Benefits of Early Palliative Care for Patients with Lung Cancer with Respect to their Coping Ability
Cancer is among the most widely spread and prevalent diseases with lethal outcomes all over the world nowadays (American Lung Association, 2016). In the United States of America (USA), lung cancer in particular is the leading cause of death among all patients with cancer (American Lung Association, 2016). In 2016, more than 224,000 of new lung cancer cases are forecast in the USA, along with more than 158,000 instances of death (American Cancer Society, 2016). This is an increase in comparison to the number of 212,584 new cases and 156,176 deaths recorded in 2013 (Centers for Disease Control and Prevention, 2013). What is more, lung cancer is the world most prevalent type of cancer with the total global annual number of new cases amounting up to 1.8 million, while the annual number of deaths reaching the level of 1.6 million incidents (American Lung Association, 2016). Globally, lung cancer is caused mostly by tobacco use, causing 20% of all cancer deaths and being responsible for 70% of lung cancer deaths (World Health Organization, 2015). Because of the high proliferation of the disease and its high mortality rate, it seems necessary to study various care options. Moreover, this study is even more important for the advanced stages because of the high chance of the lethal outcome of the disease. Hence, the aim of this paper is to present a research proposal for an evidence-based practice (EBP) project about early palliative care in advanced lung cancer.
As it was previously mentioned, lung cancer is a highly prevalent and deadly disease that has been the number one cancer killer in the USA since 1987, when it surpassed breast cancer as the leading cause of death among women (American Lung Association, 2016). However, only relatively recently the researchers have become interested in amending standard cancer care and supplementing it with early palliative care (Bauman & Temel, 2014). It should be noted that palliative care is considered as a supplementary care method for all types of cancer. Currently, palliative care is considered to be an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness (Yoong et al., 2013, p. 283). In turn, National Hospice and Palliative Care Organization (2016) defines palliative care, as patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering and involves addressing physical, intellectual, emotional, social, and spiritual needs of patients.
Thus, the American Society of Clinical Oncology has included an option of early introduction of palliative care for patients in advanced stages of the disease into standard cancer care protocols. This may also mean that palliative care programs need refinement and development. In addition, it has been suggested that palliative care programs for patients with advanced lung cancer should include seven key components relating to rapport building, symptoms, coping, understanding of the disease, available treatments, end-of-life planning, and family relations (Yoong et al, 2013). Overview of the available literature shows that coping stage is a largely understudied component that needs to be further researched. In order to study coping component as an outcome measure, it is, first, necessary to define it. Hence, the World Health Organization (1999) defines coping, as a capacity, a capacity to respond and recover from something stressful. Another opinion is that only primarily good coping may be defined, as active problem solving that is optimistic, resourceful, practical, and flexible (Coping skills for life: Think smart, live well, n.d.). As a result, coping ability is understood as the capacity of the patient to utilize inner resources and various support techniques, as well as external support in order to be able to deal with the diagnosis, remain positive about the treatment and its outcomes, and not to fall into severe depression and despair.
The issue of early palliative care in general and its particular focus on coping abilities, as well as its introduction into care programs for lung cancer patients is highly topical and important issue for the health care field. The matter is that the results of previous studies by Greer et al. (2012) and Pirl et al. (2012) show a positive impact of early palliative care on the depression predispositions, survival of lung cancer patients, their end-of-life care, and quality of life of their family, yet they do not study changes in the coping ability of patients. In fact, most studies of palliative care for lung cancer patients focus mainly on the quality of life (Vanbutsele et al., 2015). Nonetheless, herein it is hypothesized that early palliative care can positively impact coping abilities of patients with advanced lung cancer.
The purpose of the research is to study the impact of early introduced palliative care complex into the general care program of advanced lung cancer patients on their coping ability. The PICOT question for this study is: In cancer patients within the first three weeks of diagnosis with metastatic, does the integration of palliative care to the oncologic visits compared to the standard care at oncologic visits, strengthen the patients coping ability over an 8 weeks time frame?
The literature review creates the theoretical framework of the extended research regarding the palliative care of lung cancer patients, who are within their first weeks of metastatic diagnosis. In this part, as an introduction to the topic, we are going to discuss the questions of general access to palliative care (Bausewein, Currow, & Johnson, 2016). Next step is to analyze the Canadian study that was conducted at the Princess Margret Cancer Center (Zimmermann et al., 2014). Further, we are going proceed to the practical studies connected to early palliative care for patients with the lung cancer, including the academic results on practical steps that can be utilized in order to improve and promote the services of this type (Irwin et al., 2013; Ferrell et al., 2015; Greer et al., 2013; Back et al., 2014).
In spite of the fact that many palliative care services around the world are sharing the same general aim, they are still different because of local healthcare structures and national system components. Moreover, there are still questions on some aspects of providing the necessary support to patients in both specialist and generalist settings (Bausewein, Currow, & Johnson, 2016). These scholars describe the necessity of palliative care specialists with the high-level education, the corresponding staff, and various other resources, necessary to provide the lung cancer treatment on a high level.
In their book, the scholars use multidisciplinary approach to describe the term palliative care, and go further with the access and support to its services. They explain how important and necessary the palliative care is for people who suffer from cancer, drawing particular attention to the primary type of lung cancer. The results of their qualitative study are mostly about the psychological and physical needs of such patients, as those who are diagnosed with cancer have the feeling of being intercepted by the society. The other cohort studies demonstrated the fact that lung cancer patients, besides having the worst symptoms, additionally suffer from greater extent of anxiety and depression (Bausewein, Currow, & Johnson, 2016).
