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A.C. Škufca Smrdel
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NU02 - Preparing Patients for Treatment (ID 270)
- Event: WCLC 2016
- Type: Nurses Session
- Track: Nurses
- Presentations: 1
- Moderators:D. Borthwick, A. Fraser
- Coordinates: 12/05/2016, 16:00 - 17:30, Schubert 5
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NU02.01 - Preparing Patients for Treatment. Providing Psychosocial Support for Lung Cancer Patients Preparing to Enter Treatment (ID 6453)
16:00 - 16:20 | Author(s): A.C. Škufca Smrdel
- Abstract
- Presentation
Abstract:
Background: Lung cancer and its treatment have a major physical impact, as well as emotional, social, psychological, spiritual, functional and practical challenges and consequences, both for the patient and his relatives. While coping with the disease they become aware of vulnerability and mortality, they are balancing hope and the realisation of mortal danger(1). Preconceptions which patients are harbouring could be an important factor at coping with the lung cancer. Both smokers (or former smokers) and non-smokers are being stigmatised, and lung cancer is connected with stereotype representation of incurable disease(2). Life is never the same as before the diagnosis. In the comprehensive approach to lung cancer, team work is of paramount importance. Beside the standard oncological treatment, for the patient there is a benefit of an early palliative care. This benefit beside better quality of life (due to better quality of life, less depression and less aggressive treatment) confers also an increase of survival(3). Here, the nurse is an important member of comprehensive care team, and is the one spending the greatest amount of time at bedside. Methods: We reviewed the literature and the current clinical practice. Results: In operationalising psychosocial care in oncology many authors are advocating so called tiered approach(4,5). Providing psycho-social support to lung cancer patients is the task of all medical workers included in the multidisciplinary care. And all cancer patients have the basic psycho-social needs, such as informational needs, basic emotional support, adequate communication, screening of needs on on-going basis and the symptom management. Patients experiencing more profound distress or have more unmet needs, should be directed into the specialist care provided by the mental health professionals or other professionals needed. At the psycho-social care of the lung cancer patients entering the treatment, there should be an emphasis on the adequate patient information concerning the disease, planned treatment, side effects and their management, the possibilities of patient’s contribution to the treatment, and also patients’ fears and existential issues should be addressed. It is important for the patient to get as many information as he deems necessary, being careful about the pace the information is given. Despite the amount of information offered in media in the recent time – many of them unfortunately also untested – many patients in their search for information prefer getting information in one-to-one communication with health provider, in relation with whom they are experiencing confidence, safety, care and professionalism(1). It is important to present the information, at the same time accurate and still preserving the hope even in the face of the odious situation, thus giving the patient and his relatives emotional support and strengthening their functional coping strategies. Therefore, medical professionals should develop good communication skills; these are proven to be associated with less unmet needs(6)by the patient and also with the increase of informed decisions regarding treatment(7). In patients with poorer communication skills, assertiveness support can help with the communication with the medical professionals but also with the relatives. The cognitive behavioural therapy strategies can take a pivotal place. Cognitive interventions are focused on the way of thinking about a situation and through it influences the behavioural and emotional response, like cognitive restructuration, helping the patient in development of positive alternative to negative thought, or distraction, changing the patient focus. Behavioural interventions, such as relaxation techniques, can help controlling physiological responses in stressful situations. An important place in the support of patient’s psycho-social needs is taking into consideration emotional and social support. In addition to patient’s relatives, friends and peers, medical workers represent an integral part of it. In the patient’s preparation for treatment, it is important to recognize those experiencing more profound distress or having more unmet needs, thus needing more help. Research has shown that cancer patients are experiencing more physical problems - the most common are pain, dyspnoea, fatigue, cough(8) - and also have more unmet needs than other patients. In excess of 80 % of lung cancer patients are experiencing some degree of psychological distress. This is more than other cancer type patients are experiencing. Depression estimates are ranging between 11 and 44 % and the fear of recurrence is ranging from 5 % up to the 89 %(8). The severity of distress is varying through the process of treatment and