Teaching And Learning Communication Skills System For Cancer Survivors

Discharge plan

Discuss about the Teaching and Learning Communication Skills System.

In the given case study, the patient named John is currently receiving his last cycle of chemotherapy that is adjuvant chemotherapy for colorectal cancer. It is an additional treatment that is given to the patient after the surgery that assists in lowering the risk of the cancer from returning (Mitry et al., 2008). Follow-up regime is also important after the curative treatment and makes the patient aware of the signs and symptoms that illustrate the recurrence of the colorectal cancer. After the procedure, he will be discharged from the hospital with his wife. Before this procedure, John along with his wife needs to meet the cancer care coordinator to discuss and learn about the self-management that follows his active treatment. Patient education is an important aspect of learning which demonstrates self-care and healthy living (Anderson & Funnell, 2010). Apart from self-care, self-management is also important that supports his recovery and well-being after the active colorectal cancer treatment. Therefore, it is important for John and his wife to learn about self-management and focus on healthy behaviors so that there are positive health outcomes.

The following essay deals with the discharge and self-management plan for John as discussed with the cancer care coordinator. The essay will also cover the survivorship issues that John might experience and the communication strategies that are required to facilitate effective education about his discharge and self-management plan. It will also deal with the evaluation of the patient education that is required for the successful education of John after his discharge from the hospital.

Also, In Australian setting, it is highly recommended to determine the implications of follow-up on the quality of patient’s life, timing and tests required for John along with the follow-up with general practitioner (Takagawa et al., 2008). Follow-up is highly recommended after the curative treatment of colorectal cancer for John. Apart from follow-up, it is crucial to know the signs and symptoms of the recurrence of colorectal cancer. According to World Health Organization (WHO), intense follow-ups and surveillance programs are important after the curative treatment as to detect the early chances of asymptomatic recurrences. According to WHO, follow-up is recommended every three to six months up to three years and then six to twelve months for the next two years followed by annual follow-ups.

After the curative treatment, in many cases, there is recurrence of the disease if some of the cancer cells survive during the treatment and grow to for tumors eventually. This occurs at the original tumor location called local recurrence or in some other area of the body with distant or regional relapse. This indicates metastasis where it spreads to other parts of the body and shows recurrence signs and symptoms. It can occur after months or years after the treatment. The signs and symptoms include; changes in the frequency of bowel movements, constipation, dark or blood stools and changes in the consistency of the stool like watery or loose stools with abdominal pain, weight loss and tiredness. There is also a feeling of fullness or cramps of bloating gas in the stomach. Early detection of the relapse symptoms in colorectal cancer is not apparent (Astin et al., 2011). This requires regular follow-ups along with the recommended health plan after the curative treatment as the symptoms might not develop until the progression of the disease. The cancer stage decides the chances of the recurrence of the disease along with treatment received and risk factors of the patient. This recurrence develops within the two years after the curative treatment has completed, so it is recommended for John to have intense follow-up up to two years.

Self-management plan

Self-management after colorectal cancer treatment is important for John that encompasses the both physical and psychosocial well-being as according to World Health Organization (WHO) the fullest health realization includes the social, physical, psychosocial, spiritual and economic aspects (World Health Organization, 2010). There is fear of recurrence of the cancer that includes that it might return or spread to other parts of the body. There are survivor issues that John might experience like physical, social, psychosocial and spiritual after the curative treatment of the colorectal cancer (Foster & Fenlon, 2011). According to the practice guideline provided by Cancer Australia, May 2012, it is stated that there is fear of cancer recurrence and require strategies to support the cancer patients (Coleman et al., 2011). The return of the cancer is the major cause of distress in the cancer patients and evidence shows that majority of the people adapt to the life after the curative treatment, however, there are some cancer survivors who experience high levels of social and psychosocial distress (Holland & Alici, 2010).

According to the Australian Government in collaboration with the National Cancer Control Initiative and National Breast Cancer Centre have recognized and developed the survivorship issues for the cancer patients.

