Effective Discharge And Self-Management For Bowel Cancer Patients

Treatment Summary and Follow-up Care Plan

Discuss about the Discharge Plan and Self Management of Bowel Cancer.

After the diagnosis, John admits that he had been having some occasional pains and a feeling of tiredness. Furthermore, he had suffered a high anterior resection for a tumor that got found during a colonoscopy which is a procedure used to evaluate the inside of the colon. The high anterior resection is the removal of the last section of the large bowel before it connects to the rectum thus reducing any chance of recurrence in primary bowel cancer. Moreover, the history results indicate ACPS B which was poorly differentiated adenocarcinoma infiltrating the serosa. Also, all the 17 lymph nodes were negative, and the margins were clear which was essential in determining whether there was further management need. Hence, this information is crucial to the Cancer Care Coordinator before deciding whether John needs additional adjuvant chemotherapy (Ong, 2016). The essence of this article is providing John with the necessary information regarding his discharge from the hospital, and self-management plan that should get followed after completing his active treatment. Furthermore, the article evaluates the signs and symptoms that got associated with bowel cancer recurrence and the strategies that prevent survivorship issues which John may encounter.

As the Cancer Care Coordinator, it is vital to outline strategies that will facilitate effective education regarding the discharge of John from the hospital and self-management plan he would use after that (Goodman, 2016). The Cancer Care Coordinator should prepare on how to explain the treatment summary and follow-up care plan that John is to use. Furthermore, the coordinator should provide information about the signs and symptoms of the bowel cancer recurrence. Also, the coordinator can provide information regarding secondary prevention and how John can live a healthy life. Moreover, the coordinator should ensure timely, regular and two-way communication with John and his family regarding the potential late effects and the progress of John. Furthermore, the follow-up care plan should get put into consideration and the supportive and palliative care requirements (Thomas, 2015). It is also essential that the coordinator identifies if John has any complex needs and this will enable the coordinator to know whether there will be the need for John to change his residence to increase chances of having an excellent social and healthy life (Lees, 2013).

After John receives curative treatment due the bowel cancer, the patient often has a high chance of acquiring adenomatous polyps and metachronous primary Colorectal Cancer. Therefore, the possibilities of a new development of primary tumor and adenomas may reoccur after about four years. It is crucial that there be an early post-discharge review which should be followed by a three to six monthly review for two years then six months to the year after that. It is vital that this review consists of the examination and history of John’s medical condition. These examinations may include the rectum getting examined, and sigmoidoscopy should also get done. The sigmoidoscopy is essential for patients who have had an anterior resection of the rectum just like John (Tjandra, 2007). Also, regular CEA (Carcinoembryonic Antigen) measures and CT (Computed Tomography) should get considered in the follow up because they may provide needed clinical information (Young, 2014). The CT should be carried out on the chest, pelvis, and abdomen and colonoscopy should get done at least three to five years after the resection. According to Tjandra (2007), CT scan can be used to scan the liver which is useful in detecting liver metastases. The Meta-analysis is randomized as a follow-up protocol that shows any detection of any extramural diseases using the CT (Primrose, 2014).  The Chest x-ray scan is also necessary for detecting any lung metastases where three prospective trials are randomized; using the Chest x-ray helps in identifying most resectable diseases (Pita-Fernández, 2014).

Strategies for Effective Education and Communication

Furthermore, the Positron Emission Tomography (PET) scans should not get used if it is not recommended at the medical facility by a certified medical practitioner (Meyerhardt, 2013).  The colonoscopy is essential because it helps in detecting the presence of any metachronous tumor, then the repeat should get done at an interval of three to five year after that (Rose, 2014). It should also get considered that if a colonoscopy does not perform before diagnosis, it must get done after completion of the adjuvant therapy (Freeman, 2013). The essence of this is that most metachronous cancers are unlikely to be detected earlier than three years following the surgery was done due to the bowel cancer that got discovered more previously. According to Meyerhardt (2013), secondary prevention may also get recommended for maintaining the body weight and active lifestyle of John. The role of the Fecal Occult Blood Test (FOBT) remains contentious with the optimal schedule. Some signs and symptoms that the patient may encounter are fatigue and pain syndromes which John agrees to have previously encountered during his diagnosis. Moreover, John may have a fear of the recurrence of cancer which may cause psychological distress and sexual dysfunction (Alfano, 2012).

John may experience weight loss due to the change in taste and decrease of appetite, and this can be a significant issue which may require John to see a dietitian before, during and after receiving treatment. Moreover, sometimes John may get nausea and experience a vomiting feeling due to the severe side effects of the chemotherapy. It is crucial that such side effects are managed to ensure John’s quality of life is improved. Also, diarrhea and constipation are serious issues that John should take into considerations in case they occur. It is essential that the coordinator educates John on noticing such symptoms and how he can manage them to improve the quality of his life (Jansen, 2015). In spite of that the treatment of rectal cancer may cause urinary incontinence, and in case it occurs it is essential that John seeks medication as soon as possible so that he may improve his life. John may also get odors and flatus due to stomas or urinary fistulae, and it is crucial that John seeks medical attention. Therefore, John should get educated on how to identify such conditions in case they occur because he will be able to find medical care as soon as possible. Furthermore, the chemotherapy may reduce sexual interest and cause sexual dysfunction, and in case John experiences the same, it is crucial that he seeks medical attention (Alfano, 2012). The medical personnel will be in the position to give sensitive and credible medication that will help improve John’s condition.

Early and Regular Review for Detected Metastases

The coordinator should provide John with the necessary relaxation techniques and medication that John can use to keep him calm, and in case the symptoms persist it is important that he sees a psychologist or a psychiatrist. Most of the cancer patients have a fear of the recurrence of cancer especially after the treatment phase, and it is essential that if John faces the same, he should see a psychologist. Moreover, the post-traumatic disorder gets sometimes associated with bowel cancer due to the tedious chemotherapy procedures that John has undergone, and it is vital that he seeks medical attention from the psychologist (White, 2012). If any of the psychological problems persist, it is advisable that John sorts psychiatrist intervention. It is essential when John faces difficulty in communicating with his family and struggles with the metastatic diagnosis. Moreover,  John meets difficulty in transitioning from palliative care and difficulty in quitting alcohol use. Observations got made when John goes out with his friends to drink on weekends, and he eats a lot of beef and neglects the greens that his wife gives him.  Furthermore,  John becomes isolated and stops going out with his friends and socializing its essential that the family gets a psychologist for him.

Most of the patients may have a change of interest in relationships and the people they associate with, and this may cause trouble when he goes back to work and tries to live a healthy life. Most of the time the depression and stress lead to this lonely feeling, and if this happens, John is advised to see an occupational therapist who would help him recover (Zhang, 2014).

John and his family may seek spiritual support that would help them during the recovery of John. Furthermore, they may get qualified spiritual caregivers who will help them in moving forward from the cancer treatment.

Conclusion

The article details the follow-up regime that John is to follow to ensure that he recovers after the completion of his chemotherapy. Furthermore, the report describes the importance of having an excellent discharge plan that will help John to recover fully physically, psychologically and socially. It is also essential to provide John with the necessary education that on how he may get to understand the signs and symptoms of recurrent bowel cancer. As such patients take on new roles in their lives, ongoing support from the health professionals become equally important. Assistance may be in the form of education with regards to their disease, its treatment, potential side effects, rehabilitation and putting up a self-management plan for the patient after being discharged. The positive results drawn from patient education are a lower prevalence of depression and anxiety, enhanced coping mechanisms, reduced decisional conflicts, improved performance status and quality of life of the patient in general.

Self-Management for Quality of Life Improvement

References

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