Pt Care Test 1: Pt-Fam Interactions & Death and Dying

what is defined as a psychosocial group in which there is a commitment for members to nurture one another?

family

what does the definition of family not include?

blood and lineage

how should we, as therapists, discuss treatment procedure questions and explanations around the patient's family?

we should "read the room" and let the patient be heard

what questions should we ask ourselves when we are following patient cues on how much the family needs to hear?

-does the patient want family included/excluded

-what concerns are voiced by patient and family members

-what are their important "issues"

what things should we be explaining to the patient about their treatment on day 1?

-positioning and immobilization

-length of procedure/treatment

-audio/visual intercommunication system

-room noises

-machine movements

-day one vs. all other days (day 1 takes the longest)

what do we need to tell the patient about the audio/visual intercommunication system?

make sure they know that we are not in the room, but can see and hear them

what do we need to tell the patient about machine movements?

the machine will move around, but it will not touch the patient

what do we need to make sure of after we give the patient all of the information about their treatment plan?

let them ask questions

what are some common, but significant concerns of patients and families?

-what will the treatment experience be like?

-concerns about treatment schedule

-concerns about transportation

-financial concerns

what are some common psychosocial issues faces by patient and family members?

-unresolved family conflicts/issues

-unfinished business

-unique coping mechanisms

-reminded of our mortality

what are some common misconceptions of patients and family members when they are diagnosed with cancer and given therapy tx?

-expectations based on experiences

-"stigma" of cancer

-disagreement about tx plan

-radiation misconceptions

-"lobby" education

-misconceptions due to lack of education

what is an example of "lobby" education?

when a patient hears in the lobby that another patient got "x" medication and it made them feel better/worse. their condition is different and patients cant listen to that as it is a source of miscommunication

who is often the primary support system for a patient undergoing cancer tx?

family

what kind of sensitivity must we, as therapists, have towards patient's and their conditions?

professional

what can we, as therapists, do to help patients undergoing tx cope?

-refer to support groups

-give them information

-professional counseling

with a professional attitude, what are we to the patient and why?

an advocate, we have more contact with them than anyone else on their care team and we serve as a voice for that person

what are two ways for us to be a good health role model?

avoiding burnout and healthy living

what does developing a professional attitude as a therapist help us to do?

-focus on the patient

-give quality care (excellence)

-contribute to the healthcare community

do we use verbal or nonverbal cues more as therapists?

nonverbal by the way we care for and handle the patient with professionalism and sympathy

what are some communication challenges that we might come across in healthcare?

hearing, vision, and speech difficulties

what must we understand about patients that will help us improve our communication skills?

cultural and generational diversity

how must we communicate with patients given their situation?

-"calm" in a stressful environment

-"hearing it" from their POV

-listening as much as we talk

what are some pointers to remember while listening to patients?

-concentrate and focus

-eye contact

-hear

-reflect

-non verbal response

what are some pointers to remember when responding to patients?

-minimal verbal response

-paraphrasing

-probing/open ended questions

-clarifying

-interpreting

what kind of relationship should we have with our patients?

therapeutic-close but not too close

what habit should we have during patient interactions?

listening and attentive/caring body language

what should we interpret during patient interactions?

the feeling and meaning of what the patient is saying

what should we restate during a patient interaction?

the main idea of the conversation

who else do we communicate with at work in which we must pay attention to our interactions?

coworkers and the families of the patients

in what ways do we have the opportunity to make a difference in the way a patient/family copes with the experience they're having?

-listening

-explaining

-resolving misconceptions

-intervening on behalf of

-bringing "calm"

what is cancer now considered to move away from such a harsh word like "terminal"?

a chronic, life-threatening disease

what are the two ways someone explains the "survivorship" of their disease?

in terms of control or time

what does NED mean?

no evidence of disease

what are some examples of defining disease status in terms on control?

local control, NED, survival

what are some examples of defining disease status in terms of time?

5 year windows (5 yr, 10 yr, etc)

what is defined as no evidence of disease within a minimum or nonexistent chance for recurrence?

cured

what have we moved away from saying when a patients cancer is gone?

"cured"

what type of cancer has the highest 5-year survival rate in all stages?

prostate (97.5%)

what type of cancer has the lowest 5-year survival rate in all stages?

pancreatic (4.4%)

why are trends in survival rates going up?

because of evolving technology

what does the term "survivorship" paint a picture of?

continuem

what is defined as the experience of living through or beyond the illness?

survivorship

what are some psychosocial themes anticipated in adults surviving cancer?

-fear of relapse or death

-dependence on healthcare providers

-survivor guilt

-uncertain sense of longevity

-social adaptation dilemmas

-contagion effect (people act like caner is contagious)

what percentage of cancer patients return to work after being diagnosed?

80%

what do patients have a fear of within employment?

-discriminatory coworkers

-survivor attitude in workplace

-fear of changing jobs due to not being hired because of a pre-existing condition

what percent of cancer survivors experience some form of insurance discrimination?

