John is a 62-year-old male patient who will be studied in this research. He was diagnosed with colorectal cancer. Initially, his wife would suggest the cancer screening tests, but he would simply brush it off, pushing the set date forward. Although John takes regular exercises, he has a history of unhealthy eating habits. Instead of eating vegetables, he prefers to eat food with meat products or fats. Therefore, it is evident that his lifestyle has not been healthy, which may have predisposed him to the condition. After his diagnosis, John started his chemotherapy and is now receiving his last cycle.
Before being discharged, it is essential that a patient is educated on the importance of follow-up visits, as well as the danger signs that the cancer is recurring. This ensures that the patient knows what to expect and that the necessary steps for post cancer screening are followed (Blazeby et al., 2010). Also, the patient needs to be equipped with self-management skills that will enable them to get back their lives.
The purpose of this paper is to educate this patient on factors relating to his discharge and self-management plan. The first section will discuss the visits that John should make to the doctor after he is discharged. The frequency will also be described, as well as what he should expect from every visit. He will be educated on the importance of sticking to the appointments made. The second section of the paper will feature a discussion of the self-management plan. Here, survivorship issues which John may experience will be discussed. The communication strategies which will facilitate effective education will be brought to light and thoroughly investigated. Lastly, there will be a discussion of the criteria that will be applied to determine whether or not the education session was successful.
Hospital discharge is an event of extremely high significance for patients recovering from colorectal cancer. This is because it is the point which differentiates primary treatment from follow-up care (Kim & Flanders, 2013). It is the point of transition where the patient will be expected to leave the hospital environment and move back into the society. It is also the point where John will move from continuous professional support to a self-management approach. A discharge plan is important as it helps a patient to attain a level of health that is at equilibrium. It enables them to leave in-patient care with confidence as they look forward towards a full recovery while at home. The follow-up regimen may consist of specific activities including the routine testing that John may need. The recommended tests and schedule are mainly based on the risk of recurrence and John’s overall health. Most recurrences occur within the first three years after treatment (Kehlet, 2009). This is why follow-up screening will be more frequent at first. Follow-up physical examinations will be conducted every three months in the first two years. After that, it will be conducted every six months. In addition to these, follow-up screening will be scheduled (Shepperd et al., 2013). First, CEA test will be needed to monitor the levels of CEA protein. This testing will be conducted every five months for five years. Second, Computed Tomography (CT) scan will be scheduled as it creates a 3D image of the inside parts of the body using an x-ray machine (Ouellette-Kuntz et al., 2015). This scan will be conducted annually for three years. A pelvic CT scan will be conducted at this point. Third, Colonoscopy will also be done to enable the doctors to check for the presence of polyps or second cancers in the rectum and colon (Rottmann et al., 2012). This will be scheduled a year after the initial surgery. If no polyps are noted, further tests will be scheduled far apart. However, if polyps are present, then the next colonoscopy will be scheduled sooner. Lastly, a Rectosigmoidoscopy is also scheduled to check for polyps, cancer and other possible abnormalities in the rectum. This test will be scheduled every six months.
The signs and symptoms associated with the recurrence of colorectal cancer are many and may vary from one patient to the next. It is important to note that recurrent cancer may develop at the original location or move to another part of the body (Sacerdote et al., 2012). The most common sign features changes in the frequency of bowel movements. This is one factor which John must look out for keenly. Second, blood in the stool or passing stools with very dark spots may also indicate the presence of a tumor. Third, constipation may also indicate something serious rather than a normal digestive disorder (Pita-Fernández et al., 2013). This should also be followed up on if it occurs. Fourth, the consistency of the stool also changes to loose and watery. Fifth, abdominal pain that may be accompanied by gas, cramps and bloating may also indicate the presence of a tumor (AIHW, 2017). Lastly, experiencing unexplained weight loss and lack of energy is also a danger sign. Early relapse is commonly mistaken for normal digestive disorders. This is because most signs and symptoms are not as alarming as they start slowly, progressing in intensity with time (Numico et al., 2014). Therefore, it is safer for John to seek professional clarification if any of these are experienced.
