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Overview of the case study

Breast cancer is the cancer of the breast cells or tissues involving the milk glands or mammary tissues. It is the most frequently occurring type of cancer, mostly in women and in a very rare case for men. Breast cancer can occur in either of the breasts or both the breast. When cells start proliferating, it can be considered as “Cancer”. In the early stage of breast cancer, it is almost curable and it includes nearly 70- 80% of the patients, i.e., non – metastatic disease. Distant metastasis disease is incurable as it spreads to other body organs (Harbeck et al., 2019).

This paper will discuss the case study of Kathleen. The patient is a 55 years old woman from Australia, and she has been diagnosed with a chronic illness, i.e., Breast Cancer. She is from Western NSW, Australia. Recently, she experienced her symptoms are recurring and getting worsen. The patient avoids visiting the hospital to see Doctors because of the crowd and the rushing of people. She wants to maintain privacy for her clinical discussions with the nursing staff regarding her disease condition. She also wants nursing care and support even after being discharged from the hospital. The patient is still under regular medicines and she is afraid of missing any medicines when she feels more unwell. The patient has been happily married for 36 years and her family members include her husband, children and grandchildren. She loves to enjoy a good time with them. Since her husband has the habit of smoking, she also smokes almost ten cigarettes per day. She knows the fact that it is not at all good for her health conditions but she finds it difficult to quit smoking. During her last visit to the clinic, she was quite embarrassed as she noticed that she had gained weight over the years, and the nurse suggested a weight management plan for her. During weekdays, a nurse has suggested eating mainly fruits and vegetables for her dinner. She does not prefer to drink alcohol but she has a habit of intaking soft drinks and almost six cans per day. But at the weekend, she prefers to cook and have traditional meals along with her family and they socialize altogether.

Key factors for the patients living with Breast cancer are: “Optimal care delivery” in Western NSW Australia which is supported by the National guides, i.e., Optimal Care Pathways. This hospital comprises of “Quick facility Directory” for acute and primary healthcare facilities. Patient can outreach for chemotherapy treatments in following clinics such as Mudgee, Parkes and Cowra. In these clinics, there are oncology nurses who administer chemotherapies to patients as well as provide supportive treatments, weekly.

Key factors

Optimal care guide helps and provides service to the people of Australia with a specific type of cancer with care and support for cancer care patients. This guide comprises good evidence resources that describe the stages and strategies of cancer care from diagnosis to survival of the patients for providing better outcomes of the patient till death. There are various resource pathways to guide specific cancer patients, who include: details of clinical pathways, quick reference guides and guides to best cancer care. A comprehensive guide can be imported into the GP software available there. This guide service assists cancer patients, their family members and caregivers in understanding the diagnosis and treatment plans of the patient. These service guides can also be translated into different languages such as Hindi, Greek, Chinese, Arabic, Italian and Vietnamese (Cancer Council, 2020).

  • Prevention and early detection- comprises of risk factors, risk assessment tools, prevention, risk reduction and screening recommendations.
  • Presentation of the disease, initial investigation and referral- Signs and symptoms are to be investigated and other referral options which advice patients for their treatment options.
  • Diagnosis, staging and planning of the treatment- comprises of different tests, staging investigations are done along with treatment planning.
  • Treatment- comprises establishing of treatment different therapies like surgeries, chemotherapies, radiation therapies and few other therapies along with team communications and responsibilities.
  • Post care treatment and recovery- comprises of treatment and follow- up of the patient and other diagnosis outlining.
  • Management of recurrent, residual and metastatic disease- comprises of detection, treatment, advance care planning, survivorship and palliative care.
  • End- of- life care: comprises of palliative care and other communications and team’s responsibilities.
  • Nurses/ Healthcare providers maintain a constructive and transparent relationship with patients and their family members to let them communicate and express their health complications or any other issues.
  • It would help to empower them, hence, building self-confidence, focusing on training skills and enhancing patient and healthcare provider relationships.
  • Self-management involves active engagement to know regarding any chronic illness.
  • Self- management is important from the aspect of managing cancer pain. Self- management is the process of managing care and support to the patient, solving their issues which cause pain, enhancing their self- efficacy, self- decision to manage their pain in everyday life.
  • Nurses recognizes symptoms and provide decision- making abilities.
  • Nurse help and guide patient through interacting with them and analysing for the pain management (Yamanaka, 2018).

