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Care of Breast Cancer Patients: Psycho-social and Spiritual Domains of Palliative Nursing

Submitted by on January 4, 2014 – 11:16 PM

palliativecareexplainedEvery human being desires to live a healthy life and die without suffering from any pain. But for many terminally ill people their diagnosis and treatment becomes obstacles in the fulfillment of their wishes. These diseases make the person’s life miserable and also make their death worse. According to WHO (2008), cancer is the first leading cause of death in developed countries and the second cause of death in developing countries.

In Pakistan breast cancer is the most prevalent cancer among women. According to an article “Global Cancer Statistics”,breast cancer is a frequently diagnosed cancer and it is the primary cause of cancer death in females, accounting for 1.38 million of the total new cancer cases and 458,400 of the total cancer deaths in 2008. Cancer does not only affect the life of individual but it also has impact on lives of the family especially primary care provider. World Health organization, (2012) defines “palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering”.

When I encounteredthe first patient in my palliative clinical, I realized the importance of palliative nursing. On my very first day of clinical posting, I met a 75 yr old female who was admitted in ABC Hospital with complains of diarrhea, pain in body and burning micturition. During the history taking session, she verbalized that about two years ago she felt a lump on her right breast. She did not discuss this problem with anyone and it went unnoticed and untreated.

When I asked her the reason for hiding this problem from others, she said it was because she wore a veil and her cultural background considered it inappropriate to talk about any problem related to breast or any other private parts of the body. She also said she feared the reaction of her family members. Her lump started growing until it became an ulcerating skin tumor. It then started bleeding and that is how her daughter in law came to know of it and took her for a check-up.

It turned out she had a 2nd grade breast tumor. At the time I met her, she had already gone through one cycle of chemotherapy and a second session was planned after eight days. She was quite upset because she was neither able to pray nor fast. She has a strong belief in God and she is thankful to the Almighty for His blessings.

As a nursing student, it is my utmost responsibility to provide holistic care to the patient and his/her family. During patient care I identified many domains which were affected, like psycho-social (family dynamics), spiritual (religious practices), physical (pain, fatigue, diarrhea, fatigue, anorexia) and communication (non-therapeutic communication). Here all domains of palliative care are interrelated to each other but I will highlight the two most affected domains: psycho-social and spiritual. This paper will shed light on the issues, interventions and recommendations regarding psycho-social and spiritual domains of palliative care.

Psychosocial domain of palliative care refers to the close relationship between the individual and the collective aspects of any social. According to Psychosocial support– IFRC,“Psychosocial support can be adapted in particular situations to respond to the psychological and physical needs of the people concerned, by helping them to accept the situation and to cope with it”.(7)

Reflecting on my patient’s psychosocial domain; she considered her lump as a normal swelling and thought that it would resolve on its own. According to Xinhua ,“A large stratum of society comprises of rural women who remain unaware about the prevention and methods of timely diagnosis of this disease so the situation is getting worse across the country”(10). Additionally, her assessment revealed that she belonged to a cultural background where a patient feels uncomfortable to seek any treatment related to private parts.

On the other hand , my patient was missing her granddaughter and due to some family conflicts no one was ready to bring her to the hospital for meeting her grandmother. She was very upset and was not eating or drinking anything. I encouraged her to eat and drink. I offered her bread and milk and fed her with my own hands.

The next day I encouraged her to eat a banana. On the last day she thanked me for encouraging her to eat and for taking care of her like her granddaughter. Before working with this patient I perceived that every woman with breast cancer has major concern related to body image. But, psycho-social concern can be more prominent in the patients from suburb areas and specially those who follow the old customs, as they have no awareness about disease processes and its treatment.

Other highlighted domain was spirituality and many patients with terminal illness find changes in their spirituality. Some patients get closer to God and find religion as a coping mechanism while others get stuck in spiritual conflicts and ask questions like “why me” and consequently set  themselves apart from the Supreme-power. They need assistance to cope with these issues (6). Similar is the case with my patient, her religious practices have been  altered because of the disease process as now she  has become bedridden and has pain while sitting or using the right hand.

She used to offer regular prayers prior to the disease process and now she is upset as she is unable to do so. But she is very satisfied with God and His blessings. She says that “I am satisfied with my life because God has blessed me with many reasons to be happy”. She said, she always had alternatives like when her husband was not working, she had her father’s money to support and educate her child and many more. But now she considers herself unclean because of the urine bag and also due to her condition. I encouraged her to reconnect herself with God and she returned to the path of spiritual and psychological health which had been disturbed before. Cornah stated that “spirituality can affect a person’s coping styles. It can also provide access to a network of social supportto  promote and sustain emotional and psychological wellbeing” (3).

While working in a palliative care setting I learnt about the domains of palliative care and tried my best to integrate knowledge into practice. As palliative care domains are interrelated to each other,efforts towards spiritual and psycho-social domains have a positive impact on the physical as well as psychological health.

 Palliative care nursing is a very new concept. It is also growing in our country but on a very slow pace and special efforts are required to uplift this field. More awareness programs and researches should be conducted to approach holistic care during the last days of a patient’s life. Health ministry should implement the palliative care nursing not only in cancer hospitals but also in every tertiary hospital.

Other than this, health care providers should be aware of their own emotions and feelings. Self reflection and self awareness are of fundamental importance to understand the patient’s emotions and life experiences (5). Moreover, nurses should also go thorough assessment of patients; they should have knowledge about trans-cultural nursing, they should acknowledge different cultural values to become a culturally competent nurse (2). Furthermore, health care team should have knowledge about spirituality so that they can identify and fulfill the need of patients by providing them quality and holistic care (1).

It is also recommend that there should be a separate room for prayers and performance of rituals for the patients only, where they can be at ease and comfort so that they can improve their health. If patients are bedridden,the nurses must encourage patients to perform their religious rituals on bed so that they do not feel upset and the spiritual domain of palliative care is not affected.

In conclusion, palliative nursing care should not be neglected in any case.  It is a significant component of holistic care and we nurses can play an important role in improving a patient’s quality of life, by using holistic approach, which includes physical, sexual, social, economical, spiritual and psychological domains. By the end of my clinicals, I realized the power of nurses; they can make a difference through selfless and dedicated interventions.


1-Baldacchino, D.R. (2011). Teaching on spiritual care: The perceived impact on qualified nurses.  Nurse Education in Practice, 11, 47-53.

2-Clark, K. & Phillips, J. (2010). End of life care: The importance of culture and ethnicity. Australian Family Physician, 39(4), pp 210-123

3-Cornah, D.D. (2006).The impact of spirituality on mental health: A literature review.

4-Jemal, A., Bray, F., Center, M. M., Ferlay, J., Ward, E., & Forman, D. (2011).Global Cancer Statistics. American Cancer Society, 61(2). doi:10.3322/caac.20107

5-Jenko, M. & Moffitt, S. R. (2006). Transcultural nursing principles: An Application to Hospice Care. Journal Of Hospice And Palliative Nursing, 8(3), 172-180

6-Koenig, H. G. (2004) Religion, spirituality, and medicine: Research findings and implications for

clinical practice. Southern Medical Journal.97:12, 1194 (7).

7-Psychosocial support – IFRC. (n.d)

8-World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.

9-World Health Organization.(2012), WHO definition of Palliative care nursing 2002.

10- Xinhua(2011). Feature: Unawareness about breast cancer more fatal than disease itself in Pakistan.



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