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Colorectal Cancer Patient’s Discharge Planning Case Study

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Updated: Jul 11th, 2021

Many people are diagnosed with cancer annually and require effective treatment to improve the quality of their lives. Colorectal cancer is the second most common type of cancer (Australian Institute of Health and Welfare, 2019, p. 42). John is a 65-year-old man diagnosed with colorectal cancer stage IIB. His sedentary lifestyle and eating and drinking habits are the risk factors for developing cancer. Despite his active social life and overall good physical condition, occasional tiredness and back pain bother a still working electrician. This essay aims at managing the disease, introducing effective treatment, and developing a survivorship care plan with collaborative approaches, education about disease discharge, and self-management.

Discharge Planning

Diagnosis and Treatment

John was diagnosed with colorectal cancer stage IIB, and surgery was used to identify whether cancer had spread outside of the bowel. The results of John’s high anterior resection contributed to the decision to use adjuvant chemotherapy. Toxicity is the major risk factor of adjuvant therapy for elderly people, but appropriate dosage and regimen increase the possibility of controlling cancer recurrence (Lund et al., 2016, p. 7). Nitsche, Stöss, and Friess (2017) showed that no age restrictions are imposed on adjuvant chemotherapy for colorectal cancer patients unless oxaliplatin is offered (p. 16). John received this therapy, including calcium folinate and fluorouracil with two different doses over 14 days.

Follow Up Regimen

The patient must follow all recommendations under existing protocols and guidelines. Hines et al. (2018) used the findings of the National Comprehensive Cancer Network to inform cancer survivors about carcinoembryonic antigen (CEA) blood tests, CT scans, and colonoscopic evaluation (p. 2). Physical examination and serum CEA measurement should happen every six months for the next five years, and colonoscopy and CTs are required every 12 months in the next three years (Young, Jorgensen & Solomon, 2015, p. 130). Regarding the age factor, a geriatric assessment is also required in the next two years to evaluate John’s physical functions, comorbidities, medications, and nutritional or emotional status. Second primary tumors (SPTs) may develop during the next four-five years with an incidence between 17-19% (Yang et al., 2018, p. 2). All these cancer-prevented follow-ups cannot be ignored in John’s case.

Referrals/Clinical Documentation

Effective communication contributes to certain positive results in after-therapy care and referrals. It allows nurses to coordinate, make observations and support the patient and his family (Bezerra et al., 2015). It is critical to document the patient’s condition and care history and share the information among all the interdisciplinary caregivers and referrals like surgeons and medical or radiation oncologists. When the patient is aware of his treatment goals and sets clear expectations, it is possible to be proactive regarding new signs.

Signs and Symptoms

Early detection of disease recurrence is based on the ability to identify new symptoms and take the necessary steps. This process usually depends on the site of recurrence and its type, either symptomatic or asymptomatic (Koh et al., 2017). Luminal recurrence includes rectal bleeding, anemia, and bowel obstruction; surgical recurrence is characterized by palpable masses and pelvic recurrence involves pain (Duineveld et al., 2016, p. 218; Koh et al., 2017). The patient should also pay attention to belly pain levels, weight changes, and constipation.

Collaborative Approaches to Education and Planning for Self-Management

Survivorship Issues

John may experience several survivorship issues: physical, psychological, social, and spiritual challenges. Physical issues include vomiting, nausea, hair thinning and loss, diarrhea, bowel issues, and weight changes associated with side effects of taken drugs (Butow, Girgis & Cancer Council Australia Colorectal Cancer Guidelines Working Party, 2018, para. 4). Psychological issues include the problem with self-esteem, anxiety, the fear of disease recurrence, and possible death (Minnella & Carli, 2018, p. 920). Social issues include problems with family relationships, self-efficacy, and community acceptance. They are related to John’s inability to comprehend changes in his life and his body, thus, he may avoid social interactions (Butow et al., 2018, para. 6). Spiritual issues are related to John’s hope that his condition may be stabilized because of his family’s spiritual support in the healing process (Young et al., 2015, pp. 127-128). Family support, communication, and establishing a new sense of purpose may contribute to a patient’s positive health outcomes.

