Fear of not knowing the answer Fear of illness of death

others Desire to shield/protect the patient Personal issues triggers Complex family dynamics Insufficient time

Distancing techniques Avoiding the patient Not asking about the emotions Ignoring clues Premature reassurances Giving advice Focusing only on the positive aspects of treatment Playing down side effects Giving false hope

Importance of answering difficult questions Maintain trust Reduce uncertainty Prevent inappropriate hope Allow appropriate adjustment Prevent conspiracy

Responding to questions Check why the pt / relative is asking this particular question Explore what they already know Check whether they want further information Encourage expression of feeling and concern/worries Acknowledge difficulty of living with uncertainty

If you don’t know the answer...... Be honest Help pt decide how they could get the desired information If feasible, offer to liaise with relevant professionals to obtain answers With extensional or highly emotive questions, help pts to find their own answers

Denial Recognise importance of denial as a coping mechanism Only challenge denial if it create serious problems for patient or relatives

communication Elicit core issues for the pt, their fears and worries Elicit beliefs about illness- based on pt’s knowledge and predictions Provide information on clinical challenges faced Explore strategies and options

Communication cont....... Focus on what can change Help establish clear goals Help pts access the informational, practical , social and emotional support they need