According to research, the physical and mental quality of life of a patient after surviving colorectal cancer tends to be inferior compared to individuals in a similar age group, but with no cancer history (Hines et al., 2014). There are long term effects of the treatments such as fatigue, insomnia, the fear of recurrence, anxiety, negativity towards one’s body image, sexual dysfunction, urinary incontinence and many others. The quality of Life refers to the subjective evaluation of a person’s satisfaction with their overall health and wellbeing (Rinaldis, Pakenham & Lynch, 2010). This is very important for cancer survivorship which features physical, functional, psychological, and social functioning (Zhao et al., 2013).
The most common concern among cancer survivors was the fear of recurrence, fatigue and sleep difficulties (AIHW, 2012). Long term adults experienced more physical limitations when conducting activities such as shopping, sports, and even engaging in social events. They are also at a higher risk for unemployment compared to the healthy adults, mostly because most survivors tend to have a form of disability (World Health Organisation, 2008). Therefore, John is expected to experience similar issues when discharged. He may have sleeping difficulties because he is very worried and anxious about what will happen if recurrence takes place. According to statistics, older colorectal cancer survivors were different from the others without the history in the sense that they tend to have more chronic conditions, experience poorer physical functioning, and even poorer general health (Dulko et al., 2013). This increases the likelihood of using mental health services as a result of anxiety and depression (Sprague et al., 2013). The patient may also be worried about finances involved in this treatment. Hence, John may experience trouble with everyday physical activities hence leading to dissatisfaction with his health.
Although there are various issues which may be experienced, several steps may be taken to prevent their occurrence. First, since a majority of the issues are related to the psychological aspect of an individual, it will provide a lot of ease if John actively engages in steps that are suggested by professionals to reduce the risk of recurrence (Siegel et al., 2012). For example, he should avoid consumption of red meat and exercise frequently to maintain the right body weight. Such recommendations for reducing the risk of recurrence will make the patient at ease as he will feel like he is actively participating in the process of prevention (Francisci et al., 2013). Second, the fact that the patient has been discharged from in patient care does not mean that no professional support will be offered (Bauer et al., 2015). Therefore, whenever anything triggers anxiety, John needs to know that he can rely on the hospital for support. In this case, the doctor will offer reassurance if the cause of concern is just but a false alarm.
Third, about social distress, all that is needed for the patient is effective communication. This will ensure that family members and friends know exactly what he prefers, and what he does not (Inter-relationships between the economic and emotional consequences, 2012). For example, maybe the survivor wants to be treated as normal. If no effective communication takes place, the people around him may act by isolating him since they may think he is fragile (Dai, 2015). Third, effective patient preparation will also enable John to avoid the issues listed above. Most of the issues are as a result of lack of sufficient knowledge. For instance, if John understands why he will always have sexual dysfunction, the result is acceptability (Lindblom et al., 2012). This will enable him to make adjustments so that the problem is no longer viewed negatively, but positively too. The patient accepts his state and does not view it as a setback, but as a room for opportunity in the future.
To ensure that effective education of John takes place before his discharge, it is important to consider the communication strategies that will be essential. First, since this education is set to begin before discharge, it is important to see to it that communication that is regular and clear is applied. When the message is easy to read and user-friendly, the patient, being of old age, is bound to understand a lot from the education (Mazor et al., 2013). Second, the nurse should encourage dialogue, whereby the patient is given room for asking questions and even contributing their knowledge on the topic of colorectal cancer survivorship. It is easier to concentrate when the learning is fun. In addition, the patient’s misconceptions and questions will be cleared and answered. Third, when explaining specific concepts relating to care and self-management, it is important to employ visuals. Visuals ensure that knowledge being imparted sticks on for a very long term as the patient will always recall the images used. It tends to be easier to understand and remember an image compared to listening and recalling the words of an individual. Fourth, when educating the patient, a nurse should take the time to reinforce important messages and themes. When repeated, the chances for them being recalled in the long term is higher that when the message is only said once. Repetition ensures that the patient indeed understands the various concepts involved in self-management. Lastly, it is important for the communication to be timely, honest, and accurate. For instance, when discussing the possible issues that John will experience after discharge, the nurse should not lie so as to make the patient feel better and more confident. On the contrary, it is better to let the patient know the negative consequences of the disease so that discussions on how best to cope can be effective.
