Introduction to Cancer and its Stages

Discuss about the Journey Of The Cancer Patient Named Michelle Sullivan.

Cancer is not a single disease and is not caused by a single factor. It is the multifactorial disease characterised by the uncontrolled cell division (Kahana et al., 2016). In advance stage, it spreads trough entire body via metastases. When talking about the cancer, there is no single way to do it, may it be the conversation is occurring in the hospital or in the patent’s home. The terms battling or fighting cancer are the terms indicating how people choose to live with cancer and respond when they have no control over it. There are discreet stages of the cancer each with its own characteristics, needs, interventions and existential crisis. It includes before diagnosis, diagnosis, treatment, recurrence, chronicity and end of life (Kahana et al., 2016). In each phase the patient is exposed to varying vulnerabilities. Overall it is considered to be the vulnerable experience as the disease affects people both physically and mentally. It also significantly affects the loved ones mentally and socioeconomically (Kahana et al., 2016). During this journey, the response of the patient and the families towards the illness is also influenced by the way the cancer related information is relayed by the health care professionals. The communication system between the patient and the radiation practioner or/and therapist determines the patients outlook towards the illness, the psychological impact and the vulnerability experienced by the patient. 

The essay deals with the journey of the cancer patient named Michelle Sullivan. She was diagnosed with the Triple Positive Breast Cancer. The essay is the reflection on the care of the patient as well as communication between her and the medical practioner. The aim of the reflective paper is to highlight the experiences of the medical professionals associated with the Michelle’s cancer surviving journey; and the inconsistencies related with care and treatment process. It includes the communication strategies used by the medical practioners to ensure effective communication with the patient. Further, the essay also demonstrates the impact of the health care provider’s professional and unprofessional behaviours on the health outcomes of the cancer patient. The reflective journal also outlines the learning and insights drawn from the encounter with Michelle to conclude the factors that marks the best care.

A reflective journal is the record of an individual’s thoughts, impressions and feelings. It is used as a tool for self assessment and plan for future practice in similar situation, while evaluating the effects of change (Horton-Deutsch & Sherwood, 2017).  Reflective practice is important for students in any setting as this process prompts thinking aloud. It allows one to enter into a discussion with oneself regarding the experiences and the events that may affect the professional practice. Students can construct their own learning goals by giving meaning to the events and experiences. The quotations used by the students in their own reflective journals give an insight of their emotional experiences and the practical skills development (Horton-Deutsch & Sherwood, 2017). This is based on the philosophy that by reflecting a student actively engages in learning instead of accepting the information passively as per Horton-Deutsch and Sherwood (2017).  There are various models of reflection that will enable one to reflect systematically to reach a conclusion. It includes Atkins and Murphy frameworks, and Gibb’s reflective model that are highly cited in the literature for its high significance (Lestander, Lehto & Engström, 2016). 

Reflective Practice in Medical Radiation and Cancer Patient Care

According to radiation therapists, reflection is an integral part of the practice as well as professional life. They engage in different modes of reflection as they perceive that it directly affects their personal growth and the clinical practice (Cashell, 2010). In several studies conducted to obtain the perspective of the nurses and other health care professionals on reflective practices, a positive outcome was evident. The common advantage reported by them is improvement in the patent care (Coleman & Willis, 2015). 

According to Tan, Cashell & Bolderston (2012) reflective journal for the radiation students is essential to gain insights by indentifying their needs. Students are benefitted by exploring and confronting the emotional side of the professional practice.  Radiation students can track how well they can communicate with the patients and the team of radiation therapists in which they are working. Reflective practice will help develop critical thinking skills and learn to cope up with each situation.  This is also in alignment with the Schön’s definition of reflective practice that emphasized on the retrospective critical thinking (Schön, 1987).  I agree with this view as I believe that refection should be practiced in present times to rectify any wrong step in the care process that may affect the patient outcomes.  Both Schon and Gibb’s view (Gibb’s reflective model) on refection touches the concept of feelings in reflective practice and its link to taking actions for future practice (Lestander, Lehto & Engström, 2016).

 It can be interpreted from the literature review; refection will help one to perform their professional duties in a manner that aligns with the accompanied values and ethics. I also believe that refection is beneficial in improving self awareness. An individual can become the critical reflector to understand personal actions and behaviors and how it impacts others and themselves. In turn this will modulate the overall behavior of a person both as a radiation therapist and as a human being. It will enable one to better perceive the right or wrong actions or behaviors that may directly hamper the patient outcomes. In conclusion I believe that reflective practice is the integral part of the student associated with any medical profession. 

Reflective practice is not without any barriers. Medical professionals have busy schedule creating time shortage for engaging in reflective practice. Further, constraints include lack of motivation to reflect on past experiences or commitment towards identifying the learning needs for future growth and development.  Such barriers if not overcome may lead to failure in accepting the change required in personal and professional domains. 

