Critically analyse the key interpersonal skills necessary to communicate effectively with patients, family and colleagues within the context of cancer care.Evaluate your own interpersonal skills in relation to communicating effectively and confidently with patients with cancer, family and colleagues.Devise an action plan to facilitate interpersonal skills development and enhance the provision of supportive care for cancer patients and the family in your clinical environment.
Cancer is proving to be the major cause of reported mortalities across the globe following the evolving lifestyle and environmental alterations. The increased fatalities from intestinal and pulmonary malignancies attribute to their unknown etiology and adverse influence on patient’s genome, thereby altering the normal physiological processes leading to episodes of intense pain and pathophysiological complications. Indeed, cancer adds up considerably to the disease burden in various developed and developing nations of the world. The cost of cancer therapy poses a major challenge to the economically weaker sections of the society in receiving qualitative treatment and palliative care for controlling the severity of symptoms and other associated comorbidities. The financial implications of the cancer care services related to the complexity of the expenses incurred in attaining the treatment of choice with respect to the severity and type of the cancer affecting the predisposed population (National Audit Office, 2010:p.7). The physical abnormalities resulting from various forms of cancer related to the cytological variations leading to disfigurement of the body structure and function. However, the loss of physical well-being during cancer conditions intensified by the adverse influences of the treatment modalities administered to counter the comorbidities and complications associated with the progression of these life-threatening malignancies (Corner & Bailey, 2008:p.210). The clinical literature provides evidences from research studies in context to the influence of psychosocial factors on occurrence and progression of metastatic malignancies (Carr & Steel, 2013:p.1).
Keen & Lennan (2011:p.230) illustrate the influence of uterine, ovarian and breast malignancies on the physiological and psychosocial state of the affected women. The loss of self-confidence and libido, infertility and family conflicts include some of the serious factors warranting the need for rehabilitating the cancer patients while rendering supportive and palliative care and treatment. The cancer reform strategy includes rendering physical and occupational therapies to the affected patients by non-physician professionals, with the intent to provide rehabilitation and psychological support in coping up with the adverse influences of the therapeutic modalities employed to control the cancer manifestations. The cancer reform strategy indeed, explores the strategic approaches to counter the progression of malignancies and providing palliative care to the patients for accomplishing their needs and expectations while attempting to regain health and survival during cancer stages (Fawcett & McQueen, 2011:p.172). The clinical literature emphasizes the role of imparting cancer education in enhancing the quality of life and health of patients striving against cancer (Foyle, & Hostad, 2007:p.48). The concepts of palliative oncology advocate the positive outcomes of imparting cancer education programs and seminars to the patients’ population. Contrarily, the physicians also require updating their skills and knowledge in context to the evidence based approaches for treating and supporting the patients affected by life threatening malignancies. The back and forth dissemination of information regarding cancer pathology and treatment approaches between patients and physicians assists in reducing the disease burden with the effective utilization of strategies and approaches for controlling the life threatening outcomes from various malignancies across the patients population. The effective communication between cancer patients and nurse professionals helps in understanding the intensity of psychosocial complications experienced by the patients during initial until advanced stages of metastatic cancers. These measurements by the healthcare professionals prove as effective tools in devising palliative and supportive care to the patients for increasing their survival rates, and competency in context to enhancing self-care skills to cope up with the intense symptoms experienced during malignancies.
The contention of palliative care advocates the monitoring of therapeutic modalities administered in treating the symptoms of life threatening malignancies, rather than exploring a permanent cure of the progressing malignancy. Moreover, the palliative care by the healthcare professionals aims at establishing synergistic relationship with the patients and their families to assist them in enhancing quality of life and restoring health in terms of defining shorter and longer term healthcare objectives for the affected patients (Regnard & Kindlen, 2002:p. 52). The efficient rendering of supportive and palliative care to the cancer population warrant through understanding of the pain episodes, available treatment modalities and their adverse affects in context to the stage of patient’s malignancy. Berger et al (2013) discuss the contention of palliative care during the advanced stages of patient’s cancer. The strategies for rendering hospice care warrant effective interaction with patient’s family and caretakers to devise and implement potential approaches for controlling patients’ pain and episodes of intense depression and insomnia. The supportive and palliative care strategies not only focus on appropriate supervision of the patients in terms of monitoring the treatment modality, they rather explore a practical approach to establish psychosocial homeostasis, and emotional and spiritual well-being of the affected individuals. The stable psychological well-being of patient’s family members highly warranted to ensure efficient caretaking in the residential environment. The increasing responsibilities following patient’s requirements pose serious financial and psychosocial challenges for the family members, thereby resulting in emotional conflicts while imparting care and support against the terminal illness. Therefore, rendering psychological counselling, educational sessions and emotional support by the nursing professionals to the family members of the striving patients required to assist them in overcoming these challenges encountered during the caretaking process. The patients of gynaecologic metastatic malignancies suffer from the state of bereavement and psychosocial disintegration during the advanced stages of their terminal illness. The palliative and supportive care strategies warrant implementing individualized care plans for tackling these sensitive scenarios during the end stages of patient’s life, to ensure substantial reduction of these psychosomatic manifestations following the cancer stages. However, consistent emphasis on allowing patients for practicing self-care during the initial stages of cancers helps them to attain psychosomatic gratification and encouragement to strive for challenging the expected outcomes of the carcinomatous conditions. The formation of various support groups for the patients and their family members helps them to tackle the intense symptoms and psychosocial challenges encountered with the onset of the life threatening malignancy. Moreover, the clinical manifestations pertaining to different stages of gynaecologic malignancies including pelvic pain, abdominal distress, diverticulosis, edema, fatigue, chest discomfort, post surgical pain and metastasis require efficient monitoring by the nurse professionals in context to rendering palliative care and therapy to ascertain the reduction of intense symptoms and stabilizing the psychosocial well-being of the patients’ population.