To evaluate whether or not the education session was successful, special criteria will be used. The nurse will ask John a few questions regarding the issues discussed so as to identify areas that need further polishing. For example, John may be asked to state some of the issues he should anticipate and then explain how he would react to it or even prevent its occurrence (Numico et al., 2014). Next, the nurse will determine whether John has already found a support team (White, 2012). This will enable the nurse to evaluate whether the patient understood the importance of taking specific measures beforehand to make the transition smooth. This criterion will be extended to when John is discharged. The first week is always challenging. The nurse will assess how he transitions to the outside world. If John overcomes challenges one after the other, and his quality of life is also improving each day, it shows that the education session was effective, which is why he can apply the information in a real world setting (Rinaldis, Pakenham & Lynch, 2010).
When discharging a cancer survivor, it is important to ensure several steps are taken before the actual date of discharge. Since cancer has a risk of recurrence, it is important for the patient to constantly undergo physical checkups and tests to determine the state of the body. This is why John has a list of appointments and tests scheduled. The signs and symptoms of recurrence are an important knowledge that the patient should have. For instance, loose and watery stool, feeling bloated, and general fatigue may feel like the usual signs and symptoms of a stomach upset. However, it is essential for John to be vigilant and to report any of these to the physician. It will enable the early identification of a recurrence, hence increasing the outcome of the patient. With the aid of a self-management plan that is prepared with the help and support of a healthcare professional, John will be well equipped to transition back into the society. This plan features a lot of factors relating to how he can care for himself best. It also includes the discussion of possible challenges that may be faced such as the inability to function effectively as before, difficulty in moving, stomach cramping and so on. It fully educates the patient on what life will be like post discharge. Therefore, the patient feels more prepared to get back into the society and move on with life. The concerns listed, with regards to cancer survivorship are general. This has been included to ensure that all factors that may affect the patient are well taken care of. This paper has effectively attained its goal of educating John on what to expect immediately after discharge and later on.
AIHW, 2012. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer series no. 69. Cat. no. CAN 65. Canberra: AIHW.
AIHW, 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.
Bauer, A., Vordermark, D., Seufferlein, T., Schmoll, H., Dralle, H., Mau, W., & … Landenberger, M. (2015). Trans-sectoral care in patients with colorectal cancer: Protocol of the randomized controlled multi-center trial Supportive Cancer Care Networkers (SCAN). BMC Cancer, 151-10. doi:10.1186/s12885-015-2002-6
Blazeby, M., Soulsby, M., Winstone, K., King, M., Bulley, S., & Kennedy, H. (2010). A qualitative evaluation of patients’ experiences of an enhanced recovery programme for colorectal cancer. Colorectal disease: The Official Journal Of The Association Of Coloproctology Of Great Britain And Ireland. 12(10 Online):e236–242.
Dai, S., Kotaro, W., Yuu, T., Atsushi, Y., Masahiko, K., Sachio, M., & … Tagawa, K. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40. BMC Cancer, 15799-804. doi:10.1186/s12885-015-1799-3
Dulko, D., Pace, C. M., Dittus, K. L., Sprague, B. L., Pollack, L. A., Hawkins, N. A., & Geller, B. M. (2013). Barriers and Facilitators to Implementing Cancer Survivorship Care Plans. Oncology Nursing Forum, 40(6), 575-580. doi:10.1188/13.ONF.575-580
Francisci, S., Guzzinati, S., Mezzetti, M., Crocett, E., Giusti, F., Miccinesi, G., & … Gigli, A. (2013). Cost profiles of colorectal cancer patients in Italy based on individual patterns of care. BMC Cancer, 13(1), 1-11. doi:10.1186/1471-2407-13-329
Hines, R., Markossian, T., Johnson, A., Dong, F., & Bayakly, R. (2014). Geographic Residency Status and Census Tract Socioeconomic Status as Determinants of Colorectal Cancer Outcomes. American Journal Of Public Health, 104(3), e63-e71.
Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. (2012). BMC Gastroenterology, 12(1), 62-71. doi:10.1186/1471-230X-12-62
Kehlet, H. (2009). Multimodal approach to postoperative recovery. Curr Opin Crit Care. 15(4):355–8.
Kim, S., & Flanders, A. (2013). In the clinic. Transitions of care. Ann Intern Med. 158(5 Pt 1):ITC3–1.
Lindblom, K., Gregory, T., Wilson, C., Flight, I. K., & Zajac, I. (2012). The impact of computer self-efficacy, computer anxiety, and perceived usability and acceptability on the efficacy of a decision support tool for colorectal cancer screening. Journal Of The American Medical Informatics Association, 19(3), 407-412. doi:10.1136/amiajnl-2011-000225
Mazor, M., et al. (2013). Patients’ and family members’ views on patient-centered communication during cancer care. Psychooncology. 22(11):2487–95.
Numico, G., Pinto, C., Gori, S., Ucci, G., Di Maio, M., Cancian, M., & … Silvestris, N. (2014). Clinical and Organizational Issues in the Management of Surviving Breast and Colorectal Cancer Patients: Attitudes and Feelings of Medical Oncologists. Plos ONE, 9(7), 1-8. doi:10.1371/journal.pone.0101170
Ouellette-Kuntz, H., Coo, H., Cobigo, V., & Wilton, A. S. (2015). Uptake of Colorectal Cancer Screening among Ontarians with Intellectual and Developmental Disabilities. Plos ONE, 10(2), 1-14. doi:10.1371/journal.pone.0118023
Pita-Fernández, S., Pértega-Díaz, S., López-Calviño, B., Seoane-Pillado, T., Gago-García, E., Seijo-Bestilleiro, R., & … Pazos-Sierra, A. (2013). Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol. Health & Quality Of Life Outcomes, 11(1), 1-7. doi:10.1186/1477-7525-11-117
Rinaldis, M., Pakenham, K. I., & Lynch, B. M. (2010). Relationships between quality of life and finding benefits in a diagnosis of colorectal cancer. British Journal Of Psychology, 101(2), 259-275. doi:10.1348/000712609X448676
Rottmann, N., Dalton, S. O., Bidstrup, P. E., Würtzen, H., Høybye, M. T., Ross, L., & … Johansen, C. (2012). No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial. Psycho-Oncology, 21(5), 505-514. doi:10.1002/pon.1924
Sacerdote, C., Baldi, I., Bertetto, O., DiCuonzo, D., Farina, E., Pagano, E., & … Ciccone, G. (2012). Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study. BMC Public Health, 12(1), 775-784. doi:10.1186/1471-2458-12-775
Shepperd, S., Lannin, N. et al. (2013). Discharge planning from hospital to home. Cochrane Database Syst Rev. 1, CD000313.
Siegel, R., DeSantis, C., Virgo, K., et al. (2012). Cancer treatment and survivorship statistics, 2012. Pubmed. 62:220-241.
Sprague, B. L., Dittus, K. L., Pace, C. M., Dulko, D., Pollack, L. A., Hawkins, N. A., & Geller, B. M. (2013). Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans. Clinical Journal Of Oncology Nursing, 17(3), 266-272. doi:10.1188/13.CJON.17-03AP
White, V. M., Macvean, M. L., Grogan, S., D’Este, C., Akkerman, D., Ieropoli, S., & … Sanson-Fisher, R. (2012). Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial. Psycho-Oncology, 21(10), 1053-1062. doi:10.1002/pon.2019
World Health Organisation, (2008). Programs and Projects, Cancer Screening and Early Detection of Cancer.
Zhao, G., Li, C., Li, J., et al. (2013). Physical activity, psychological distress, and receipt of mental healthcare services among cancer survivors. Pubmed. 7:131-9.