Psychosocial Care of the Newly Diagnosed Cancer Patient

1. Psychosocial Care of the Newly Diagnosed Cancer Patient

2. Objectives The learner will be able to: • Identify initial responses to receiving a cancer diagnosis. • Identify coping strategies employed by newly diagnosed patients and effective nursing responses.

3. Diagnosis • Represents a significant threat to security and the order of life • Produces cultural fears of pain, suffering, and death, even though many cancers are now treatable • Produces a myriad of emotions: • Fear, anxiety, uncertainty, anger, grief, loss, guilt, powerlessness, denial, depression, hope

4. Recognition Phase • Initial awareness of possible disease • Lump, abnormal bleeding, changes in body noted. • Typically motivates people into action to investigate • Timing of action is dependent on cultural and family beliefs about cancer, previous experiences, finances, fear, or lack of knowledge about the severity of symptoms.

5. Receiving the Diagnosis • How a patient receives the information can affect how the patient responds. • Nurses often reinforce the diagnosis and provide support and clarification. • Studies support that patients who are prepared for a possible cancer diagnosis, receive written information, discuss life expectancy/severity openly, have a support person with them, have questions answered, and are involved in treatment planning experience less anxiety.

6. Response to the Diagnosis • Initial responses are typically disbelief, shock, numbness, and anxiety. • Waves of emotion, followed by periods of calmness, are common. • Early responses can include denial, attempts to identify cause (“Why me?”), and no emotional reaction at all (forestalled until a later time). • Intermittent extreme anxiety and depression are common. • Most people can develop an initial plan of action after the first few days following diagnosis.

7. Coping Strategies • Coping is highly individualized. • Some behaviors labeled as maladaptive may actually be helpful. • Support patients in the coping strategies that work for them that do not harm others or interfere with care; encourage new coping strategies only when current ones are not effective. • Focus evaluation of coping on outcomes, not the use of specific strategies. • Consider cultural influences and beliefs when assessing coping strategies and social support issues.

8. Developmental Considerations • Cancer exhibits feelings of anxiety and fear no matter what age it may occur. • Lines of simple, truthful communication need to be kept open. • Everyone can benefit from age-specific support groups • Children and adolescents: • Do not always understand the significance of a cancer diagnosis • Young adults: • Often focus on how cancer will affect relationships • Older adults: • Often have comorbidities that affect treatment

9. Nursing Responses to Coping Strategies • Accept and acknowledge the patient’s perceptions—feelings, behaviors, symptoms, and sensations—even if they seem unusual. • Adapt nursing teaching needs and requirements when possible to assist the patient with coping. • Enlist others to assist as needed for difficult situations, such as cultural and language barriers.

10. Hope and Communication • Studies support that some concept of hope is present for most people with cancer regardless of the stage of disease and the goals of care. • The concept of providing “false hope” is outdated; encouragement of hope is crucial. • Provide clear, timely, bidirectional communication in the manner best suited to the patient, taking cultural influences into consideration.

11. Resources • American Society of Clinical Oncology (ASCO)’s “Coping” information (includes cultural, gender, and age-specific information: http://www.cancer.net/patient/Coping/ • Yale School of Medicine’s “Cancer Diagnosis: Coping With Terminal Cancer” (includes developmental and age-specific information): http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW025771

12. References American Society of Clinical Oncology (ASCO). (2005-2012). Coping. Retrievedfromhttp://www.cancer.net/patient/Coping/. Bush, N.J. (2008). Both sides now. Oncology Nursing Forum, 35, 155156. Carroll-Johnson, R.M., Gorman, L.M., & Bush, N.J. (Eds.). (2006). Psychosocial Nursing Care Along the Cancer Continuum (2nd ed.).Pittsburgh, PA: Oncology Nursing Society. Nail, L.M. (2001). I’m coping as fast as I can: Psychosocial adjustment to cancer and cancer treatment. Oncology Nursing Forum, 28, 967970. Schofield, P.E., Butow, P.N., Thompson, J.F., Tattersall, M.H.N., Beeney, L.J., & Dunn, S.M. (2003). Psychological responses of patients receiving a diagnosis of cancer. Annals of Oncology, 14, 4856. doi: 10.1093/annonc/mdg010 Yale School of Medicine. (2012). Cancer diagnosis: Coping with terminal cancer. Retrieved from http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW025771.