The obstacles encountered by the patients, their families and medical fraternity in efficiently rendering support and palliative care to the target population require serious consideration by the healthcare professionals for strategically devising reform strategies in overcoming these potential challenges obliterating patients care and therapy during various stages of metastatic malignancies. The potential barriers hindering the provision of supportive and palliative care services to the patients’ population include the lack of appropriate provisions for rendering palliative care in clinical settings and oncology clinics. Moreover, the absence of adequate training programs for health care professionals and prevalent bias in treatment approaches with respect to the socioeconomic and ethnic fluctuations between the patients population prove to be the potential barriers in rendering effective care and support to the cancer patients (Foley & Gelband, 2001:p.4). The financial perspectives including insufficient investment in the palliative care services and lack of research studies attribute to the existing gaps in the supportive care strategies practiced among the patients population. The cancer patients surviving under socioeconomic burden and confined to underdeveloped geographical locations face challenges in terms of inadequate supportive care and therapy for treating the symptoms of life threatening malignancies. The absence of a national policy for defining the accountability factor for cancer mortalities attributes to the deficits in supportive and palliative care for the patients population. The deficit in care giving strategies pertaining to rational approaches to ascertain the provision of rendering familial support to the patients’ population attributes to the potential barriers in restoring health and wellness among the victims of metastatic malignancies. The important manifestations of gynaecologic cancers including, infertility, menstrual irregularities, impotence, gastrointestinal complications, metastasis, metabolic morbidities and psychosomatic disorders require thorough analysis and research by the physicians and qualified nurse professionals to effectively devise and render proactive strategies in restoring the psychosocial homeostasis and well being of the target population. The epidemiological perspectives of malignancies and their manifestations warrant conducting research trials to explore the environmental and regional influences in the progression of cancers and consequent mortalities among the affected patients. Indeed, lack of research studies in context to exploring the effectiveness and outcomes of evidence based traditional, complementary and alternative therapies in alleviating the intensity of cancer symptoms acts as a potential barrier in effectively utilizing these approaches under supportive and palliative care programs for the cancer patients. Therefore, these necessities require due consideration to streamline and efficiently practice evidence based strategies in rendering care and therapy to the patients with terminal illness. The high costs for therapy and supportive care prove to the major barrier in providing uninterrupted qualitative care and therapy to the patients of gynaecologic, hematologic and pulmonary malignancies. Therefore, health care plans warranting cost-effective execution of supportive and palliative care strategies by the nursing fraternity require implementation with the intent to restore the psychosomatic well being of the patients affected with metastatic malignancies.
