1. As a healthcare professional trained in palliative care, you intended to discuss the concept of mindfulness with Ling Ling who is having colon cancer. Define the concept of mindfulness and describe the aspects of Ling Ling’s life which you will incorporate in your discussion.
2. Critically analyse the issues of coping pertaining to the right of choice, right to make decisions and self determination as an older adult.
3. “Most people know how they want to live, but not how they want to die. Therefore it is a good idea to think and talk about end of life issues and plan early.” Reflect on this statement and discuss whether advanced care planning should be carried out with patients on admission to the hospital or only when they are left with three months of life?
1. Mindfulness is known as the process that helps a person to maintain consciousness, unite his thoughts, physical sensations, feelings to generate a positive vibe that affects the surrounding environment positively. This is a way to accept and pay attention to the thoughts and feelings without being judgmental. Mindfulness allows people to neglect the rights and wrongs about any situation and let them sense their real feeling about that moment rather than past or future (Williams & Kabat-Zinn, 2013). Mindfulness is a useful tool to help people suffering from chronic and non-curable disorders. Due to their illness and fear to loose social connections, patients develop stress and hypertension that deteriorates their health condition and pace their health degradation. Mindfulness in this situation, help them to calm their stress and sense their real feelings (Goodman & Schorling, 2012). Hence, in healthcare mindfulness is important for healthcare professionals as well as for stressed patients.
In the case study of Ling Ling (65), she is suffering from colon cancer stage four. She is been admitted to hospital, however due to her stressful family conditions, she herself diced to be discharged from the hospital. She has three sons and two of them are suffering from severe health issues. Her elder and second son are suffering from chronic renal failure and both are on dialysis. Ling Ling’s husband is works as an odd job worker and does not involve himself in any household decisions (Ndubisi, 2012). In this case, she is only one to win breads for her family and take important decisions for them. Ling Ling used to work in the Oncology department of the hospital she has been admitted after the onset of the disease. She was referred for the palliative care, which she stared to avail after her pains becomes worst (Burton et al., 2017).
Due to her depression and stressful health conditions, she should be aware of the concept of mindfulness to reduce the stress level and the pain she is suffering from. As she was the only one to take decisions about her family, she become depressed after hearing about her elder and second son’s health complications. She wanted to be with her family in this adverse condition and wanted to celebrate the last Chinese New Year by cooking food for her family. These situations are due to stress, hypertension and due to her high emotional behavior, she was unable to understand her health complications. Hence, a hospice team was appointed for her to provide care at her home.
According to the concept, mindfulness has the ability to change her thoughts and calm her emotional outflow as these two things affected her health adversely. Her vulnerability that made her discharge herself from the hospital could have been controlled with the concept of mindfulness. She was suffering from colon cancer; however, she wanted to cook for her family that describes her priorities in life. She wanted to serve for her family until death and even wanted to die in her own home with her family members all around. Mindfulness practices could have helped her to control these emotions. She flowed with all the feelings and emotions of her life and after the death of her elder-son she broke completely. However, the healthcare workers used their mindful behavior and let Ling Ling perform all the events she wanted to complete in her short lifetime without judging her actions.
As Ling Ling was standing at the end of her life, mindfulness was the only way to attain peaceful and calm death. However, she was bound with all the responsibilities of her home and she was the only one to take care of her two severely ill son, hence she did not wanted to be distracted from her family. Hence, she self-discharged herself. Furthermore, if Ling Ling was to avail mindfulness practices in her life, she would be advised on all these life incidences of her own (Aanestad & Jensen, 2016).
2. Right of choice is a fundamental preconditions that allows every individual to act with freedom and allows those individuals with sufficient choices for their conditions. Right of choice in healthcare allows every individual to avail healthcare of his or her choice without any contract and decide the intervention, chosen for him or she will be applied or not (Victoor et al., 2012). In a society, full of biomedical healthcare providers, a huge amount of population has to visit the doctors they do not trust. This step can affect their health positively as well as negatively. Hence, right of choice let the people to avail healthcare of their choice and this condition let them achieve quality healthcare (Lambin et al., 2013).
