Cancer and End-of-life Care: Reflections of an Oncology Unit Nurse
Losing a loved one or seeing them suffer from severe illness is a difficult time in one’s life. When one family member has a terminal disease, the whole family suffers along with sick person. Cancer, when diagnosed in the later stages, can almost never be cured. When the all-too-few treatment options for cancer are exhausted, and the prognosis looks extremely poor, patients are resigned to palliative care.
According to World Health Organization, palliative care seeks to improve or maintain the quality of life of patients and their families in the face of life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (W.H.O, 2016).
The prevalence of hepatic carcinoma in Pakistan is very high. A study conducted in Pakistan showed a 10.7% prevalence of hepatic cancer in adult males. During my clinical rotation in palliative care, I had a 65 year old male patient of liver cancer. He had presented with a history of severe abdominal pain for last three months along with the present complaints of pain, nausea, vomiting, weight loss, peripheral edema, generalized weakness and ascites. He was the sole bread winner of his family.
As I was interviewing the patient’s wife, she started crying and at that time, I felt very upset with myself when I thought about my own family. I realized how difficult a time it is for someone whose family member is ill and hospitalized. This scenario affected all domains of palliative care, but the most affected domains that need consideration are the physiological and psycho-social domain. According to W.H.O., cancer patients need psychosocial monitoring in order to assess anxiety and depression.
In the physiological domain, my patient had many physical symptoms such as pain, nausea, vomiting, and weakness; due to which he was unable to perform his job and other activities. In psycho-social domain, there are many problems that directly or indirectly affected the patient’s behavior. Firstly, patient was anxious due to hospitalization because he was the only earning member in his family and hospital expenses were a major concern for the patient and his family. Secondly he was not comfortable at all and preferred isolation.
According to this scenario, l have incorporated Kolcaba’s comfort theory which contains major domains of palliative care but the most important are physical and physio-social domain. The domains discussed above are both connected, as it increases patient’s suffering and decreased his ability to work effectively. Kolcaba’s comfort theory maintains that comfort has three main forms: relief, ease and transcendence (Kolcaba & Fisher, 1996).
As a student nurse, I am accountability to help and support my patients to overcome their physiological and psycho-social needs. In order to alleviate this patient’s symptoms, I provided comfort care to him through positioning and several mind diversional activities like musical therapy. I also taught my patient deep breathing exercise to decrease his pain and also ensured that his pain medications were promptly administered.
To help my patient cope with this condition in future, I recommend as a student nurse that I can encourage my patient and his family to reduce their anxiety level. I also guided patient’s family regarding financial supports like welfare department so they can help them financially. At a national level, policy change can promote palliative care delivery and emphasize palliative care in Pakistan.
Abreu.R.M, S, F. C., & etc., N. &. (2014). Hepatocellular Carcinoma: The Final Moments of Life. Department of Gastroenterology, Clinical Division, Hepatology Branch, University of Sao Paulo School of Medicine, Sao Paulo,, 377-383.
Krinsky, R., & Murillo, I. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 147-150. Retrieved from: www.elsevier.com/locate/apnr.
Wilson. O, Avalos. G., & Dowling., M. (2016). Knowledge of palliative care and attitudes. British Journal of Nursing, 25(11), 600-605. Retrieved from: http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=565f8b41-f5e4-46b1-8ec4-5ba37f5dda1a%40sessionmgr4007&vid=1&hid=4204
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