The life threatening metastatic gynaecologic, hepatic, renal, prostatic and pulmonary malignancies require surgical intervention in their advanced stages to challenge the progression of abnormally growing cancerous cells, with the intent to increase the survival rates among the target population. Butler & Fine (Butler & Fine, 2008:p.215-18) describe various reconstructive surgical interventions practiced in excising neoplasm pertaining to the anatomic location of abdominal wall. Indeed, intestinal and uterine malignancies have the potential to extend until the proximity of abdominal wall with their metastatic progression requiring abdominal wall reconstruction intervention to restore the anatomic integrity of the diseased location. The clinical literature emphasizes the need for surgical intervention in treating gynaecologic malignancies including uterine cancer. Lopes et al (2011:p.216) describe the surgical intervention approaches utilized in treating uterine carcinomas including endometrial malignancies. The degree and extent of pelvic metastatic invasion is the deciding factor for the choice of surgical intervention in gynaecologic malignancies. The surgical intervention for endometrial carcinoma warrants the execution of complete hysterectomy followed by postoperative adjuvant therapy to challenge the relapse of the invading malignancy. The clinical literature reveals the absence of curative therapy in terms of medication or dietary management to prevent or treat the progression of endometrial cancers among the patients population. The option of undergoing surgical intervention during various stages of endometrial cancer indeed, validated by the statistical probability of the progression of endometrial metastasis to the adjacent or distantly located healthy organs (Mak et al, 2012:p.77). Although the survival rates for the advanced stages of endometrial cancer do not exceed the tenure of five years, surgical intervention proves to be the only viable option to minimize the manifestations of the terminal illness to an extended timeframe. However, postoperative chemotherapy and radiotherapy interventions are the methods of choice in treating the cases of endometrial carcinoma to rule out the probability of the secondary invasion. The decision for surgical intervention in cases of endometrial carcinoma follows the confirmation of diagnosis through MRI scans and biopsies; however, the extent of metastatic tissue invasion considered as the clinical parameter in proceeding with the invasive techniques for challenging the cancer progression (Surwit & Alberts, 1989). Indeed, the decreased survival rates among the patients with advanced stages of endometrial cancer warrant the need of a clinical debate in considering the options of surgery vs. radiation or hormonal therapy for minimizing the intensity of metastatic manifestations in the absence of a definitive cure for the disease. The clinical studies reveal the advantages of the endoscopic intervention in treating the cases of endometrial carcinoma (Acton, A:p.70). However, brachytherapy proves to be a potential intervention in treating endometrial cancers in context to retaining the reproductive capability and quality of life of the women under initial stage of endometrial malignancies.
The evidence-based literature provides documentation from research studies indicating the positive outcomes from total abdominal hysterectomy as compared to oral therapy for treating gynaecologic malignancies (Ferri, 2013:p. 334). Indeed, the surgical intervention in cases of endometrial carcinoma proves to be highly effective in controlling the complications including uterine hemorrhage and hormonal imbalances among the cancer patients. Conversely, Parrott & Condit (1996:p.374) describe the side effects and adverse events following the surgical procedures in cases of the terminal illness. The manifestations including psychosomatic and sexual dysfunction and hormonal imbalances constitute the probable outcomes of total hysterectomy executed for treating endometrial carcinomas. The other clinical complications of surgical intervention include abdominal cramps and scanty vaginal discharge indicating the probability of post surgical pelvic infection requiring immediate therapeutic administration. Furthermore, the surgical approaches in treating endometrial carcinoma also include the methods of endometrial ablation and resection of the lymph nodes. Indeed, lymph nodes resection warranted in cases of endometrial metastasis, where the cancerous growth attains the potential to disseminate to the adjacent or distant organs during its progression. The most serious outcome of lymphadenectomy includes the pathophysiological complications in patient’s immune system, thereby increasing the susceptibility to acquire comorbidities pertaining to viral and bacterial manifestations. The physicians require practicing evidence based approaches in accordance with the intensity and extent of endometrial metastatic invasion prior to arriving at the conclusion in context to surgical intervention for treating the life threatening cancerous condition in its advanced stage. The complications arising from postsurgical chemotherapy and radiotherapy vs. patient’s life expectancy from the terminal illness require careful monitoring while exploring the surgical approaches vs. hormonal therapies for alleviating the intensity of cancer manifestations.
The medical fraternity including qualified physicians and registered nurse professionals employed for rendering cancer therapy and care require thorough understanding of the potential impact of cancer manifestations on the life of patients as well as their associated family members. Jim et al (2009:p. 650) illustrate the psychological effects of the diagnosis of breast cancer resulting in reported cases of psychosexual dysfunction among the affected population. Similar findings relate with the reported cases of endometrial and ovarian carcinomas adversely influencing the quality of life and psychosocial homeostasis of the cancer patients. The clinical literature provides evidence based contention indicating the patterns of sleep deprivation in the patients diagnosed with cancer conditions (Redline & Berger, 2014:p.194). The epidemiological studies describe serious fluctuations of the sleep patterns in cancer patients as compared to the normal sleep profile of the healthy population across the