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Addressing Psychological Support Needs in Breast Cancer Patients

November 11, 2010 | AONN+ Blog | Breast Cancer
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Administrative Director, The Johns Hopkins Breast Center; Director, Johns Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

Oncology nurses for decades have assessed the psychological needs of their breast cancer patients. So it is not surprising that this assessment would become an important function for an oncology nurse navigator as well. Several issues warrant attention in making an assessment of patients' emotional needs. And various ways can be used to address those needs. Some of them are listed below for you to consider incorporating into your nurse navigation psychological assessment of your patients:

  1. Ask patients what their experience and knowledge base is of breast cancer. Focus specifically on other women they may have known who were diagnosed in the past. Did they become survivors? Were they family members?
  2. Are they accepting of evidence-based medicine/standard of medical care or is their tendency to lean more toward holistic medicine, making it more difficult to treat them in a traditional way?
  3. Have they been getting routine screening mammograms or has a long time lingered between the last mammogram and the findings on a breast examination that resulted in a biopsy confirming a diagnosis of cancer? (For example, such delays can result in the patient feeling guilty and perhaps even seeing treatment as being a waste of time, assuming she is destine to die or deserves to, having neglected her health.)
  4. Do they have a supportive family?
  5. Are they able and willing to take time off from work and other responsibilities to get the care they need?
  6. What is the relationship with their breasts? Do they consider their breasts their best physical feature? Are they their primary erotic zone? Do they fear they will be rejected by men in the future if the breasts are altered in some way or lost to this disease?
  7. Is this their first experience with a personal medical crisis?

It is important to consider asking all of these questions when making your assessment of your patients' emotional needs. Based on the answers, you will be in a better position to counsel them as well as provide them the support they need to proceed successfully with treatment. Some resources to consider providing patients that can help them psychologically include:

  1. Match them with a survivor volunteer based on age, stage of disease, and anticipated treatment plan. More and more cancer centers are developing and implementing one-on-one support programs for newly diagnosed cancer patients. Providing your patients a mirror image of themselves in the near-future can aid in seeing that they are not alone, and that the treatment is “doable.” If such a program does not already exist, consider creating one. Another option may be the Reach to Recovery program offered through the American Cancer Society.
  2. Encourage them to attend a support group. Most cancer centers offer disease site–specific support groups. They usually meet once a month and in some cases more often.
  3. Empower them with information so that they can participate in their treatment decision making. Rather than doing things “to them,” you want the team taking care of them to be doing things “with them.”
  4. Discuss their feelings about sexuality and intimacy, and openly discuss or direct them to a therapist who can talk with them about what impact breast cancer treatment (surgery, chemotherapy, hormonal therapy) may have short and long term. Identify ways to manage sexual dysfunction that may accompany specific treatments, and provide guidance on how to reduce these effects. Provide their partners with resource information as well.
  5. Provide them a list of credible websites that may provide additional psychological support, such as chat rooms, educational seminars online, and ask the expert features. Examples include: www.breastcancer.orgwww.lbbc.org;www.hopkinsbreastcenter.org; and www.youngsurvival.org.

Reassess your patients periodically as they journey through treatment to ensure their psychological well-being. An important time to reassess their emotions is at the end of active treatment. It is not unusual for patients to feel a sense of abandonment when treatment is done. Provide them resources for survivor retreats, which are designed to help women reengage in their lives and become emotionally healthy again. Such programs offer various sessions on: setting new life goals; nutrition; exercise; following a healthier lifestyle; stress management; differentiating between long-term side effects and new onset of distant recurrence; coping skills to overcome fear of recurrence; humor therapy; and networking opportunities with others who have recently completed their treatment. 

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