PSYCHOSOCIAL IMPACTS OF CANCER Flashcards
THE PSYCHOSOCIAL APPROACH
- CONSIDERS THE INDIVIDUAL IN TERMS OF AN INTERACTION BETWEEN PSYCHOLOGICAL FACTORS AND THEIR ‘SOCIAL CONTEXT’
(THE PERSON AND THEIR INDIVIDUAL EXPERIENCE, EMOTIONAL WELLBEING, KNOWLEDGE AND BELIEFS, SOCIAL NETWORKS, CULTURE AND SES)
(IN TERMS OF CANCER, ESSENTIAL TO ADD THE ‘BIO’ APPROACH AS WELL; BIO-PSYCHO-SOCIAL MODEL)
HOW MANY PEOPLE ARE LIVING WITH THE DIAGNOSIS OF CANCER IN THE UK?
3 MIL
HOW IS THE NUMBER OF PEOPLE LIVING WITH CANCER IN THE UK CHANGING EACH YEAR?
INCREASING BY OVER 3% (TOTAL NUMBER SET TO EXCEED 4 MILLION BY 2030)
HOW MANY PEOPLE DIAGNOSED WITH CANCER IN ENGLAND AND WLES SURVIVE FOR 10+ YEARS?
50%
HOLISTIC NEEDS ASSESSMENT?
- BROADER APPROACH THAN MEASUREMENT OF HEALTH RELATED QUALITY OF LIFE
A Holistic Needs Assessment (HNA) is a simple questionnaire for your patients. You can carry out the assessment at any stage of the cancer pathway, on paper or electronically, to help you:
identify a patient’s concerns
start a conversation about needs
develop a Personalised Care and Support Plan
share the right information, at the right times
signpost to relevant services
- LINKED TO DEVELOPMENT OF PATIENT/PERSON CENTERED CARE DURING THE 1980s (NOW CALLED PEOPLE CENTRED CARE BY THE WHO)
- MORE INDIVIDUALISED WITH A FOCUS ON WHAT IS IMPORTANT TO THE PATIENT THEMSELVES AND FRAMED IN TERMS OF NEEDS AND CONCERNS!!!!!!!!!!!!!!!!!!! (COVER BROD RANGING DOMAINS)
THE DISTRESS THERMOMETER
The Distress Thermometer (DT) was developed as a simple tool to effectively screen for symptoms of distress. The instrument is a self-reported tool using a 0-to-10 rating scale. Additionally, the patient is prompted to identify sources of distress using a Problem List. The DT has demonstrated adequate reliability and has been translated into numerous languages. The tool is easy to administer and empowers the clinician to facilitate appropriate psychosocial support and referrals.
DESCRIBE THE PSYCHO-SOCIAL FACTORS THAT MEDIATE THE PSYCHOLOGICAL RESPONSE TO CANCER
KNOWLEDGE AND BELIEFS ABOUT CANCER
- VARY BETWEEN COMMUNITIES (MYTHS AND EXPLANATIONS AROUND WHAT CNCER IS AND WHERE IT COMES FROM)
- AT AN INDIVIDUAL LEVEL, BELIEFS DEPEND ON PREVIOUS EXPERIENCE AND KNOWLEDGE SOURCES
- STILL A LOT OF FEAR EVEN TALKING OPENLY ABOUT CANCER
- STIGMA AND SHAME
CHARACTERISTICS OF THE PERSON
- AGE, SEX
- PSYCHOLOGICAL FACTORS (OLDER PEOPLE GENERALLY MORE ACCEPTING OF THE DIAGNOSIS BUT PRE-EXISTING ANXIETY AND DEPRESSION MIGHT IMPACT THIS)
IMMEDIATE NETWORK
- FAMILY, FRIENDS COULD BE SUPPORTIVE, AVODIANT ETC)
- FEELINGS OF ISOLATION
SOCIOECONOMIC CONTEXT
- IMPACT OF POVERY, DEPRIVATION, RACISM
- IMPACT ON EXPERIENCE AND TRUST IN HEALTHCARE
UNCERTAINTY AND CANCER
- ONE OF THE MAJOR PSYCHOLOGICAL IMPACTS
- UNCERTAINTY IS INHERENT FROM PRE DIAGNOSIS ONWARD AND DIFFICULT TO DEAL WITH
- AMOUNT OF UNCERTAINTY CHANGES ALONG THE CARE PATHWAY
UNCERTAINTY IN ILLNESS THEORY
The Uncertainty in Illness Theory (UIT), developed by Nursing Theorist Merle Mishel, explains how patients and caregivers perceive and manage uncertainty, a cognitive stressor at the heart of many acute and chronic disease experiences.