Prevention Strategies

Different prevention strategies can be used to address the identified survivorship issues. To prevent physical issues, the National Chronic Disease Strategy (NCDS) can be used, and it is based on prevention across the continuum, early detection and treatment, preventive care, and self-management (Department of Health, 2017, para. 1-3). According to the NCDS, John will be educated on what signs and symptoms are related to the weight status and the work of the gastrointestinal tract to pay attention to address physical problems during self-management.

To overcome John’s problems with self-esteem, anxiety, and fears, relaxation-based therapy will be proposed to help the patient by reducing tension and focusing on his feelings (Butow et al., 2018, para. 17). The social cognitive theory will help to address John’s social and spiritual challenges. Using psychological exercises related to this strategy, John will increase his self-efficacy and motivation, and he will be demonstrated how successful he can be in monitoring his condition and changing behaviors while developing self-regulatory skills (Grimmett et al., 2017, p. 635).

Health Education, Communication Principles and Strategies

Health education helps nurses and coordinators to promote skill development in patients (Bezerra et al., 2015, para. 1-2). In John’s case, a nurse will provide important lessons about how to protect the health, avoid cancer recurrence and protect good family relationships (Grimmett et al., 2017, p. 640). The first step in health education is to inform John about the survivorship care plan, the importance of following it to avoid post-surgery and chemotherapy complications and preclude recurrence (Minnella & Carli, 2018, p. 920). John should be educated that the next several years will be critical in preventing and controlling colorectal cancer (Young et al., 2015, pp. 133-134). The next step is education regarding daily physical activities, changes in eating habits, and required changes in the lifestyle (Young et al., 2015, p. 130).

Communication principles used by a nurse during health education sessions need to be discussed. The healthcare workforce is responsible for delivering information to families having different levels of health literacy (Australian Health Minister’s Advisory Council, 2017, p. 31; Cancer Council Australia, 2018, p. 21). Thus, the nurse must explain to John all possible outcomes to ensure that his intentions towards performing the necessary behaviors are positive. Reflective listening and asking open-ended questions are strong techniques for nurses to identify the patient’s needs and his readiness to focus on the goal to achieve positive treatment results (Young et al., 2015, pp. 132-133). Communicating with John, the nurse will apply the necessary knowledge to examine chronic alterations, assess co-morbidities, understand cancer progress and introduce care management using evaluation and persuasion (Bezerra et al., 2015, para. 1-2). Additionally, the nurse will provide feedback as the technique to observe the achievements of the patient and stimulate John to continue treatment (Young et al., 2015, p. 134).

Evidence-based strategies that facilitate health education and John’s goal-setting are theoretical frameworks and behavior change models. The theory of planned behavior emphasizes the intention of the patient to perform behaviors that are determined by three major factors: attitude, a subjective norm, and perceived behavioral control (Buffart et al., 2018, p. 1448). Attitude includes the patient’s state of mind as it relates to health objectives and expectations. Norms represent social pressure and the support of other individuals. Control involves the desire to follow a course of action and reflect on health changes in time (Buffart et al., 2018, p. 1448). John will be motivated to change his attitude to his condition, improve supportive relationships with relatives and other people and control his health-related behavior.

In addition to the theory of planned behavior, a specific model of care should be chosen to help John work with goals. The Flinders Program should be selected as it aims to improve the quality of life by providing a link between the patient, his family, and disease at six months (Battersby, Harris, Smith, Reed & Woodman, 2015, p. 1367). Using this program, John will focus on setting goals regarding what he wants to achieve about his health, and it will contribute to developing self-management skills. The distinctive features of this model include a perfect combination of shared decision-making, the management of symptoms, self-management plans, the patient adoption of behaviors, and physical or social functioning (Battersby et al., 2015, p. 1368).

During the process of promoting health education and applying the selected strategies and models, the patient should be able to express his thoughts and concerns. Therefore, reflective listening and empathy are the communication techniques for a nurse to stay emotionally aware of the patient’s needs (Young et al., 2018, pp. 286-288). Communication offers the chance for a nurse to understand patient expectations before treatment, along with his priorities and whether he experiences any anxiety or other mental changes (Young et al., 2018, pp. 286-288). Important principles include the close perception of all participants, face-to-face meetings, two-way processes, and attention to the condition of all organs in the body (Young et al., 2018, p. 291).