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Zimmermann et al. (2014) in their research also mention about the reduced life quality of those patients, and that the situation worsens closer to the end of their lives. In their study, which was conducted at the Princess Margaret Cancer Center, they questioned patients on the quality of their life, including spiritual well being, their satisfaction with medical care, and medical interactions problems. Every month they measured the results and they continued for four months. The results of the research have demonstrated that 461 patients completed the baseline measures, both in the control and in the intervention groups. After three months of studies, the difference in the score change between the groups was barely visible. However, after the fourth month, those differences were significantly in favor of the intervention group. The scholars interpret their results supporting early palliative care and stating about the promising findings on the quality of life measures (Zimmermann et al., 2014).
Another category of scientists also discuss the positive impact of palliative care, mentioning the quality of life (QOL) and suffering relief of patients with advanced cancer (Irwin et al., 2013). Closer to the end of their life, these patients have both psychological distress and physical pain. This is the reason they choose the methods of therapy that is directed aggressively against cancer. The scholars, based on their literature review, promote palliative care as a conceptualized need in comparison to curative therapy of cancer. Their preliminary research suggests that early palliative care is beneficial for QOL, healthcare level and general mood of the patients. Moreover, the clients with non-small cancer of lungs have a potential to make their life longer. The main research findings of their literature review are about the influence of palliative care on patients with advanced cancer survival chances (Irwin et al., 2013).
Analyzing the importance of palliative care within the frames of QOL concerns and symptom management further, Ferrell et al. (2015) conducted the study to test the effectiveness of the intervention of interdisciplinary palliative care. The object of their research was connected to the patients with non-small cell lungs cancer (NSCLC). They were enrolled in quasi-experimental study and divided into the usual and intervention care groups. In addition to four educational sessions, the patients were also functionally assessed of Distress Thermometer and Spiritual Well-Being Therapy. The primary analysis included 491 patients, and those who received the interventions demonstrated to better QOL results. The general improvements of the results were the most noticeable within the earlier stages of the disease, compared to the stage IV. The main conclusion of this research is that the interdisciplinary approach to palliative care, especially in the ambulatory settings, is necessary because it significantly improves the symptoms, QOL, and distress of patients with NSCLC (Ferrell et al., 2015).
It is also vital to investigate the questions of early palliative care and treatment options for the advanced cancer patients within the frames of the supportive care services. Greer, Jackson, Meier and Temel (2013) took innovative approach to their research, paying particular attention to the support of service providers toward the patients with this diagnosis. They described several factors to explain the existence of disparages in cancer care amid the category of vulnerable population, which is very important during the early stages of cancer treatment and palliative care services.
One of the main problems they discuss is the lack of professionals who are trained to conduct clinical care and research. The scholars further mention about the evidence paucity to test and develop the interventions to support the patients appropriately. Finally, they analyze the fact of limited financial resources that are also very important in the process of curing and alleviating cancer symptoms (Greer, Jackson, Meier & Temel, 2013).
Due to the various misconceptions regarding the functions and general role of care providers, who sometimes failed to identify patients psychological distress, many clients perceived the oncologists and their treatment with distrust and misunderstanding. Another study was conducted with the patients who were diagnosed with metastatic lung and colorectal cancers, and it suggests that those clients did not understand that chemotherapy, unfortunately, is not going to cure them (Greer, Jackson, Meier and Temel, 2013).
Scientists also mention the lack of communication between the oncologists and patients, which is also one of the main barriers for clients to feel less distressed, hopeless, and anxious. In the case of early palliative care, patients have the opportunities to develop certain communication bridge with the members of their supportive teams. This can help patients to understand their illness better and to develop decision-making options regarding the treatment. In their literature review, scholars present the examples of different studies of the palliative care patients and their service providers. The results have demonstrated the fact of better QOL of those participants who are on the early stages of cancer treatment resenting the intervention group (Greer, Jackson, Meier and Temel, 2013).
Moreover, the scholars suggested the relationship between the two interventions during the early palliative care and general clinical outcomes. The caregivers in their practice should apply the aforementioned approach, based on a certain education and training support, in the process of their decision-making. It will result in better QOL and physical symptoms, and change the mood of the patients. They also discovered the necessity of illness understanding and knowledge of the patients, which would help them to cope with the behaviors of the latter. As a result, they can choose anticancer therapies or end-of-life care. Finally, the main conclusion of this research is that early palliative care with all the rules to follow may result in patients higher chances to survive (Greer, Jackson, Meier and Temel, 2013).
Back et.al. (2014) are among those scholars who conducted qualitative study, further discovering the role of clinician in early palliative care of cancer patients. The scholars are convinced that this type of care increases prognostic awareness of patients, provides better QOL, and may even lead to their survival. However, as they stressed, not much research was conducted on the methods of achieving this model in the early outpatient care field.
They examined the focus groups with the clinicians who participated in the early palliative care trial, dealing with the metastatic lung cancer. The results of the study discovered three main roles of clinicians: symptoms management function to improve physiological state, patients engagement role in the facilitation of emotions, and interpreting function, which is about the general communication between the patient and his oncologist. The received data of this study is the solid foundation for various training programs for palliative care clinicians.
The conducted literature analysis provides the theoretical framework and main principles to support the positive effect of early palliative care on the patients with metastatic lung cancer. Different training programs can be developed further and offered to the clinicians. Moreover, the conducted research may become further niche to fill the gap in the academic literature. It is about the emphasis on nursing care giving, based on Watsons human values nursing theory that is connected to kindness, and love toward other people. In addition, it is related to scholars definition of health: the process that enables patients to increase the control over their health, while improving it (Watson, 2008). Indeed, it strengthens the patients coping abilities, which reflects on their QOL, quicker anxiety overcoming, and finally, creates a possibility to survive.