Cancer Pain in End of Life Cancer Patients - Essay Example

? Cancer Pain in End of Life Cancer Patients literature review Grand Canyon Imafidon, Rachael Angie Lawson January19, Professional Capstone Project (Developing and Implementation Plan) Introduction The capstone project is a comprehensive project in the MPH curriculum intended to test student’s competency in applying theoretical concepts learnt in course work. Following successful completion of my literature review and proposal, I will be required to complete the actual project. Pain management is the most significant aspect of end-of-life care, particularly among cancer patients. Trauma and anxiety that follow cancer diagnosis, has been established as the leading cause of immature deaths among cancer patients. Arguably the mainstream cancer management program are insufficient hence the need for alternative treatment. The current cancer management systems concentrate on the physiological aspect of cancer pain. Moreover available pain management practices concentrates on the symptoms of pain rather than the source of the pain. The proposed project will evaluate possibilities of alternative and more efficient pain management practices in the context of source of pain and holistic well-being of the patient. This paper presents my Capstone Project implementation plan, which considers the current constraints and resources. Obtaining Necessary Approval(S) The choice for the project was based on my academic and professional interests. I am also confident of obtaining support from members of my department and hence the choice. In order to implement the project successful, I will require approval and support from staff and students in my department. To obtain the necessary approval from the members of my department I will require making official communication with the concerned people. Following my receipt of approval from the head of department, I will make request for collaboration from other teaching and nonteaching staff of our department. I intend to write official letters to teaching staff concerning my intent and competency in implementing the proposed project. Secondly, I will describe the insufficiency of the current pain management strategies and the need for improvements. The problem-based strategy will be based on the need to make timely implementations. This will be considered a supplementary strategy to the existing official request process. I will also need support from my peers particularly in project review and data collection. I will also need to describe the significance of the project to my peers in order to win their support. Current Problem/ Deficit Pain treatment is a significant aspect in the end of life care. Different people develop different pain symptoms and hence the need for differentiated pain management strategies. Unfortunately, the current pain management strategies concentrate on pain symptoms rather than the source of pain. For example, a doctor will concentrate on symptoms of pain such as headache and backache, rather than the actual cause of the pain. The second issue relates to the definition and scope of pain. The mainstream pain management strategies underestimate the significance of other dimensions of pain such as social and spiritual pain. A comprehensive pain management strategy needs to incorporate the other aspects of pain. The project proposes a standardized scale to assess pain, using four basic approaches to pain relief, which include: modify the source(s) of pain(s), alter the central perception of pain, modulate transmission of pain to the central nervous system and block transmission of pain to the central nervous system (Ferrel, Levy and Paice, 2008, p.577). Moreover the project proposes an interdisciplinary intervention integrating “physical, physiological, social and spiritual well-being of the patient so that the patient experiences comfort and dignity at the end of life. The process will involve counseling and use of pain relieving medication. Medication is primarily intended to relieve physiological pain without inflicting additional complications on the patient. Additional choice for medication will ensure that patients experience minimal discomfort. Primary medication or pain reliever will be given orally. However, this method will only be applicable to patients without miscellaneous abdominal problems such as vomiting. Alternatives will include subcutaneous, intravenous and intramuscular injections. Doctors and nurses will be required to seek advice from the palliative care team while administering pain-relieving drugs. The order of strength of painkillers prescribed to a patient is also significant. Doctors or nurses will use the weaknesses but the most effective available painkiller. Non-opioid pain relievers such as paracetamol should be prescribed at the initial stage. If pain persists, doctor’s nurses are advised to prescribe mild opioids such as hydrocodone or codeine. Strong opioids such as morphine should follow in the same sequence. Lastly, patients should be informed on how to cope with the news of terminal diagnosis. News about life limiting conditions such as cancer leaves patients with undefined questions. Depression is a direct consequence of such an occurrence. The project proposes counseling at every stage in the hospice care program. Patient training is also a crucial aspect of the project. Evidently, there are not sufficient doctors and nurse to offer specialized care to patients at a hospice or palliative care centre. Following this observation, I recommend patient training as a strategy of improving care and quality of life among cancer patients. The training will offered by doctors and nurses in a care home. Such training will endow patients with the ability to explore available information on hospice care and treatment. Patient training will also enable patients to monitor