Emotional Pain Following a Cancer Diagnosis

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Emotional Pain Following a Cancer Diagnosis

• Wendy Johnson.
• MSc. In Practice Development
• Pain Management
• Completed 2006

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• Definition of pain
• The agreed definition of pain put forward by the
  experts the IASP in 1994 is
• an unpleasant sensory and emotional experience
  associated with actual or potential tissue
  damage
• Do we agree with this?

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The Study

• To look at emotional pain specifically relating
  to
• psycho-social issues in palliative patients.

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WHO DEFINITION OF PALLIATIVE CARE (2008)
An approach that improves the quality of life of
patients associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification and
impeccable assessment and treatment of pain and
other problems, physical, psychosocial and
spiritual
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Aims of the Study

• Identify whether patients do experience emotional
  pain.
• Identify how emotional pain is related to their
  psychosocial well-being and whether this is
  recognised by professionals.
• Explore how professionals identify these emotions
  and deal with this aspect of pain.
• Determine if the support received by patients
  meets their needs.
• Identify if there are any educational needs for
  professionals

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Methodology

• Qualitative research descriptive rather than
  quantities using in depth interviews
• Narrative analysis using the patients story and
  putting together themes which were then analyzed
  in relation to the patients own agenda.
• Finally to offer recommendations for practice

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What is narrative analysis?

• Narratives as they are known are stories given
  by an individual to give an insight into their
  experiences
• It allows the practitioner/researcher become part
  of the individuals world letting them share
  their story
• The individuals story is allowed to reported
  using their own words

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Why use narrative analysis?

• Allows the person to regain form and meaning to
  their lives (Carlick and Biley 2004)
• Allows life and pain to be freed from its chaos
  by sequencing events and giving order
• (Frank 2004)
• It is the persons own perception allowing their
  viewpoint (Kinsella 2005)
• As nurse we should develop an understanding of
  individuals experience and their personal truths
  through stories through stories rather than the
  biophysical (Payne 2004)

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Participants

• 3 participants one male and two female
• Age group 48-64
• Two were seen at home one at centre (patient
  choice)
• Patients were aware they could exit the study at
  any time
• Back-up counselling support offered, but not
  taken up
• Changes made to names and only brief vignettes
  given to protect identity

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Four Core Themes

• 1.Changes in social/family status
• 2. Patients expectations of professionals
• 3. Attitudes of others towards cancer
• 4. Reaction to diagnosis

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Core Theme Changes in social/family status

• Storyteller 1 Dianne
• Stories of a changing life in a
• nice family

Dianne the mother of the family. A true
matriarch she had a responsible job as a
supervisor over 250 staff in healthcare.
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Core ThemePatients expectations of Professionals

• Storyteller 2 -Jim
• Stethoscopes and Tissues
• Jim Known as the big guy had been an
  electrician travelling all over the country.
  Always ready to help family and friends.
• A discerning man who often spoke in metaphors.

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Core ThemeAttitudes of others towards cancer

• Storyteller 1 Dianne
• Stories of being distanced
• Dianne the mother of the family. A true
  matriarch she had a responsible job as a
  supervisor over 250 staff in healthcare.

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Core ThemeReaction to diagnosis

• Storyteller 3 Mary
• Stories of the comforter
• Mary called herself a carer and a family
  person, she was main carer to her husband who had
  a major stroke, and in the past had cared for her
  mother and father

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How then does this affect our practice?

• Patients when given the opportunity are very
  willing to share their story
• Holistic interviews with patients should be on
  their terms and their agenda
• Professionals need to set aside time to discuss
  these issues
• Professionals need to be aware of the impact of
  their actions/comments

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Discussion

• Emotional pain of living with cancer issues not
  new ones, difficult to put into a particular
  model as they are intertwined
• Educational needs. Communication is still a
  key issue surrounding a cancer diagnosis. These
  issues can have resounding impact on the patient
  and family.
• Patients own story. May be part of the process
  of re-ordering their life.

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Recommendations

• Patients needs should be identified using a
  person centred approach in order that their main
  concerns can be identified
• Professionals should continue to be educated in
  end of life care particularly communication
  skills in order to elicit this information
• Narratives/storytelling should be identified as a
  tool not only in the research arena, but also in
  patient assessment
• The time and effort needed to develop a
  therapeutic relationship should be acknowledged
  as part of nursing activities

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Conclusion

• The study, though small was rich in textual
  evidence. It highlighted the emotional needs/pain
  of those who have a cancer diagnosis.
• It identified that though we (professionals)
  acknowledge the total pain model. We may not
  fully appreciate the impact of living with
  cancer
• It highlighted that it is not just physical pain
  eg. Tissue damage that can cause pain.
• It identified the need for ongoing education and
  planning in end of life' patient services.

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.....and finally

• As a researcher the study allowed me to become
  part of the patients world. I became privy to
  information they had previously not thought I
  would be interested in, but as the interviews
  showed, were truly important.
• Given the time, and their own agenda patients
  are willing to tell you their own story about
  living with cancer.
• ... and I felt privileged that they did.

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Thankyou

• ..any questions?

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ReferencesWorld Health Organisation (2006).
http/www.who.int/cancer/palliative/definition/en/
. WHO definition of Palliative Care. Accessed
24.3.06Carlick.A, and Biley.F.C (2004).
Thoughts on the therapeutic use of narrative in
the promotion of coping in cancer care. European
Journal of Cancer Care.13 308-317. Frank.A.
(2004) Asking the Right Question About Pain
Narrative and Phronesis.Literature and
Medicine23.nno2 (Fall 2004) 209-225. The John
Hopkins University PressIASP (2006)httpwww.iasp
-pain.org/ter.s-phtml. Pain terminology. Pain
terms updated 1994. Date accessed
24.3.06.Kinsella.E.A (2005) Constructions of
self-ethical overtones in surprising locations.
J.Med EthicsMedical Humanities
20053161-71Payne.S, Seymour J, Ingleton C.
(2004) Palliative Care Nursing Principles and
Evidence for Practice Open University Press