PERIOD OF MAXIMUM VULNERABILITY FOR MANY CANCER PATIENTS IS:
END OF TREATMENT (FEELING LIKE FALLING OFF THE CLIFF, LOSS OF STRUCTURE OF GOING FOR APPOINTMENTS, AWAITING FOLLOW UP TO FIND OUT WHAT THE TRETAMENT HAS ACHIEVED…)
DESCRIBE THE PSYCHOLOGICAL AND MENTAL HEALTH IMPACT OF CANCER AND HOW BEST TO MANAGE IT
- PSYCHOLOGICAL DISTRESS COMON AND UNDERSTANDABLE
- FATIGUE, MEMORY AND CONCENTRATION PROBLEMS (CHEMO BRAIN, CHEMO FOG), FEAR OF RECURRENCE, PTSD, ANTICIPATORY GRIEF, LOSS OF MEANING, SOCIAL ANXIETY, LONELINESS, RELATIONSHIP PROBLEMS…………….. (ALL OF THESE ARE IN MANY CASES MANAGEABLE BY APPROPRIATE CARE AND SUPPORT)
- COMMUNICATION BETWEEN THE PERSON AND THE CLINICAL TEAM IDENTIFIED AS THE MOST IMPORTANT IN MANAGING THESE IMPACTS
IN WHAT % OF CANCER PATIENTS DO DEPRESION AND ANXIETY OCCUR?
DEPRESSION: 20%
ANXIETY: 10%
NICE GUIDANCE FOR PSYCHOLOGICAL SUPPORT FOR CANCER PATIENTS?
- RECOMMENDED ALL PATIENTS!!!!!!!! SHOULD BE ASSESSED AND ASSINGED INTO ONE OF THE 4 DIFFERENT LEVELS OF CARE DEPENDING ON THE SEVERITY OF THEIR MENTAL HEALTH NEEDS (SELF-HELP AND INFORMAL SUPPORT RECOMMENDED FOR ALL LEVELS); UNFORTUNATELY, MANY PEOPLE NOT ACTUALLY ASSESSED IN PRACTICE
LEVEL 1: ALL HEALTH AND SOCIAL CARE PROFESSIONALS, RECOGNITION OF PSYCHOLOGICAL NEEDS, EFFECTIVE INFO GIVING, COMPASIONATE COMMUNICATION, GENERAL PSYCHOLOGICAL SUPPORT
LEVEL 2: HEALTH AND SOCIAL CARE PROFESSIONALS, SCREENING FOR PSYCHOLOGICAL DISTRESS, PSYCHOLOGICAL TECHNIQUES SUCH AS PROBLEM SOLVING
LEVEL 3: TRAINED AND ACCREDITED PROFESSIONALS, ASSESSMENT OF PSYCHOLOGICAL DISTRESS AND DIAGNOSIS OF SOME PSYCHOPATHOLOGY, COUNSELLIG AND SOME SPECIFIC PSYCHOLOGICAL INTERVENTIONS SUCH AS ANXIETY MANAGEMENT AND SOLUTION-FOCUSED THERAPY, DELIVERED ACCORDING TO AN EXPLICIT THEORETICAL FRAMEWORK
LEVEL 4: MENTAL HEALTH SPECIALISTS, DIAGNOSIS OF PSYCHOPATHOLOGY, SPECIALIST PSYCHOLOGICAL AND PSYCHIATRIC INTERVENTIONS SUCH AS PSYCHOTHERAPY, INCLUDING COGNITIVE BEHAVIOURAL THERAPY
EXAMPLES OF SUPPORTIVE INTEREVENTIONS FOR CANCER PATIENTS
- COUNSELLING
- GROUPS (SUPPORT GROUPS, ACTIVITY GROUPS ETC)
- EDUCATION
- SELF MANAGEMENT INCLUDING EXERCISE, DIET, MINDFULNESS
- CAN BE ONLINE AND/OR F2F
(EFFECTIVE FOR MANY PEOPLE)
MAGGIE’S CENTRES?
Maggie’s centres are a network of drop-in centres across the United Kingdom and Hong Kong, which aim to help anyone who has been affected by cancer. They are not intended as a replacement for conventional cancer therapy, but as a caring environment that can provide support, information and practical advice (caring for psychosocial needs of people with cancer). They are located near, but are detached from, existing NHS hospitals.
- beautifully architected buildings in a nature setting
- have online services as well
