Psychosocial Issues

 stephanie@ONS 

Welcome to the ONS Hot Topics Live Chat. We will now begin. I would like to introduce our expert Molly Loney.

 mloney 

Welcome to the Psychosocial Issues Web Chat series. Meeting psychosocial needs of our cancer patients can challenge any Oncology nurse, so this session will hopefully help you find answers or validation for ways you can support your patients. Do you have any issues or questions you would like to discuss?

 willie 

I don't have a particular question, but am interested in psychosocial issues with recurrent cancer.

 mloney 

This is something many of our cancer patients fear even when in remission. Is there a specific issue that you have encountered with your patients?

 willie 

Mainly the decision to go thru treatment again. How to help with this decision.

 mloney 

That is a tough decision and one that we need to help each patient make based on his/her own unique situation - considering disease state, symptoms, prognosis, risks vs. benefits, quality of life, support system, other co-morbidities, & life goals. So there is no easy, one-size-fits-all answer. It helps to encourage the patient to tell you what he/she is thinking about, what has been discussed by the physician, & what he/she…

 mloney 

…has the energy & desire to do.

 mloney 

Willie, have you found a helpful strategy?

 willie 

I have had several patients express fear of side effects.

 willie 

Reassurance does help, but ones who have had problems are more fearful.

 mloney 

You can acknowledge their fear and help them talk about past experience with treatment. Many times the fear is based on perceptions not actual experience - or hearing about someone else's negative experience.

 willie 

Do you know of any useful web sites for someone who has a recurrent cancer?

 mloney 

I agree that reassurance doesn't solve the problem or resolve the fear. But your being open to hearing & talking through their fears goes a long way in conveying an important message that they are not alone & you are here to offer support & guidance - now & if they do decide to go for more treatment.

 mloney 

Chemocare.com is a great site for cancer patients at any point in their disease experience with much evidence based information on treatments, drug actions & side effects, & symptom prevention & management. ONS also has a good symptom management site with useful information. Both sites have user friendly information that can be printed for patient reference. The ONS site is www.cancersymptms.org.

 mloney 

We've been discussing how to support cancer patients with fear of treatment when cancer recurs. Are there other issues you would like to discuss... or challenging patient situations?

 mloney 

A challenging situation we discussed yesterday was how to respond to a cancer patient who talks about "wanting to kill herself" with news of her dx. Have any of you experienced this issue?

 willie 

I have had a man who had a recurrence of his leukemia who talked about suicide.

 willie 

He said the only reason he didn't was because of his family.

 mloney 

I had a young woman newly dx'ed with breast cancer express thoughts of suicide - after her mom & sister both died at young ages from breast cancer. When I helped her talk about her thoughts & feelings, she laughed & said she was trying to see how I would respond & if I really cared. I think she probably was thinking about suicide - & so I assessed her risk by asking direct questions (do you have a plan? what would make you follow your plan?). Even though she was not at immediate risk I got the team & SW involved for added support.

 mloney 

Willie, it sounds like you helped him find reasons for going on - what else were you able to do to support him?

 willie 

We did have MSW consult

 mloney 

I think it's important to remember that we don't have to do it all for our patients & that there usually is a team to help. What other close encounters have any of you had with patients' coping with their cancer experience?

 willie 

Thank you.

 mloney 

Do you all work with adult cancer patients? When I first started in Nursing I worked with Peds...& had a 10 year old leukemic patient tall me she thought she was going to go to sleep & not wake up. How would you respond?

 steph199 

I deal only with adults.

 evansj 

I would tell her that it is ok to feel that way and engage her to talk some more about her feelings

 evansj 

I deal with adults, but feelings are feelings they do not know an age

 mloney 

Sounds like the same approach I took. This question often comes up with adults as well. Usually our patients are trying to find a way to talk about their fears & future.

 evansj 

Patients need an outside source to talk to besides their family, don’t you think?

 mloney 

No matter the patient's age, it challenges us to know what to say or do - & we often feel like we need to fix things or make them better. ONs is releasing into publication a good nuts and bolts book by Burke as Editor on Psychosocial Issues in Cancer Patients - & a colleague & I have a chapter on supporting patients when facing grief, loss & death in the face of cancer. Although not a cookbook it offers useful tools & suggestions.