The emotional issues include the intense episodes of distressing and unpleasant emotions like fear, anger or helplessness to cancer (Stanton, Rowland & Ganz, 2015).

The social issues include the extent of the patient to adjust to the disease after the treatment and the effects of the disease on the patient’s family members (Jarrett et al., 2013).

Psychosocial issues include the anxiety or depression, traumatic symptoms and difficulties in the relationships that the cancer survivors might experience (Duijts et al., 2014).

Physical issues are the direct manifestations after cancer treatment like pain and fatigue (Van Londen et al., 2014).

Survivor issues are also evident in the cancer survivors like John where there are changes in the lifestyle, life priorities, coping with the side-effects of the treatment and medications, social exclusion and the recurrence of the colorectal cancer (Gramatges et al., 2014).

There are also some special issues that John might experience like spiritual issues that include the confrontations with meaning of life and morality (Rowland & Bellizzi, 2014). This also has implications on the social relationships and on the family (Gao et al., 2010). There is a need to provide support for these above-identified survivorship issues that John might be experiencing. Self-management education strategies and interventions are required to prevent and support John for the effective management of the disease and prevent the further complications and improve his quality of life. Psychosocial interventions are required for John to address the fear of cancer recurrence and uncertainty about the recurrence which is a major concern after the completion of the treatment. The interventions include knowledge regarding the side-effects, symptoms of recurrence and coping skills that are directed towards reduction and prevention of the fear and concerns in cancer survivors (Koller et al., 2012). Self-management also provides supportive care for John as it helps to improve his quality of care, healthy lifestyle and proper psychosocial functioning. It would also empower him and build self-esteem in John. The healthcare practitioners need to be empathetic towards John and apply supportive expressive therapy and effective communication skills while communicating with the cancer survivors that help to address and also prevent the survivorship issues of John (Jefford et al., 2008).

Survivorship Issues

The transtheoretical model of health behavior change is a vital self-management model for coping with survivorship issues that progresses through five stages requiring change; precontemplation, contemplation, preparation, action and maintenance. It promotes self-efficacy and self-esteem in the cancer survivors (Riekert, Ockene & Pbert, 2013). This model can be applied to John’s self-management of the survivorship issues. The first stage is the precontemplation stage where John is unaware of the problems and issues that are associated with the cancer survival. The healthcare professional in the second stage makes John aware of the problems and the desire to behavior change like the transtheoretical model of health behavior change (Prochaska, 2013). It is commonly used in client-centered approach where the clinician acts as coach to build confidence and work towards the goal of behavior change and healthy lifestyle. This can be done through patient education and learn about the risk and complications associated with the unhealthy behavior. The healthcare professional should educate John and motivate him to adopt the changes healthy behavior called the preparation stage. In the action stage, John should practice the healthy behavior that promotes self-management of the disease after the curative treatment. Healthy behavior like weight management, energy restriction, exercise and healthy behaviors helps to manage overall health and reduce the changes of asymptomatic cancer recurrence. In the maintenance stage, there is sustenance of the healthy behavior change and facilitation of the change. In this stage, there is requirement of communication strategies that reinforces change. Before the implementation of the transtheoretical model of health behavior change, it is important for the healthcare professionals to have communication skills to interact and motivate John to self-care management and addressing of the survivorship issues (Schwarzer, 2008). Self- care management includes a healthy diet, regular medications, physical exercise and regular health check-ups that promote self-efficacy, fast recovery and reduce the risks and complications associated with the colorectal cancer and recurrence. In a study conducted by Hawkins et al., (2010) reported that positive behavior change is associated with low levels of psychosocial issues that promote positive health outcomes and well-being. Cluze et al., (2012) showed that the positive health behavior change like contact with the general practitioner, follow-up visits and compliance with medications and healthy lifestyle ensures reduction in psychosocial levels in the cancer survivors. In addition, the transtheoretical model of positive behavior change model is an effective way to motivate for the behavior change to prevent recurrence and promote positive health.