rehabilitation; the time of diagnosis is a period during which more patients are entering psycho-social treatment than later during treatment(1,5). With the aim of early recognition of patients with more profound distress, screening procedures are being implemented. Beside different questionnaires, International Psycho-Oncology Society is striving to implement the distress thermometer with 10 grades(9). The psycho-social interventions, performed by mental health professionals are proven to increase wellbeing, improve adjustment and coping, and reduce distress in people with cancer. In the field of psycho-oncology, the most commonly used methods are cognitive behavioural therapy, learning of relaxation skills, psycho education, and also partnership and family therapy(4). Providing psycho-social treatment for patients with more profound distress is connected with multiple challenges. Beside patient recognition and implementation of screening programmes, the next challenge is patient’s compliance, as psychological treatment can for a patient still be stigmata. Despite limited evidence of its efficacy patients prefer emotional and social help from the nurse than from allied professionals, because their medical expertise is seen as an advantage(5). In many healthcare systems the availability of psycho-social treatment, to the patient who needs it in the proper time, and the development of required resources, still in many cases underutilised, is the next challenge. This, despite proven ethical, emotional as well as economic benefits of psycho-social treatment. Conclusion:The nurse is playing one of the crucial roles in comprehensive treatment of lung cancer patients. She is indispensable in providing psycho-social support to the lung cancer patients, preparing to enter treatment. She is providing the basic psycho-social support, such as patient’s need for relevant information, basic emotional support, communication, screening for needs on an ongoing basis, symptom management. She is also pivotal in recognizing patients, experiencing more profound distress or has more unmet needs and can run a screening programme. REFERENCES: 1. Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients’ Lived Experiences. Cancer Nurs. 2015;38(6):E12-21. 2. Pujol J-L, Mérel J-P, Roth C. How preconceptions about lung cancer treatment interact with medical discourse for patients who accept chemotherapy? Psychooncology. 2016 Jul 23 [cited 2016 Aug 21]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27449209 Accessed August 20, 2016 3. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42. 4. Hutchison SD, Steginga SK, Dunn J. The tiered model of psychosocial intervention in cancer: a community based approach. Psychooncology. 2006;15(6):541–6. 5. Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology. 2016;25(8):882–90. 6. Walling AM, Keating NL, Kahn KL, Dy S, Mack JW, Malin J, et al. Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer. J Oncol Pract. 2016;12(6):e654-69. 7. Janssens A, Kohl S, Michielsen T, Van Langendonck S, Hiddinga BI, van Meerbeeck JP. Illness understanding in patients with advanced lung cancer: curse or blessing? Ann Palliat Med. 2016;5(2):135–8. 8. Pozo CLP, Morgan MAA, Gray JE. Survivorship issues for patients with lung cancer. Cancer Control. 2014;21(1):40–50. 9. Bultz BD. Guide to implementing screening for distress, the 6th vital sign: Background, recommendations, and implementation. Cancer Journey Action Gr. 2009;(May):4–43.
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PA03 - Patient Support and Involvement in Research (ID 359)
- Event: WCLC 2016
- Type: Patient & Advocacy Session
- Track: Patient Support and Advocacy Groups
- Presentations: 1
- Moderators:J.C. King, P. Muszumanski
- Coordinates: 12/06/2016, 11:00 - 12:30, Schubert 6
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PA03.03 - How to Live with Lung Cancer? The Slovenian Lung Cancer Patient Support (ID 6756)
11:30 - 11:45 | Author(s): A.C. Škufca Smrdel
- Abstract
- Presentation
Abstract:
Background: Cancer Patient’s Association of Slovenia (CPAS) is a non-governmental organisation, connecting the patients with all cancer types as well as their relatives and health professionals. The central programme that is being offered to patients by CPAS for more than three decades is an organized self-help »On the way to recovery«, that offers support in self-help groups on 20 locations and peer-to-peer counselling in two Info centres. The lung cancer patients are entering the programme alongside the other cancer patients. The peer-to-peer support programme has developed the system of regular supervisions, initial education, the study material aimed at volunteers and the network of self-help groups spread over the Slovenia. The research analysing peer-to-peer support showed clear benefits for the patients[1,2]. Since 2014, the Lung Cancer Support Division is organised in the framework of CPAS. Its main aim is the development of the programmes for lung cancer patients and their relatives. In Slovenia, with roughly 2 million inhabitants, there are some 1230 new lung cancer patients every year, and 1100 deaths due to lung cancer[3]. Patients with lung cancer are treated in four oncological centres (Institute of Oncology Ljubljana, University Clinic Golnik, University Medical Centres Ljubljana and Maribor). Among the burdens, all