Incorporation of strategies regarding management of pain is quite important in daily life for better quality of life. Self- management is always a priority in healthcare sector. Healthcare professionals also provide self- management training programs for patients and encourage them to join for the management of pain. It also boosts up their motivation towards self- managing them and their cancer pain. Educational programs are being conducted by the healthcare providers based on various approaches such as behavioural, psychological, emotional or mental approaches in regards of proper assessment and treatment of cancer pain for the patient (Kim et al., 2020). Overall understanding from this section is to achieve better outcomes, pain relief, and well- being to empower them in order to attaining better quality life of a patient.

The patient can be recommended to the comprehensive cancer care centre, The Chris O’Brien Lifehouse located in Sydney, Australia. The Chris O’Brien Lifehouse (COBLH) is a non- profit organisation in Sydney with a 125-bed built-up for patient admission. This hospital is located in the Western suburbs of Sydney, NSW, Australia. COBLH works in close relation with local public hospital, hence affiliated to Royal Prince Alfred (Grant, Marthick & Lacey, 2019). Patient can also outreach for to the following clinics such as Mudgee, Parkes and Cowra in Western NSW, Australia for chemotherapy treatments. There are oncology nurses in these clinics who administer chemotherapies to patients as well as provide supportive treatments, on weekly basis.

Comprehensive cancer centres maintain a holistic approach and maintains the well- being of the patient surviving with cancer. This also incorporates evidence- based therapies and qualified therapies which is patient- centric and personalised. This hospital provides oncology services which are integrated including massage, acupuncture, reflexology, dietetics and exercise physiology for every patient. This cancer centre also conducts integrative and supportive programmes based on medical care specialists. Healthcare workers of this cancer centre maintain team work or group learning, integrating team and development service based on a structured model. Clinicians follow personalised treatment for each patient and improving their survival rates. Integrative Oncology is the important service facility available in this hospital. It is well structured care services by highly qualified and experienced medical specialists. The strategic incorporation is maintained within oncologists, nurses, surgeons and other staffs of the hospital.  Therefore, overall service in this cancer centre attains to meet the high demands and patient service satisfaction in a safe and evidence- based manner (Porter et al., 2017).

Empowerment

Cancer patients usually feel challenges for communicating their health issues or personal problems. Patients usually face understanding difficulties when they speak their native languages and cannot speak in English or does not understand English. Language problem is mainly faced by Aboriginals and Torres Islanders people. Patient also finds difficulties in expression of their emotional and psychological issues (Jacobs & Shulman, 2017). Patient also wants to maintain privacy of her disease condition, diagnosis procedures and treatments; wants to discuss privately with clinicians or nursing staffs. According to public health interventions, specific needs and language or cultures should be tailored which is usually faced difficulties by many patients. Mostly Greek, Arabic and Chinese speaking patients face difficulties in speaking. Therefore, from overall scenario, language and culture barriers must be in focus to overcome for convenient of people (Hyatt et al., 2017). Other barriers faced by BC patients are travelling distance from suburbs area to the main city, availing of resources, getting financial support, few patients are not much educated so they face challenges to understand regarding their health issues, their diagnosis and treatment plans.

Nursing interventions is an essential part of the healthcare sectors which helps to improve the people’s well- being and to address care and needs for the patient.  For better outcome of the patient, appropriate nursing intervention in terms of disease assessment and assessment evaluation is very important. For cancer patient, during and after chemotherapy treatment, nursing intervention is a must prospective to be considered. Tailored way of nursing for chemotherapy related distress specifically for adult patients required attention. Intervention and management simultaneously must be goal- directed in support of the patients. Critical thinking and critical analysis needed for the nurses while managing acute or chronic patients (Verhoeven et al., 2020). Nursing intervention must be designed in a plan and well-developed way to cope up well with many patients altogether. Nursing interventions plays a significant role in physical, psychological and emotional issues for the patient living with cancer or undergoing cancer treatment. The effectiveness of nursing interventions has a significant impact on attitudes, anxiety, distress, fatigue, sleep, any functional disability, psychosocial issues like emotional or mental tolls and overall quality of life. Nurse should include physical exercise or activity- based interventions to prevent powerlessness of the patient. These overall interventions strategies should bring out the positive outcomes of the cancer survival patients. Clinical practice development is the most important intervention components to guide patients which will be beneficial for them (Tuominen et al., 2019).