Right to make decision on the other hand, let the patient decide about the healthcare they are provided with and take a call about it. The patient in this scenario can decide whether they want to avail the healthcare intervention provided or prescribed by the physician to him (Blanck & Martinis, 2015). This right is helpful in the societies where, the patients are not informed about the treatment they are going through and hence, they are unaware of the consequences related to it. Furthermore, unawareness about the healthcare affect them adversely and patient’s health start degrading. Hence, for these conditions, right to make choice help the patients to take decisions alongside the healthcare professionals for betterment of their own condition (Schildmann et al., 2013).
Self-determination is a very important concept in the healthcare system that emphasizes the control of patient in the healthcare strategy created to serve the patient. Older adults are generally dependent on the public systems and society they are living in. while availing a healthcare they have to be dependent on the healthcare professional for every medication or treatment intervention (Deci & Ryan, 2012). However, self-determination, the ability to decide, think and making choice can help them to broaden their ability and affect their health positively. This self-determination process help them to choose action that satisfies their end period of life. hence, self determination should be a mutual practice where, healthcare professional provide the patients opportunity to take decisions and the patient should be able to take right choices for betterment of his own health (Patrick & Williams, 2012).
In this case, study, Ling Ling was provided with all these three rights while attaining healthcare. After being admitted to hospital, she asked the nurses to finish her life in adverse conditions as while working in the oncology department of hospital she witnessed the pain and condition patient’s has to suffer. Hence, she wanted to end her life. When the doctors asked her to avail the palliative care to treat her adverse pain and stress, she refused at first. The doctors could have forces her to the treatment procedure as she was unaware of the process. But the doctor explains all the process and positive consequences of the process to her and convinced her to undergo palliative care treatment.
The healthcare team also provided her with the right of decision-making and self-determination during her treatment. When she get to know that her elder son’s health condition id critical and he is undergoing surgery, she became furious to go to her home. She wanted to spend the last few days of her life in her won house with her children and husband. She wanted to celebrate the Chinese New Year by cooking food for her children. These wishes gave her satisfaction and she wanted to achieve this before her last breath. She made choices for herself and the doctors gave her the choice hence, right of decision-making was given to her.
However, these rights and tools become burden for the healthcare team to provide Ling Ling with quality healthcare. When she self-discharged herself from the oncology department, she was not in a condition to walk. However, just to fulfill her duties towards her family she discharged herself from the hospital. Furthermore, one more burden came into existence when Ling Ling refuses to undergo the palliative care at her home. She was unable to understand that palliative care has the ability to improve her condition (Lokkerbol et al., 2014). However, after discussing about the consequences, she agreed to the treatment. A team of social worker and healthcare hospice was assigned for her treatment at home. However, she refused to take those treatments to celebrate New Year with her family. Hence, all these situations worked as burdens for the treatment of Ling Ling’s colon cancer and these burdens were result of different rights that was given to her in treatment procedure (Hicks et al., 2012).
3. Advanced care planning is a process to make decisions about the care someone want to receive if conditions makes him unable to speak for himself. These decisions are personal decisions regardless of the medical treatment strategies. Advanced treatment care plan includes personal values, preferences and discussions with the family members (Brinkman-Stoppelenburg, Rietjens & van der Heide, 2014). In adverse conditions, when the patient is unable to convey his or her decisions, he or she will use her family members and friends to take decisions. Advanced healthcare team discusses all these issues with the patient who only has few months left in their life, to ease the process of healthcare at the end of life conditions (Mack et al., 2012). I the case study as well, Ling Ling was given the choices to take decisions for her health. However, her husband was unable to take decisions and Ling Ling was the only one to decide for her healthcare.
Perception of death is different for everyone. As the world is divided in several religious thoughts, concept of death differs from one place to another. Ling Ling was a Chinese woman and her rituals traditions were very important for her existence. Hence, she decided to celebrate the Chinese New Year instead of acquiring quality healthcare. She wanted to die in her own house with her family around and in the advanced care discussion she confessed her wish. However, this wish was against the Chinese perception of death and according to Chinese beliefs, death of any person inside home brings bad luck. Hence, her husband decided to admit her in hospital in her last days (Wright et al., 2014).
According to me, this incident completely contradicted the concept of advanced care planning, where the patient himself decide about the death. However, Ling Ling’s husband did not allowed her to fulfill her wish. Her husband was not the breadwinner for the family and therefore, was not included in any important decision of their house. Ling ling used to perform all the works and decide every small big decisions for her family. However, after she became unable to speak for herself, her husband started taking odd decisions and she had to die with her wish not been completed.