 evansj 

When will it be released?

 steph199 

Yes, and we our hospital has a Minister on staff, we had 21 yr old with testicular CA and he would come up and chat with the young fellow about cars and occasionally brought him a magazine about the same. Believe he young man felt comfortable talking with a man, especially about a subject he enjoyed.

 mloney 

I agree about patients needing an objective outside source for communication - but that puts us in a demanding helper role - bearing witness to their grief & loss & rollercoaster like experience. So the trick is taking care of ourselves as well.

 mloney 

That is important - sometimes we get so immersed in the grief & loss involving cancer for some of our patients, we forget they need normalcy as well. Maybe those conversations helped the young man reconnect with his past life before cancer.

 evansj 

I believe we can be our brother’s keeper as long as we take care of ourselves. Good point.

 evansj 

Has anyone used humor with their patients?

 steph199 

All the time,,,,,,and they with us.........

 evansj 

Don’t you just love the big smile you get?

 mloney 

The hard part of self care is finding time to vent or debrief in the middle of a busy shift. The book is due for publication by fall, but can check with ONS Press.

 mloney 

Humor is a great bridge in the right situation. Sometimes it helps our patients fell we are relating as human to human not nurse to cancer patient.

 evansj 

Thank you for the resource. We had a cancer survivor day on 6-7-2009 and the guest speaker reminded us that humor is what gets us through life.

 mloney 

Have you considered a retreat through your chapter or organization? Our chapter sponsored one with great success & humor was a big part of it as well as experiential exercises with music, art, & complimentary therapies.

 mloney 

We have about 18 minutes left in the chat tonight. What has been your most challenging situation in trying to support your cancer patients?

 mloney 

Have you run into one of your patients who turns away any help anyone tries to offer while complaining that no one cares?

 evansj 

the biggest problem I incur is the physicians not being honest with the patient

 mloney 

We talked about that issue some yesterday. It is too common& puts both the patient & nurse at a loss. Who ends up giving the needed information?

 mloney 

Usually the patient has a sense of what is going on before being told - & that is what nurses are confronted with too often without the MD backing. The best way to address this is to try opening communicating with the

 mloney 

MD & whole team.

 mloney 

I think we all are in Oncology Nursing because we are committed to making a difference for our patients - & it's hard when not all team members are on the same page with that philosophy. Or they think not telling the truth is a way of helping.

 evansj 

Don’t you think that is where the issue with the patient not wanting help comes from? I try to approach the patient that feels that way by trying to remember that if it was me hearing that information I may feel the same way

 steph199 

We have times when family did not want their family member to know they so ill and had cancer.

 evansj 

I don’t understand that either. Doesn’t the patient have the right to know?

 mloney 

Good thought. Tuning into the patient's agenda & needs from his/her perspective is the starting point.

 mloney 

Stephanie, how did you handle that situation?

 steph199 

Staff followed the family's instructions because they were guiding the pt's care.

 evansj 

is the patient alert and oriented

 mloney 

Sometimes that is all you can do. But we can serve as patient advocates for autonomy & informed consent as part of treatment planning. We need to make sure we also uphold those patient rights & get Ethics involved if needed.

 mloney 

Those kinds of situations necessitate a family meeting with the team & patient...

 steph199 

I believe dealing with family members is a blessing and some rare times a curse!

 evansj 

how can you do that with honesty if the doctors are not honest…

 evansj 

…with the patient

 mloney 

When you are assigned to care for a cancer patient, you end up having several more needs to address with the family - I agree. The trick is to again not take it all on yourself & involve the team early on.

 evansj 

I agree! Getting the family, physicians, and other nurses on board is the key. less stress for us.

 mloney 

It also helps reframe the problem from being between the nurse & MD to a family or team issue, which can be more readily addressed. And Ethics Committees/resources are there to help arbitrate with MDs or family who don't ensure patient rights.

 steph199 

Thanks one and all for some good information. Have a nice evening.

 mloney 

Our time is running out so I want to thank you for good dialogue on this topic. Have a good day!

 evansj 

Thank you!