Conclusion

To conclude, the discharge plan for John and strategies to overcome survivorship issues have been presented concerning interpreting the patient’s needs. The main issues include the necessity of overcoming the side effects of chemotherapy and focusing on a follow-up regimen. The patient should be educated regarding the signs and symptoms of the disease recurrence and informed regarding helpful referrals. Survivorship issues related to John’s case include physical, psychological, social, and spiritual challenges, such as the loss of hair, weight changes, anxiety, problems with self-efficacy, and the increased dependence on his family. Recommended solutions include education according to the NCDS model, the application of the relaxation-based therapy, social cognitive theory, the theory of planned behavior, and the use of the Flinders Program.

References

Australian Health Minister’s Advisory Council. (2017). National strategic framework for chronic conditions. Web.

Australian Institute of Health and Welfare. (2019). Web.

Battersby, M., Harris, M., Smith, D., Reed, R., & Woodman, R. (2015). A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services. Patient Education and Counseling, 98(11), 1367–1375. Web.

Bezerra, I. M. P., Alves, S. A. A., Machado, M. D. F. A. S., de Lima Antão, J. Y. F., Martins, A. A. A., Arrais, T. M. S. N.,… Valenti, V. E. (2015). Health education for seniors: an analysis under Paulo Freire’s perspective. International Archives of Medicine, 8(28). Web.

Buffart, L. M., de Bree, R., Altena, M., van der Werff, S., Drossaert, C. H. C., Speksnijder, C. M., … Stuiver, M. M. (2017). Demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors. Supportive Care in Cancer, 26(5), 1447-1456. Web.

Butow, P., Girgis, A., & Cancer Council Australia Colorectal Cancer Guidelines Working Party. (2018). Web.

Cancer Council Australia. (2018). Web.

Department of Health. (2017). Web.

Duineveld, L. A. M., van Asselt, K. M., Bemelman, W. A., Smits, A. B., Tanis, P. J., van Weert, H. C. P. M., & Wind, J. (2016). Symptomatic and asymptomatic colon cancer recurrence: A multicenter cohort study. The Annals of Family Medicine, 14(3), 215–220. Web.

Grimmett, C., Haviland, J., Winter, J., Calman, L., Din, A., Richardson, A., … Foster, C. (2017). Colorectal cancer patient’s self-efficacy for managing illness-related problems in the first 2 years after diagnosis, results from the ColoRectal Well-being (CREW) study. Journal of Cancer Survivorship, 11(5), 634-642.

Hines, R. B., Jiban, M. J. H., Choudhury, K., Loerzel, V., Specogna, A. V., Troy, S. P., & Zhang, S. (2018). Post-treatment surveillance testing of patients with colorectal cancer and the association with survival: Protocol for a retrospective cohort study of the surveillance, epidemiology, and end results (SEER) – Medicare database. BMJ Open, 8(4), 1-7. Web.

Koh, C., Gormly, K., O’Rourke, N., Lee, P., Luck, A., Yan, T., & Cancer Council Australia Colorectal Cancer Guidelines Working Party. (2017). Web.

Lund, C. M., Nielsen, D., Dehlendorff, C., Christiansen, A. B., Rønholt, F., Johansen, J. S., & Vistisen, K. K. (2016). Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colorectal cancer: The ACCORE study. ESMO Open: Cancer Horizons, 1(5), 1-8. Web.

Minnella, E. M., & Carli, F. (2018). Prehabilitation and functional recovery for colorectal cancer patients. European Journal of Surgical Oncology, 44(7), 919-926. Web.

Nitsche, U., Stöss, C., & Friess, H. (2017). Effect of adjuvant chemotherapy on elderly colorectal cancer patients: Lack of evidence. Gastrointestinal Tumors, 4(1-2), 11–19. Web.

Yang, L., Xiong, Z., Xie, Q. K., He, W., Liu, S., Kong, P., … Xia, L. (2018). Second primary colorectal cancer after the initial primary colorectal cancer. BMC Cancer, 18(1), 1-9. Web.

Young, A. L., Lee, E., Absolom, K., Baxter, H., Christophi, C., Lodge, J. P. A., … Toogood, G. J. (2018). Expectations of outcomes in patients with colorectal cancer. BJS Open, 2(5), 285-292.

Young, J. M., Jorgensen, M., & Solomon, M. (2015). Optimal delivery of colorectal cancer follow-up care: Improving patient outcomes. Patient Related Outcome Measures, 6, 127-138. Web.

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