On October 11, 2010 The Archives of Internal Medicine published an article titled Hospice Use and High-Intensity Care of Men Dying of Prostate Cancer. Within this article it is described that men with prostate cancer are not enrolling in hospice services and many are only utilizing the service in their last week of life. This disparity and underuse of an available health service could be linked to a cultural stereotype or to a perception of hospice as one of defeat in the fight against cancer.
The conversation of prognosis is a difficult for many individuals and it is hard to define. Many families and patients want to know “how long” when given a cancer diagnosis; statistics are the only resource for answering this life-altering question. In my experience as an Oncology nurse the initial response from a newly diagnosed cancer patient is one of fear followed by the mind-set of war and victory against the disease.
In conversations about cancer treatment (surgery, chemotherapy, radiation) we as health-care providers often leave out discussions regarding quality of life. Modern medicine sees quantity of life as the treatment focus, as in how many days on earth. Quality of life is often overlooked or omitted all together. The article sited above regarding hospice care is of particular interest because the central focus and mission of hospice care is quality of life, a concept that I have been intrigued with for some time.
As a new nurse working in Oncology I was scared of conversations of death, dying, and defeat. I was uneasy when a patient was going through the various stages of grieving and it took time to become comfortable with myself as a health-care provider and to engage and facilitate these conversations. I had a patient who was diagnosed with stage 3-breast cancer who decided on no treatment. She and her husband agreed they wanted to spend their final years together traveling the world, seeing new places, and experiencing life together. They did not want to spend their time in hospitals and doctors offices. She did not want to cut open her body or loose her femininity by cutting off her breasts. She wanted quality not quantity of life.
I was blessed to have a patient open my eyes to the idea of quality of life and to invite me into this entire realm of cancer care that I had been so scared of. Quality of life is often reviewed when treatment is no longer an option. As a health-care provider I believe that we need to initiate this conversation concurrently throughout treatment. By assessing and evaluating a person’s quality of life we can better provide care to the individual and not just treat the disease.
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