1. Psychosocial aspects of nursing in caring a patient with a cancer

2. 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

3. Factors related to severity of psychosocial problems
Disease
Environment
Individual

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

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

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

7. 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?

8. 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

9. 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

10. 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?

11. 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

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

13. 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

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

15. 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

16. 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

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

18. 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

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