Transtheoretical Model

To facilitate positive self-care management, effective communication skills are required while communicating with John and in promoting self-efficacy and self-esteem that reduces the survivorship issues (Uitterhoeve et al., 2010). Communication with John should include the information that helps him and his family to understand the circumstances, expectations, beliefs, values and personality (Gleason-Comstock et al., 2015). This includes the emotional reactions of John that provide information about the management of colorectal cancer and reduce chances of recurrence. Effective communication by healthcare professionals enhance the patient understanding and recall, improve patient satisfaction and reduce the survivorship issues and emotional distress (National Health and Medical Research Council, Department of Australia (Kurtz, Silverman & Draper, 2016). The information provided to John regarding metastases or a recurrence should be succinct, pertinent in a private place and uninterrupted time. Communication strategies are required provide high social support, health education and literacy and self-efficacy. It also promotes empowerment, overcome fear of cancer and emotional distress.

The strategies include establishing support and trust that addresses John’s emotions and concerns (Berkhof et al., 2011). Both verbal and non-verbal communication methods are important to establish feeling of trust and in reducing the knowledge gap that gives rise to psychosocial issues (Garg et al., 2016). The verbal strategies include open-ended questions that include questions that are related to the disease or treatment (Paternotte et al., 2015). Non-verbal strategies include looking, smiling, affective touch, careful listening and physical proximity. According to Kissane et al., (2012) the communication skills that healthcare professionals may adopt an effective conversation with John include open mind that welcomes any questions, attentiveness, genuine interest and empathetic listening. Friendliness, initialization of conversations that provide him scope for questions and invest time and effort in patient education. These skills are beneficial for fostering the collaborative care, two-way communication via feedback that build mutual respect and trust in the treatment and management. The emphasis on the contextual information aids to enable patient engagement and tailoring of care for John. The cultural background of the patient is also an important factor that acts as a barrier to effective communication between the healthcare professional and the patient. Understanding and assessing of John’s cultural background provide a non-judgmental atmosphere and comfortable conversations in regards to the personal and difficult issues of John.

The evaluation criteria that illustrate effective patient teaching are enhancing the two-way communication that includes feedback. When the patient provides feedback, it is possible for the healthcare professionals to assess and evaluate the level of understanding to reduce the knowledge gap about the disease and treatment. It also enhances collaborative care and promotes patent satisfaction. By encouraging open-ended questions help to assess the understanding of the disease by Teach-back method is an important method that can be used to evaluate the effectiveness of patient education (Tamura-Lis, 2013). This communication method is adopted by healthcare professionals to confirm the understanding that is being explained to the patient. Health education questionnaire would also help to evaluate the level of knowledge of the patient education session to assess the knowledge regarding the disease, treatment and self-management. Behavioral determinants assessment like physical activity, symptom monitoring and medication adherence would also help to evaluate the effectiveness of the patient education session (Dohmen et al., 2011 ).

Follow-up

Conclusion

The above case study deals with the patient education of John after he had undergone the curative treatment for colorectal cancer. The colorectal cancer follow-up is required for the investigation of the pathways that would help to investigate the recurrence of the disease. Intense follow-up regime is recommended for John that includes the hematological, colonoscopic and radiological evaluation. The return of the cancer is the major cause of distress in the cancer patients and evidence shows that majority of the people adapt to the life after the curative treatment, however, there are some cancer survivors who experience high levels of social and psychosocial distress. Self-management after colorectal cancer treatment is important for John that encompasses the both physical and psychosocial well-being as according to World Health Organization (WHO) the fullest health realization includes the social, physical, psychosocial, spiritual and economic aspects (World Health Organization, 2010). The transtheoretical model of health behavior change is a vital self-management model that progresses through five stages requiring change; precontemplation, contemplation, preparation, action and maintenance. Before the implementation of the transtheoretical model of health behavior change, it is important for the healthcare professionals to have communication skills to interact and motivate John to self-care management and addressing of the survivorship issues (Schwarzer, 2008). It promotes self-efficacy and self-esteem in the cancer survivors. Both verbal and non-verbal communication methods are important to establish feeling of trust and in reducing the knowledge gap that gives rise to psychosocial issues.

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Monitoring

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