their physiological conditions and request professional care where applicable. The Proposed Solution The proposed solution was selected due to its effectiveness and applicability. Unlike other related solutions, the proposed solution concerns the total well-being of the patient and hence its applicability. Moreover, the solution is sustainable because it accounts for scarcity of resources. For instance, patients training recommended in the program solve issues of insufficient medical personnel. The project also minimizes expenditure and, hence efficient. The choice for the proposed solution was based on its user friendliness. In this context, user friendliness refers to lack of complexities in the solution and its application. Indeed, the solution is intended for ordinary people and facilities. Last but not the least; the described solution was selected due to its advocacy on quality of life for patients. The described pain management strategy ensures that patients obtain maximum relief from pain while maintaining the quality of their life. This incorporates their social, spiritual and psychological aspect of life. Rationale The proposed solution coincides with the literature review completed in module 2. The literature review identified key peer reviewed articles that point out lapses or propose change to the current pain management strategies. According to Fayers et al. (2011, p.1608), there are two dimensions of pain namely, intensity and interference. This indicates insufficiency in the mainstream pain management strategies, which rely on physiological pain. Fine et al., (2010, p.791). Point out lack of pain management guidelines for cancer patients. This necessitates the need for patient training as advocated in the solution. Additionally, Syrjala et al., (2008, p.175) state that training patients through video and other relevant materials increase patient’s responsiveness to hospice care and treatment. Consequently, Mair (2009) introduces the idea of spiritual, social and physical wellness in hospice care. Implementation Logistics The proposed solution will be integrated into the current organization structure in three phases. The solution is based on the patients and, hence organizational changes will be implemented from the patients. However, management staffs in care homes are expected to initiate the proposed changes through training and conferences, which will be held prior to the initial implementation. Nurses and doctors will then be required to pass information or knowledge acquired from training to the patients. Information concerning prescription and alternative pain management strategies will be offered to doctors and nurses by care experts. Upon receiving the training, participants will be required to test their newly acquired skills through audition held at their respective organizations. Successful participants will be awarded certification to recognize their participation in peer and patient training. Resources Required For Implementation Implementation of the project is dependent on availability of relevant materials. Materials required for the project will be classified according to its purpose. Evidently, the project is education oriented and, therefore, educational materials form the bulk of the requirements. Educational materials include pamphlets, handouts and posters. These materials are intended to create/improve people’s awareness on the proposed solution. Each of the proposed material will be applied according to its effectiveness. Secondly, the project will require assessment tools to analyze effectiveness and people’s attitude towards the proposed solution. Assessment tools include questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention. My department will provide most of the items in this checklist. On the other hand, stationeries and paper materials required for the project have been ordered from Smartcom Solutions Ltd. In order to maintain our efficiency throughout the project, technology tools will be required. These include statistical software, computers, smart phones and imaging devices. Fund will also be required to finance the exercise. I have already made a proposal to the health department to request for funds. However, primary funds will be obtained from the department’s postgraduate research allocation. Finally, successful completion of the project will require staff or personnel initiate, oversee and evaluate change. Staff members from my department will act as consultants on crucial maters while students are eligible for data collection and review assignments. This is in accordance with the capstone project protocol that the school observes. References Fayers, P.M., Hjermstad, M.J., Klepstad, P., Loge, J.H., Caraceni, A., Hanks, G.W. & Kaasa, S. (2011). The dimensionality of pain: Palliative care and chronic pain patients differ in their reports of pain intensity and pain interference, Pain, 152 (7), 1608-20. Ferrel, B., Levy, M.H. & Paice, J. (2008) Managing pain from advanced cancer in the palliative care setting, Clinical Journal of Onchology Nursing, 12 (4), 575-81. Fine, P., Herr, K., Titler, M., Sanders, S., Cavanaugh, J., Swegle, J. & Reyes, J. (2010), the cancer pain practice index: A measure of evidence-based practice adherence for cancer pain management in older adults in hospice care, Journal of Pain and Symptom Management, 39 (5), 791-802. Mair, J. (2009). Caring for people with chronic cancer pain, Journal of Community Nursing, 23 (5), Retrieved from http://www.cabdirect.org/abstracts/20103191291.html;jsessionid=068AB866513E2085DAA99062B77F7607?gitCommit=4.13.11-15-g9672536 Syrjala, K.L., Abrams, J.R., Polissar, N.L., Hansberry, J., Robinson, J., DuPen, S. & DuPen, A. (2008), Patient training in cancer pain management using integrated print and video materials: A multisite randomized controlled trial, Pain, 135 (1-2), 175-186. Read More