Congress Abstracts 2004

61

A PSYCHOEDUCATIONAL SUPPORT MODEL BASED ON THE CONCEPT ANALYSIS OF SUFFERING. Lynn Hryniuk, RN, MSN, ANP, Cancer Advocacy Coalition of Canada, Dundas, ON, and William Hryniuk, MD, Barbara Ann Karmanos Cancer Institute, Detroit, MI.

Psychoeducational interventions (PEIs) for patients with cancer can have a major impact on quality of life (QOL) and affect treatment outcomes. The oncology nurse is uniquely positioned to determine the need for, and appropriateness of, various PEIs for her clients.

A wide variety of PEIs, each with a different objective, is available to improve QOL. A coherent and consistent framework for applying them in concert would be useful. A model has been developed that provides such a framework. It is based on a concept analysis of suffering. The model describes the natural history of S, and indicates how each PEI operates separately to facilitate its resolution, thus expediting a positive outcome. Suffering occurs when an individual perceives a threat of disintegration of “self” from a global trigger factor (natural causes, third party, or unknowingly maladaptive thoughts) and, lacking control, feels helpless to defend. Fear and other unpleasant emotions result. Consequences can be negative (maladaptive behaviors, depression, and turmoil without resolution) or positive (meaning-making, healing, and transformation—H&T).

Nurses can (1) directly interdict the natural cause (cancer) as part of the treatment team, (2) refer to other multidisciplinary services to deal with third party or maladaptive thoughts, (3) explain the natural history of suffering, encouraging client to understand its personal meaning, and help them understand positive and negative consequences, (4) provide knowledge about treatment and disease enabling client regain of control, (5) facilitate access to anxiolytic maneuvers (meditation, music therapy, imagery, etc.), and (6) indicate sources of spiritual support.

The model was applied to 50 patients with newly diagnosed breast cancer who were undergoing adjuvant chemotherapy. Of those randomized to intervention (model-based personalized prescription of PEIs most likely to relieve suffering and expedite healing and transformation in the individual case), the pre-stratified obese patients had reduced chemotherapy toxicity and improved QOL compared to the usual-care obese controls. (ASCO 2003 abstract #171).

The model provides a useful framework for assessing and educating patients, educating professionals, and may be applicable to other life situations attended by suffering.