globe. Therefore, appropriate nursing intervention approaches clinically warranted to devise evidence based measures in context to the psychological conflicts and abnormal sleep patterns experienced by the patients affected by cancer conditions. The family members of the patients diagnosed with cancer experience the risk of encountering psychosocial problems and financial complications emanating with the progression of the terminal illness. They may display abnormal eating patterns and difficulty in managing the patient’s intense symptoms during the advanced stages of various cancer conditions. The cognition and behavioural stability of the family members indeed affected under the stress of the probable outcomes and expected mortality from the progressing malignancy. The nursing fraternity dealing with the cancer patients and their families require rendering psychological and social support to the family members of the affected patients to ascertain affective caretaking of the patients in context to the family environment. The in-depth analysis of patient’s insecurities and psychological distress assists the nursing professionals to formulate coping strategies for effectively alleviating the psychosomatic manifestations of the affected patients. The nursing professionals require careful monitoring of the therapeutic modalities prescribed for controlling the intensity of patients’ symptoms including lack of sleep, myalgia, debility, anxiety and depression. Additionally, the financial concerns encountered in rendering remedial modalities to the cancer patients require appropriate consideration to assist the patients and their families in striving against the life threatening manifestations of the terminal illness. The complicated side effects following the surgical interventions employed in treating cancer conditions include chronic pain syndrome, swelling of lymph nodes, persisting vomiting, anaemic episodes, psychological distress, impotence and other hormonal abnormalities. The intensity and prevalence of these side effects varies in accordance with the rendered surgical intervention and patient’s geographical location and climatic variations. The employment of the surgical modality targeted for the malignant condition warrants proactive analysis of the expected postoperative outcomes to ascertain devising strategic palliative approaches in reducing the influence of these manifestations following the surgical intervention. The evaluation of potential of targeted vs. standardized treatment approaches in controlling the cancer symptoms and their serious manifestations require conducting clinical trials in controlled environment in statistically analyzing the effectiveness of these approaches to enhance the quality of life and survivorship of the affected population. The cancer therapies employed for treating the advanced stages of various malignancies associated with the risk of disrupting the respiratory, cardiovascular and reproductive mechanisms of the patients resulting in reducing the quality of life and destabilizing the state of wellness following the therapeutic or surgical intervention. The problems pertaining to integumentary system, episodes of sustained blood pressure, thromboembolism, defects in healing mechanism, congestive heart failure, autoimmune disorders, hair loss, intense cough, dyspnoea, allergies, oral thrush, vomiting, dehydration and debility include the serious manifestations adversely affecting the health and wellness of the patients population in a variety of cancer conditions. Similarly, the problems following the postsurgical chemotherapy and radiotherapy warrant the administration of protective measures by the healthcare professionals in proactively dealing with and minimising the episodes of the intense outcomes of these therapeutic modalities.
The clinical perspective of rendering supportive care and therapy for the cancer patients advocate the contention of utilizing evidence based approaches in developing palliative care models for increasing the quality of care and challenging the mortality rates of the population affected by life threatening malignancies. The financial burdens of the cancer patients and their families’ warrants configuring prospective strategies to reduce the cost of care and therapy for wiping out disparities and inequalities in context to the remedial mechanism employed in controlling physical and psychological manifestations of the terminal illness. Indeed, the prospective models for supportive and palliative care require careful analysis of disease management strategies, protocols and pathways in context to end of life care and therapy, and practical approaches for controlling the physical, psychological and social manifestations of the fatal metastatic malignancies.
References
Ashton, A 2013, Endometrial Cancer: New Insights for the Healthcare Professional, ScholarlyEditionsTM, Georgia
Berger, A, Shuster, J, & Roenn, J 2013, Principles and Practice of Palliative Care and Supportive Oncology, Lippincott, USA
Butler, C & Fine, N 2008, Principles of Cancer Reconstructive Surgery, Springer, USA
Carr, B & Steel, J 2013, Psychological Aspects of Cancer, Springer, USA
Corner, J & Bailey, C 2008, Cancer Nursing: Care in Context (2nd edn.), Blackwell, UK
Fawcett, T & McQueen, A 2011, Perspectives on Cancer Care, Wiley, UK
Ferri, F 2013, Ferri’s Clinical Advisor, Elsevier, USA
Foley, K & Gelband, H 2001, Improving Palliative Care for Cancer, National Cancer Policy Board, USA
Foyle, L & Hostad, J 2007, Innovations in Cancer and Palliative Care Education, Radcliffe, UK
Keen, A & Lennan, E 2011, Women’s Cancers, Wiley, UK
Lopes, T, Spirtos, N, Naik, R & Monaghan, J 2011, Bonney’s Gynaecological Surgery (11th edn.), Wiley, USA
Mak, S, Hulse, P & Carrington, B 2012, MRI Manual of Pelvic Cancer (2nd edn.), Informa, UK
National Audit Office 2010, Delivering the cancer reform strategy, Department of Health, Great Britain
Parrott, R & Condit, C 1996, Evaluating Women’s Health Messages: A Resource Book, Sage, USA
Redline, S & Berge, N 2014, Impact of Sleep and Sleep Disturbances on Obesity and Cancer, Springer, NY
Regnard, C & Kindlen, M 2002, Supportive and Palliative Care in Cancer: An Introduction, Radcliffe, UK
Surwit, E & Alberts, D 1989, Endometrial Cancer, Kluwer, USA
Yeung, S, Escalante, C & Gagel, R 2009, Medical Care of Cancer Patients, BC-Decker, USA
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