Recommendations

Conclusion

From an overall perspective, it can be concluded that chronic illness is a health condition or a disease that is incurable permanently (Beyondblue, 2022). Complications or problems do not go away completely but can be managed to a certain level for the chronic physical illness. These patients tend to suffer from other accompanied complications, such as depression, anxiety, mental issues, psychological problems or emotional toll. Chronic conditions of a patient may impact the quality of life of a person including social and economic conditions (AIHW, 2021).

References

AIHW. (2021). Chronic disease Overview - Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Retrieved 16 March 2022, from https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview

Beyondblue. (2022). Chronic physical illness, anxiety and depression. Retrieved 17 March 2022, from https://www.beyondblue.org.au/docs/default-source/resources/bl0124-chronic-physical-illness-and-depression-fact-sheet-lr_12-18.pdf?sfvrsn=e21646eb_2

Cancer Council. (2020). Optimal Care Pathways - Cancer Council Western Australia. Cancer Council Western Australia. Retrieved 16 March 2022, from https://www.cancerwa.asn.au/professionals/optimal-care-pathways/.

Grant, S. J., Marthick, M., & Lacey, J. (2019). Establishing an integrative oncology service in the Australian healthcare setting—the Chris O’Brien Lifehouse Hospital experience. Supportive care in cancer, 27(6), 2069-2076. https://link.springer.com/article/10.1007/s00520-018-4460-2

Harbeck, N., Penault-Llorca, F., Cortes, J., Gnant, M., Houssami, N., Poortmans, P., & Cardoso, F. (2019). Breast cancer. Nature reviews Disease primers, 5(1), 1-31. https://www.nature.com/articles/s41572-019-0111-2?sap-outbound-id=49A38F6E8D37A0C6932643E34692F4CEB9A2880C&mkt-key=005056A5C6311ED9999F74ACC2DF940A

Hyatt, A., Lipson?Smith, R., Schofield, P., Gough, K., Sze, M., Aldridge, L., & Butow, P. (2017). Communication challenges experienced by migrants with cancer: A comparison of migrant and English?speaking Australian?born cancer patients. Health Expectations, 20(5), 886-895. https://doi.org/10.1111/hex.12529

Jacobs, L. A., & Shulman, L. N. (2017). Follow-up care of cancer survivors: challenges and solutions. The Lancet Oncology, 18(1), e19-e29. https://doi.org/10.1016/S1470-2045(16)30386-2

Kim, S. H., Park, S., Kim, S. J., Hur, M. H., Lee, B. G., & Han, M. S. (2020). Self-Management needs of breast cancer survivors after treatment: results from a focus group interview. Cancer nursing, 43(1), 78-85. doi: 10.1097/NCC.0000000000000641

Porter-Steele, J., Tjondronegoro, D., Seib, C., Young, L., & Anderson, D. (2017, March). 'Not one size fits all': A brief review of models of care for women with breast cancer in Australia. In Cancer Forum (Vol. 41, No. 1, pp. 13-19). https://search.informit.org/doi/abs/10.3316/informit.684555175280607

Tuominen, L., Stolt, M., Meretoja, R., & Leino?Kilpi, H. (2019). Effectiveness of nursing interventions among patients with cancer: an overview of systematic reviews. Journal of clinical nursing, 28(13-14), 2401-2419. https://doi.org/10.1111/jocn.14762

Verhoeven, D., Allemani, C., Kaufman, C., Mansel, R., Siesling, S., & Anderson, B. (2020). Breast Cancer: global quality care optimizing care delivery with existing financial and personnel resources. ESMO Open, 4, e000861. doi: 10.1136/esmoopen-2020-000861

Yamanaka, M. (2018). A concept analysis of self-management of cancer pain. Asia-Pacific journal of oncology nursing, 5(3), 254-261. https://doi.org/10.4103/apjon.apjon_17_18

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