Symptom Control in Palliative Care

Mrs Kapoor is a 67-year-old British Asian lady who was diagnosed with colorectal cancer 2 years ago, and has undergone surgery (with stoma formation) followed by chemotherapy, which has helped to control the disease. Her most recent scans indicate that the cancer has recurred, and has spread. The treatment options have been discussed with her and her family, and she has decided that due to the extent of the disease, and the likely benefit of the treatment she would prefer to have a more palliative approach in managing the disease. Mrs Kapoor and her family are aware that she is nearing the end of her life.
Mrs Kapoor lives with her husband, daughter and mother at home. She also has a married son who lives nearby and a grandaughter.
Mrs Kapoor has family in India, and her Hindu faith is important to her.
You are part of the inter-discilplinary team caring for Mrs Kapoor, and it is your role to ensure her nursing needs are met.(This is the scenario of Mrs kappor).

Principle Chosen – Person Centered

Definition: The emphasis on the personal needs of patients and their adaptation to current treatment conditions is a significant aspect of care. According to Hui and Bruera (2016), addressing individual needs in units with enhanced therapy, for instance, oncological departments, is essential. The reason is that not only the physical but also morale of patients leaves much to be desired, and the participation of staff in personal assistance can facilitate improving well-being and a speedy recovery.

Explanation: The application of person-centered care is relevant in oncology departments due to the fact that cancer patients are not able to fulfill many needs on their own and have to rely on nurses’ help. As Zimmermann et al. (2016) note, analysing the effectiveness of this approach makes it possible to assess the importance of the individual interaction of personnel with those who undergo severe chemotherapeutic procedures. All patients perceive the current treatment conditions differently, experiencing stress, anxiety, fear, and other negative emotions. In addition, such concerns may cause extremely undesirable outcomes, such as suicide. In order to prevent this, oncology ward medical personnel should resort to the method of person-centered care to help patients adapt to current living conditions and stimulate their desire for recovery.

Chosen Care: Symptom Control

Definition: Since care in oncology departments is largely based on controlling the manifestations of the disease, symptom analysis is an important component of proper treatment. Pain is the most common manifestation of cancer at different stages, and appropriate assistance in identifying and reducing this symptom is an important task for medical personnel. Constant observation and interaction with patients may allow minimising the unpleasant effects of tumors expressed in acute pain and contribute to improving both the physical and moral status of patients.

Ways it affects Mrs Kapoor:

  1. The voluntary refusal of treatment determines further circumstances that uncontrolled colorectal cancer causes. If symptom control is not maintained at a proper level, the patient’s condition will worsen because, as Walling et al. (2016) argue, unmet pain will aggravate the course of the disease. The woman will suffer from constant bouts of ache, and her life will become unbearable due to acute pain. At the same time, the illness will progress, and the relief of its main manifestation will be the main type of intervention conducted by medical staff.
  2. Mrs Kapoor’s family members will have to accept the fact that the patient will no longer undergo chemotherapy and voluntarily agree to palliative care. Her spiritual beliefs will not be affected since she is a supporter of the Hindu religion that, as Barbato (2017) notes, does not call for voluntary tortures. According to Kelley and Morrison (2015), in those conditions when spiritual concerns are addressed, it is easier for many patients to accept the consequences of a particular disease.
  3. For Mrs Kapoor, the consequences of the development of the disease may vary. As Schuurhuizen et al. (2017) note, approximately 40-50% of patients undergoing treatment for colorectal cancer have metastases at different stages. Such an outcome will make the last days of Mrs Kapoor difficult because pain control implies eliminating acute ache through strong painkillers and sedatives. As a result, there is a possibility that the patient will often be unconscious under the influence of these drugs.
  4. In case Mrs Kapoor does not have an idea about the features of the symptom control process and all the necessary interventions, this can worsen her psychological state. Hannon et al. (2016) argue that the education of patients in palliative care plays a significant role and is the tool of minimising depression. If the nursing staff does not show proper attention, the probability of Mrs Kapoor’s nervous breakdowns may be high despite her beliefs.

Demonstrate how your chosen principle could be applied in order to support Mrs Kapoor and her family in relation to the care need identified. (650 words) (this must be in your own words, and not merely copied from the wiki)Chosen Care need from the vignette, with an explanation on how this may affect Mrs Kapoor and her family. (400 words) You must select a care need not related to the care domain you were allocated as part of your group wiki directed work. (this must be in your own words, and not merely copied from the wiki).