cancer patients are carrying, such as confronting its own vulnerability, mortality, coping with the hardships of treatment, psychic distress often combined with the fear of recurrence, lack of social support and changes in financial situation, some are disease specific. The burdens lung cancer patients are experiencing are connected with the poor prognosis, poorer quality of life and greater symptom management needs. These are due to physical troubles, social presentation of lung cancer as death sentence, sense of guilt and stigmatisation, but are also due to the need of information regarding new treatments available[4–6]. To be able to react on the specific lung cancer patient’s needs, we have within the Lung Cancer Support Division supplemented volunteer self-help programme »On the way to recovery« with the programme »How to live with lung cancer« [7]. How to live with lung cancer is a one-day programme, which is being implemented in various also smaller places and medical institutions throughout the Slovenia. It is aimed at lung cancer patients, their relatives and also health providers. The programme is carried out through recognized consultants working with lung cancer (surgeons, medical oncologists, radiation oncologists, physiotherapists, nurses and clinical psychologists from the medical institutions treating lung cancer). Methods: All participants in the programme were given a specific designed evaluation questionnaire. We present an evaluation from the program participants in the year 2016. We analysed the participants’ responses and the evaluation will be used in further program development. Results: The participants are being highly satisfied by the programme as whole and also with the individual sets of lectures. They are highly appraising the help our programme is providing in understanding the health situation, communication with the health professionals and in understanding coping processes. The programmes main goal is to inform participants on the lung cancer diagnostics, treatment and the rehabilitation possibilities. This information is given by the relevant professional. There is a special emphasis on the new and more efficient treatment possibilities. The programme presents in depth the ways and the means for the optimal coping with the disease and its treatment and also the advices for the living with the disease. We are widening the importance of comprehensive patient treatment, informing on psycho social considerations, possibilities on entering the CPAS programmes (and also related programmes that are offered locally), we are informing on benefits of early inclusion in the palliative care thus busting the myths regarding the palliative care. Except for presenting information, the programme’s goal is also the social support for lung cancer patients, as a large amount of the time is set by for the talk and the exchange of experiences among the participants. The inclusion of different professions into the comprehensive care of cancer patients due to the patients’ needs is being represented on the symbolic level with the joint presentation, where the presenters are alternating thus rounding up the “story” of treatment and rehabilitation. Incorporated in this programme is also a chance for the patients and their relatives to have an individual conversation with the medical professionals regarding their treatment and dilemmas. While the programme is being primarily aimed at the patients and their relatives, the local medical professionals are also invited. This beside the information point of view gives them also a chance to interact with the presenters and an opportunity to discuss with them their questions and dilemmas. Through this we are trying to ensure the equal availability of treatment and to approach the people with medical and psycho social support. Conclusions: With this programme we are following all three fields where the peer support programmes have been found to be beneficial to patient. Namely, their informational needs about the cancer and its treatment, management of emotional distress and finally the facilitation of empowerment [1,2]. REFERENCE: 1. Meyer A, Coroiu A, Korner A. One-to-one peer support in cancer care: a review of scholarship published between 2007 and 2014. Eur J Cancer Care (Engl). 2015;24(3):299-312. 2. Campbell HS, Phaneuf MR, Deane K. Cancer peer support programs-do they work? Patient Educ Couns. 2004;55(1):3-15. 3. Studio N. Rak v Sloveniji 2012 Cancer in Slovenia EPIDEMIOLOGIJA IN REGISTER RAKA EPIDEMIOLOGY AND CANCER REGISTRY. 2016. 4. Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients’ Lived Experiences. Cancer Nurs. 2015;38(6):E12-21. 5. Pujol J-L, Mérel J-P, Roth C. How preconceptions about lung cancer treatment interact with medical discourse for patients who accept chemotherapy? Psychooncology. July 2016. [Epub ahead of print] 6. Pozo CLP, Morgan MAA, Gray JE. Survivorship issues for patients with lung cancer. Cancer Control. 2014;21(1):40-50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24357740. Accessed August 21, 2016. 7. Čufer T., Simonič A., Koren P., Crnjac A, Računica K., Rajer M., Kovač V, Škufca Smrdel A. C. VPM. KAKO ZIVETI Z RAKOM_za splet-film. 2015. Available at: https://drive.google.com/file/d/0ByMyk7OmgaDSVzR3ME1vZzltbVU/view. Accessed Sept 20, 2016
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