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Psychological Aspects of Oncology Patient “Contributing Factors & Intervention” Elham Abd El-Kader Fayad Professor of Psychiatric & Mental Health Nursing 3/5/2006
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For oncology client the following areas should be examend: Adjustment and quality of life. Symptoms control. Immune function. “Disease progression”
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Adjustment & quality of life Psychosocial factors contributing to adverse outcomes: → Cancer can be emotionally jarring experience. → Accompanied by multiple challenges & disruptions.
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Studies of quality of life & psychological adjustment focuses the attention on several questions Which patient are most vulnerable to psychological difficulties?
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What challenges emerge for patient’s with different sites of disease at different phases of treatment? Disabilities? Tumor site? Choice of treatment & time since diagnosis? This plays an obvious role in shaping psychological responses to cancer.
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Symptoms Control Nausea, vomiting, pain, fatigue & hot flashes are among the symptoms that have been targeted for adjective psychological interventions.
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Interest in symptoms control helped set the stage for closer interdisciplinary collaboration in the clinic, introducing an alternative to the more traditional practice of referring medical symptoms to medical specialists & psychological problems to mental health specialists.
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Immune Function & Disease Outcome Psychological factors contributing to disease progression.
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Growing evidence suggests that social isolation, associated with all- cancer mortality after controlling for traditional risk factors. Social support may have differential effects on survival.
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Psychological factors such as: stress, pessimism, or isolation affect the medical treatment.
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Stress and psychological factors influence health behaviors contributing to poor diet, diminished appetite, disrupted sleep, limited exercise, increase cigarette smoking, and intensified substance abuse.
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Associated Common Psychological Symptoms Certain psychological symptoms are common to clients diagnosed with cancer these include anger, depression, anxiety, helplessness, and hopelessness
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Anger Clients with cancer diagnosis typically demonstrate behaviors that are indicative of anger.
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These behaviors reflect feelings of helplessness and frustration about the illness and the effects the illness has on daily functioning.
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Behaviors likely to be exhibited include demanding types of action, loud verbalization, slamming of items, and social withdrawal.
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Depression Clients with cancer diagnosis typically demonstrate symptoms of depression related to disruption of daily functioning.
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Signs associated with depression include feelings of helplessness/hopelessness, flat affect, poor eye contact, disrupted eating/sleeping patterns, absence of motivation and compliance, and decreased energy level.
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Anxiety Oncology clients typically demonstrate feelings and behaviors of anxiety. This reflects feelings of real or imagined threat to body image.
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Anxiety results in autonomic nervous system stimulation with increased heart rate, increased respirations, increased visual acuity, diaphoresis, shortness of breath, and restlessness.
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Helplessness/Hopelessness Oncology clients demonstrate feelings of helplessness/hopelessness.
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Helplessness relates to feelings of powerlessness associated with being unable to change what is happening, while hopelessness relates to feelings of despondency and loss of optimism.
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This is reflected in feelings of loss of control (feeling that an event can be managed) and individuality and increased dependency on others.
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Associated Psychiatric Symptoms Psychosis is the inability of a client to understand and know reality or cope with demands of daily living.
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Psychotic symptoms that may be demonstrated in clients with selected medical illness diagnoses include evidence of delusions and hallucinations, thought process disruption, and difficulty in caring for oneself.
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Assessment The nurse uses various resources to collect psychological, biological, and social data.
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Subjective and objective symptoms, family/significant other reports, and diagnostic reports are considered in the assessment phase.
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Psychological Assessment Elicits clients’ emotional reaction & coping abilities and support resources.
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A stress appraisal should be done with identification of the source of stress, number of stressors, and duration of stressors.
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Depression symptoms assessment should be completed with notation of time of initial symptoms, duration of symptoms, and physical appearance.
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Identification of coping behaviors is part of the psychological assessment and includes assessment of adaptive and maladaptive behaviors that reflect a client’s ability to identify problems and analyze feelings
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The assessment phase should also include identifying the emotional stage of the illness.
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Clients often progressively move through stages of illness and interventions should be planned according to the emotional stage.
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These Stages include Denial of the illness and associated limitations. Anger at loss of control and associated limitations. Bargaining, with a plea for another chance and a seeking of new answers/treatments.
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Depression when grieving occurs due to loss or anticipated loss. Acceptance/adaptation when conflicts are resolved and the client participates in care.
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Management In cancer illness: Client experiences feelings of helplessness & hopelessness. In addition, feelings of depression, anger, and hostility are experienced.
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The client’s response will be affected by coping skills, developmental/lifespan level, spiritual, cultural, biological, and psychosocial factors.
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Interventions for clients with cancer should include use of empathy and compassion; a focus on aspects of the client’s life that were positive, spirituality assessment and reinforcement; support of family and significant others; and allowing client dignity, client control, and use of pain management.
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