  1. Further treatment and palliative care will become part of Mrs Kapoor’s life. To help her spend this time as painlessly as possible, the symptom control system should be applied. According to Hui et al. (2015), one of the ways of ensuring appropriate conditions in a clinical setting is maintaining a high level of communication and meeting patients’ basic needs. When cancer progresses further, it is crucial to eliminate pain by watching Mrs Kapoor’s condition and taking into account her complaints. The nursing staff should be attentive to the needs of and her well-being since inaction will aggravate the illness and make time in the clinic difficult for the patient and her family, which is big enough. Mrs Kapoor is not very old, and she is in her right mind and aware of the consequences of her decision. A person-oriented principle of care will allow taking into account the individual health indicators of the patient and her current state.
  2. In order not to have a detrimental effect on the patient’s psyche and her perception of the world, symptom control should not contradict her inner convictions, in particular, religion. Since Mrs Kapoor is a supporter of the Hindu faith, there is no need to convince her to abandon the possibility of fighting cancer. It is essential to accept the decision that she made to assist her and reduce the impact of the illness. Kumar et al. (2017) note that the role of family members in helping patients with advanced cancer is also significant. Accordingly, the joint cultural background that Mrs Kapoor and her relatives have may contribute to the woman’s more comfortable staying in a clinical environment. An opportunity to communicate with relatives and discuss with them the features of symptom control can have positive results for Mrs Kapoor’s psyche and her morale.
  3. For Mrs Kapoor not to be unconscious under the influence of strong narcotic drugs most of the time, it is crucial to follow the correct mode of symptom control. Fatigue that patients may experience while in a clinical setting is the common symptom of advanced cancer (Pyszora et al. 2017). Therefore, the nursing staff should make all the necessary efforts to monitor the condition of the woman and adhere to the care plan that is appropriate for the physician’s prescriptions. Too many medications can suppress the mind of Mrs Kapoor, and too small doses, on the contrary, may be fraught with the development of severe pain. In order to prevent such consequences, it is essential to interact with the patient constantly to have detailed information regarding her well-being and sensations that cause her discomfort. Otherwise, the quality of care will be inadequate, and the woman will be severely depressed.
  4. The nursing staff providing care for Mrs Kapoor should provide her with relevant information regarding the specifics of symptom control and the importance of the woman’s role in the overall treatment process. Beets et al. (2017) state that specialists working in cancer departments should contact not only patients but also their families to provide comprehensive support and safety. If Mrs Kapoor is aware of the importance of symptom control and the information that she should share with nurses, this will make the care process less complicated and more favourable for her. Despite the principles of palliative care, Mrs Kapoor should be able to cope with stress on her own and overcome negative emotions in order to interact with nurses and relatives. Thus, education is an integral part of symptom control and is to be maintained by medical professionals for all stakeholders to be aware of the course of the disease.

When summarising the case of Mrs Kapoor and the care plan, it can be noted that symptom control is a significant component of palliative care. Progressive cancer may create severe discomfort and affect patients’ morale negatively. Therefore, nurses should adhere to a person-centered principle as part of the treatment process.

References

Barbato, M 2017, ‘Interreligious resources for pain management: contributions from Hinduism and Christianity’, Journal of Interreligious Studies, vol. 20, pp. 80-89.

Beets, G, Sebag-Montefiore, D, Andritsch, E, Arnold, D, Beishon, M, Crul, M, Dekker, JW, Delgado-Bolton, R, Fléjou, JF, Grisold, W, Henning, G, Laghi, A, Lovey, J, Negrouk, A, Pereira, P, Roca, P, Saarto, T, Seufferlein, T, Taylor, C, Ugolini, G, van de Velde, C, van Herck, B, Yared, W, Costa, A & Naredi, P 2017, ‘ECCO essential requirements for quality cancer care: colorectal cancer. A critical review’, Critical Reviews in Oncology/Hematology, vol. 110, pp. 81-93.

Hannon, B, Swami, N, Pope, A, Leighl, N, Rodin, G, Krzyzanowska, M & Zimmermann, C 2016, ‘Early palliative care and its role in oncology: a qualitative study’, The Oncologist, vol. 21, no. 11, pp. 1387-1395.

Hui, D & Bruera, E 2016, ‘Integrating palliative care into the trajectory of cancer care’, Nature Reviews Clinical oncology, vol. 13, no. 3, pp. 159-171.

Hui, D, Kim, YJ, Park, JC, Zhang, Y, Strasser, F, Cherny, N, Kaasa, S, Davis, MP & Bruera, E 2015, ‘Integration of oncology and palliative care: a systematic review’, The Oncologist, vol. 20, no. 1, pp. 77-83.

Kelley, AS & Morrison, RS 2015, ‘Palliative care for the seriously ill’, New England Journal of Medicine, vol. 373, no. 8, pp. 747-755.
Kumar, P, Wright, AA, Hatfield, LA, Temel, JS & Keating, NL 2017, ‘Family perspectives on hospice care experiences of patients with cancer’, Journal of Clinical Oncology, vol. 35, no. 4, pp. 432-439.

Pyszora, A, Budzyński, J, Wójcik, A, Prokop, A & Krajnik, M 2017, ‘Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial’, Supportive Care in Cancer, vol. 25, no. 9, pp. 2899-2908.

Schuurhuizen, CSEW, Braamse, AMJ, Konings, IRHM, Sprangers, MAG, Ket, JCF, Dekker, J & Verheul, HM 2017, ‘Does severe toxicity affect global quality of life in patients with metastatic colorectal cancer during palliative systemic treatment? A systematic review’, Annals of Oncology, vol. 28, no. 3, pp. 478-486.

Walling, AM, Keating, NL, Kahn, KL, Dy, S, Mack, JW, Malin, J, Arora, NK, Adams, JL, Antonio, ALM & Tisnado, D 2016, ‘Lower patient ratings of physician communication are associated with unmet need for symptom management in patients with lung and colorectal cancer’, Journal of Oncology Practice, vol. 12, no. 6, pp. e654-e669.

Zimmermann, C, Swami, N, Krzyzanowska, M, Leighl, N, Rydall, A, Rodin, G, Tannock, I & Hannon, B 2016, ‘Perceptions of palliative care among patients with advanced cancer and their caregivers’, Canadian Medical Association Journal, vol. 188, no. 10, pp. E217-E227.