30%

what offers continuance of group medical coverage in some situations?

COBRA (federal law 1986)

are males or females more modest?

females

body image involves both ____-__________ and ______ ________

self-perception, social feedback

what specific cancers might cause someone to have altered body image or sexuality?

-breast cancer

-head and neck cancers

-cancers resulting in ostomies

-GYN, prostate, or testicular

-patients receiving chemotherapy

why are healthcare workers and patients both reluctant to discuss alterations in sexual functions?

-embarrassed

-patient privacy

-social, religious, or cultural beliefs

-notions and biases about age, gender, and sexual behavior

why might patients have a dysfunction in their sexuality?

result of disease or treatment

what should always be readily available for cancer patients and should be assessed with other side effects?

counseling

with who is the first communication about sexual issues often discussed with?

trusted nurse or therapist

what percentage of cancer patients report sexual dysfunction?

20-90%

if the patient "tests the water: with the therapist and gets and uncomfortable response...

they are less likely to mention it to the physician

what percentage of patients have curative cancer?

70%

what will happen to the percentage of patients with curative cancer over the years?

it will go up

what percentage of patients have palliative cancer?

30%

what kind of cancer is treated for comfort, not cure, and can extend life expectancy for a bit?

palliative

fear of _____ is strong in our culture

death

what does every culture see differently, with many seeing it as a normal transition to peace and rest?

death

what has technology allowed us to focus on regarding death?

postponing it

we have largely _________ ourselves from death

separated

what are the two popular theories on death and dying?

-5 Stages of Death and Dying

-4 Aspects of Coping with Dying

who wrote "5 Stages of Death and Dying"?

Elisabeth Kubler-Ross, MD

who wrote "4 Aspects of Coping with Dying"?

Charles Corr, MD

who proposed a 5-stage model in 1969 on death?

Elisabeth Kubler-Ross, MD

what was a critique of Elisabeth Kubler-Ross, MD, "5 Stages of Death and Dying"?

-patient interviews were not accepted as "valid" research (not scientific)

-too rigid

what are the 5 stages according to Dr. Kubler-Ross?

Denial, Anger, Bargaining, Depression, Acceptance

what is the first response to death?

denial

which of the 5 stages of death are these responses most correlated with?

"No, not me. It cannot be true."

"I'm too young to die."

denial

which of the 5 stages of death has the response of disbelief that it is happening to you/your family?

denial

what is the second response to death?

anger

which of the 5 stages of death are these responses most correlated with?

"Life is not fair"

"Why me? What have I done to deserve this?"

anger

what stage of death comes from a sense of loss of control?

anger

who is anger directed at for the 2nd stage of death?

everyone and/or no one in particular (dr, job, spouse, self)

at what stage of death is the patient willing to compromise?

bargaining

which of the 5 stages of death are these responses most correlated with?

"Promise to do or not do xyz, if I can have more time"

bargaining

what stage of death is often based on upcoming events important to the patient?

bargaining

what stage of death is an attempt to postpone death?

bargaining

what stage of death is the patient seeking a chance to "clean up" life to show good behavior?

bargaining

which of the 5 stages of death are these responses most correlated with?

"What difference does it make anymore?"

depressions

what is a normal part of the process of preparing to die/facing the inevitable, which often involves feelings of guilt?

depression

who is the patient mourning for during the depression stage?

not only for self, but for pain its causing family/friends. mourning "loss" in general

what may happen when trying to encourage during the depression stage?

may not be meaningful or may offend

which of the 5 stages of death are these responses most correlated with?

"I've had a good life... I am ready to go"

acceptance

what stage of death comes after the patient has worked through the numerous conflicts and feelings?

acceptance

at what stage of death is the patient less emotional, possibly even showing little or no feelings?

acceptance

what stage of death is NOT happiness, just acknowledgement?

acceptance

at what point in the stages of death will the patients interests diminish, preferring to do only those activities of personal value?

acceptance

one of the criticisms of the Kubler-Ross Model says that there is "no evidence that dying people...

go through each stage and in their proper order

one of the criticisms of the Kubler-Ross Model says that there are research limitations. what else does it say about interviews?

that they should have been followed by another method of data gathering

critism of the Kubler-Ross Model:

what does it say plays a role in attitude toward death that the model doesn't consider?

environment and culture

critism of the Kubler-Ross Model:

is it too simplified. what does it say that means?

puts pressure on patients to resolve one stage and rapidly move on to "healthy" acceptance

critism of the Kubler-Ross Model:

does not fit with what age group?

majority who die in old age

who's approach says that we cope by having our needs met in 4 areas?

Corr's

what part of Corr's aproach is related to pain relief, comfortable bed at home, food that tastes good?

physical

what part of Corr's aproach is related to time to cry, time to grieve, and freedom to be sad?

psychological

what part of Corr's aproach is related to resolving issues with loved ones and spending time with supporters?

social