I think the patient should be given the advanced treatment plan early in the life. This would have enabled them to take decisions from starting of their healthcare intervention. However, the method of applying advanced care plan before three months of death is not productive. Patients suffering from acute diseases are unable to communicate in such late conditions of disease. Hence, they communicate with the help from their family members and friends. In this situation, if the family members too unable to understand the situation can lead to disparities the advance care plan. Hence, the patient should be given the opportunity to decide their end of life situation in the early stages of the treatment, after being admit to the hospital. Therefore, if their condition becomes worst and they become unable to communicate with the doctors, professional will be aware of the decision made by the patient and the patient will be able to die peacefully (Balboni et al., 2012).
Ling Ling’s last wish to die in her own house cannot become effective, as no one in her family was aware of her wish. All her children were either suffering from adverse health conditions or were preparing for jobs. Her husband too were not aware of her death condition and did not participated in any household decision. Therefore, if the healthcare providers performed the advanced healthcare plan earlier, she would have able to convey her wish to die in her own home. Hence, I believe that advanced care plan should be implemented at the time of admission.
Aanestad, M., & Jensen, T. B. (2016). Collective mindfulness in post-implementation IS adaptation processes. Information and Organization, 26(1), 13-27.
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., ... & Balboni, T. A. (2012). Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology, 31(4), 461-467.
Blanck, P., & Martinis, J. G. (2015). “The right to make choices”: The national resource center for supported decision-making. Inclusion, 3(1), 24-33.
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-1025.
Burton, A., Burgess, C., Dean, S., Koutsopoulou, G. Z., & Hugh?Jones, S. (2017). How effective are mindfulness?based interventions for reducing stress among healthcare professionals? a systematic review and meta?analysis. Stress and Health, 33(1), 3-13.
Deci, E. L., & Ryan, R. M. (2012). Self-determination theory in health care and its relations to motivational interviewing: a few comments. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 24.
Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. The International Journal of Psychiatry in Medicine, 43(2), 119-128.
Hicks, E., Sims-Gould, J., Byrne, K., Khan, K. M., & Stolee, P. (2012). “She was a little bit unrealistic”: Choice in healthcare decision making for older people. Journal of Aging Studies, 26(2), 140-148.
Lambin, P., Roelofs, E., Reymen, B., Velazquez, E. R., Buijsen, J., Zegers, C. M., ... & Marshall, M. S. (2013). Rapid Learning health care in oncology’–An approach towards decision support systems enabling customised radiotherapy. Radiotherapy and Oncology, 109(1), 159-164.
Lokkerbol, J., Adema, D., Cuijpers, P., Reynolds, C. F., Schulz, R., Weehuizen, R., & Smit, F. (2014). Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study. The American Journal of Geriatric Psychiatry, 22(3), 253-262.
Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., ... & Weeks, J. C. (2012). End-of-Life Care Discussions Among Patients With Advanced CancerA Cohort Study. Annals of internal medicine, 156(3), 204-210.
Ndubisi, N. O. (2012). Mindfulness, reliability, pre-emptive conflict handling, customer orientation and outcomes in Malaysia's healthcare sector. Journal of Business Research, 65(4), 537-546.
Patrick, H., & Williams, G. C. (2012). Self-determination theory: its application to health behavior and complementarity with motivational interviewing. International Journal of behavioral nutrition and physical Activity, 9(1), 18.
Schildmann, J., Ritter, P., Salloch, S., Uhl, W., & Vollmann, J. (2013). ‘One also needs a bit of trust in the doctor…’: a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making. Annals of Oncology, 24(9), 2444-2449.
Victoor, A., Delnoij, D. M., Friele, R. D., & Rademakers, J. J. (2012). Determinants of patient choice of healthcare providers: a scoping review. BMC health services research, 12(1), 272.
Williams, J. M. G., & Kabat-Zinn, J. (Eds.). (2013). Mindfulness: Diverse perspectives on its meaning, origins and applications. Routledge.
Wright, A. A., Zhang, B., Keating, N. L., Weeks, J. C., & Prigerson, H. G. (2014). Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ, 348, g1219.