Friday, February 6, 2015
Providing Spiritual Care According to Disease Process: Cancer
Providing Spiritual Care According to Disease Process: Cancer Some of the types of cancer hospice patients present with and which the hospice Chaplain will become acquainted are: lung, colorectal, prostate, female breast, bladder, pancreatic, gastric, liver, head and neck, and brain. This list is not meant to be exhaustive. When it comes to the emotional and spiritual needs of the cancer patient, there is a general term used to describe the patient’s suffering: distress. The National Comprehensive Cancer Network developed the NCCN Distress Thermometer for patients. Quoting the introductory remarks on the NCCN Distress Thermometer site, http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf, “Distress is an unpleasant emotional state that may affect how you feel, think, and act. It can include feeling of unease, sadness, worry, anger, helplessness, guilt, and so forth. Everyone with cancer has some distress at some point of time. It is normal to feel sad, fearful, and helpless.” When the Chaplain enters the dynamic of the patient’s environment he or she may identify from where the distress is manifesting itself. It will prove instructive for the Chaplain to review the actual Distress Thermometer at this location, http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf. The Chaplain may have the patient complete the Distress Thermometer assessment so he/she can get a better sense of where the patient is emotionally and spiritually. Two cases highlight the emotional distress cancer patients’ experience. I had the privilege of providing spiritual care to a gentleman stricken with prostate cancer. Without belaboring the medical aspect, the cancer metastasized and he was nearing end of life. He prided himself of his independence. Indeed, he was a painter and had many of his works in studios in various parts of the world. He was a traveler having taken many trips overseas. But, now, his world was his apartment at an ALF. There came a time when he hit the brick wall of realizing his life was short and his activities outside of his apartment would be curtailed. I was present when the hospice DME delivery service dropped of a walker, a cane, a wheelchair, and a potty chair. This patient was devastated. The Existential Slap (please locate this essay from the November 13 posting) hit him hard. He went into a depression. What brought him out of this depression was a short phrase in a conversation he and I had about a popular movie, The Bucket List. Since this man’s personality would not allow him to be held hostage to depression he began to make his bucket list. One of the events he wanted to initiate was a family meeting where he would have his adult grandchildren pull out the boxes of 35mm slides (for our current techie generation, slides were in vogue for many years prior to the digital camera) and reminisce about their overseas trips with ‘Grandpa’. The plan sounded good. On Christmas Eve I stopped by the ALF, knocked on this patient’s door, was greeted by his son and welcomed in. What I saw would make any heart glad. Slides were scattered on the floor, granddaughters laughing and telling stories as they held the slides up to catch the light. And, there he was… my patient seated in his chair, hands on his lap, eyes glued to the scene unfolding before him. He looked at me, nodded approvingly and welcomed me to the party. It was not too long after that Christmas Eve that his life ended. The keys to spiritual care with him involved empathetic presence, interactive listening, pastoral counsel, and a pet therapy dog. In regards to the pet therapy dog that visited the patient, further explanation should validate the value of this mode of care. In a recent study found in THE JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY,¬ January 2015, which can easily be accessed at http://www.oncologypractice.com/fileadmin/content_pdf/co/JCSO_Jan_2015_22_Fleishman.pdf the following gives credibility to the use of pet therapy dogs: Nonscientific qualitative responses to the intervention focused on 2 areas: the unconditional love that pets were seen as providing and the friendly dedication on the part of the pet owners. One patient was quoted saying, “Every dog visited me in the past few treatments and makes me feel good. It is such a good program.” Another patient had suggested that the AAVs [Animal Assisted Visits] be extended to others outside of the study: “It is such a great thing, it should be offered to everyone in the waiting room, not just to individual patients.” As patients became increasingly uncomfortable over the course of radiation therapy, experiencing pain, fatigue, skin lesions, and the inability to eat, swallow solid food, or to speak, the therapy dogs remained happy to see them, not seeming to notice any alteration in appearance. Patients also commented on the value of the human visitors. One patient said that she greatly looked forward to and relied on the support she received from the owners of the therapy dogs, but said, “People couldn’t have just come alone without their dogs – that would have been awkward and silly.” Another patient stated, “I greatly benefitted from the presence of the dogs. They dispelled my worries while I was waiting for my treatment.” My conclusion is that if your hospice has pet therapy dogs trained for this type of patient care it should be embraced as a part of your spiritual care. The second instance has to do with my sister who died of colorectal cancer. Her journey through this disease was fraught with debilitating nausea after each chemotherapy treatment and general malaise with intense pain. From diagnosis until death she had only a few months of life. It is unfortunate that she was not referred to hospice. She journeyed through this disease with just her spouse providing support. At the time, I was living and working over 1,000 miles away. She and I had at times long telephone calls that focused on her inner well-being and overall spiritual life. I visited with her a few times prior to her death. What I gleaned from this experience includes: hospice care should be made available to all patients faced with end-of-life diagnoses; spiritual care can be provided by family members; the spouse or other caregiver must be vigilant to advocate for the patient as there is not a hospice Team present to do that; and follow-up with the surviving spouse is utterly necessary. In the case of my brother-in-law, he grieved himself to death almost one year after my sister’s death. I would also counsel my Chaplain colleagues that officiating at the funeral of one of your family members may not always be the wisest things to do… courageous and compassionate, yes; wise, not always. I did conduct her funeral service. For me, deferring would have provided me the opportunity to grieve and mourn without the concerns of developing a funeral sermon and all that goes with that. In reflecting on the Distress Thermometer and my sister’s experience, she would have scored fairly high as she was deeply concerned about the finances, treatment decisions (she ultimately declined further chemotherapy because she said, “it was killing me faster than the cancer”), and the many physical problems she faced as the cancer progressed. In conclusion, I urge my Chaplain colleagues to gain insight into the type of cancer your patients are suffering with and to use the Distress Thermometer as an aid to understanding the issues they are facing. Your skills as a clinical chaplain will come into play as you provide Interventions which will provide them the comfort and assurance they need.