Importance of Professional Standards and Code of Conduct

A health care practice is regulated by the code of ethics, code of conduct and professional standards in every country. When it comes to the medical practioner-patient relationship there are various ethical considerations such beneficence, public rights, privacy and confidentiality of the information. Other than dealing with patents these ethical considerations are also important to determine the workplace professionalism. It includes attitude and behaviour towards the seniors, colleagues, leaders and mangers. It facilitates working with integrity and prevents unprofessional conduct. These standards and code of conduct are valuable for professionals to understand the factors that may evoke ethical and legal implications. It will help understand how these may impact the profession and the patient care (Doherty & Purtilo, 2015).   

In Australia there are various organisations that have developed the practice standards as well as code of conduct for the medical radiation practioners.   One of the organisations is the Australian Health Practioner Regulation Agency or AHPRA (Australian Health Practioner Regulation Agency, 2017). It develops the standards and code of practice for the radiations practioners as guided by the ARPSANA and implements them into practice. The primary authority in Australia for radiation and nuclear safety is known as the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA).  This government agency is committed to the public protection as well as saving environment from detrimental effects of the radiations. It develops standards for radiation and nuclear safety in collaboration with the “Radiation Safety Health and Safety advisory council” (Australian Health Practioner Regulation Agency, 2017). It ensures regularity within all the practices. The standards developed by this agency pertain to the clinical education, patient care, training and development of the practioners and the accreditation of practice (Australian Health Practioner Regulation Agency, 2017).  AHPRA is responsible for the registration and accreditation of 10 health professions across Australia. It supports the national boards of Australia for registration of the practioners into various fields, health schemes and accreditation schemes with the primary goal of ensuring the patient safety. It implements the national schemes under the National Law of different states and territories (Australian Health Practioner Regulation Agency, 2017). The standards created by them are guided by the research conducted by the international organisations such as “United Nations Scientific Committee on the Effects of Atomic Radiation” (UNSCEAR) (Australian Health Practioner Regulation Agency, 2017).  These guidelines have been found to promote the safety of people as radiation professionals are obliged to adhere to these guidelines.  It assists them to save the patients and colleagues from the ionizing and non-ionizing radiations.

Role of Australian Health Practioner Regulation Agency (AHPRA) and The Medical Radiation Practice Board of Australia (MRPBA)

In Australia the organization designated for the medical radiation profession is the, “The Medical Radiation Practice Board of Australia” (MRPBA). This national board is responsible for setting standards, values and code of conduct to support all the practioners of medical radiation domain (MRPBA, 2015).  It enables them to deliver suitable work within the ethical boundaries. The code 1.2 highlights the elements of the good radiation practice emphasizing on values, qualities trustworthiness, and compassion that facilitate patients trust and reliance on practioners.  It also highlights the importance of the reflective practice for the practioners to stay updated with changing demands of the profession.  As per literature these standards and code of conduct have been successful in enhancing the patient outcomes as well as work experience.  The MRPA in its code 3.3 states the importance of the communication in building therapeutic relationship with the clients and giving effective treatment (Medical Radiation Practice Board of Australia, 2014). There is a need of regular audit to ensure that three is compliance with these standards. Regular audit and stringent policies to punish non-compliance to standards is necessary for the practioners to work within scope of practice.  Audit is necessary as setting standards alone does not necessitate ethical practice (Ivers et al., 2012). There is need to ensure sufficient awareness among the practioners about the import mace of these standards. 

My first encounter with Michelle occurred in month of April during one of my lectures within RMIT, Bundoora campus. She had visited to discuss her journey of cancer. She was introduced as Michelle Sullivan, a 52 year old woman. She was diagnosed with Triple positive breast cancer and was completely cured. She also had Ductal Carcinoma in Situ (DCIS) confined to breast. Her story comprehensively described how communication is the detriments in addition to others detriments that commonly accompanied cancer.

As I listened to the story of Michelle, she would not have been diagnosed until quite late, if only she had not received the letter for free breast screening in 2015. She was notified to be entitled to free mammogram by Breast-Screen Australia on the 50th birthday.

Due to lack of complete understanding of what a breast screening program entails the woman had a disturbed communication with health practioner at first interaction. She was least aware that her complain about feeling lump in her breast would not be resolved in the screening clinic. After two weeks of mammogram she was called for follow up, and was conformed for biopsy. She was then diagnosed with DCIS before Christmas. It was found to be small aggressive tumour present in the inner lining of breast milk duct.  Treatment was started immediately after her diagnosis. It comprised of breast surgery, chemotherapy and radiotherapy.

Conclusion

While narrating her story, Michelle demonstrated her struggle more due to lack of emotional support than the physical side effects such as hair loss, fatigue, and others. Her partner being female she was not asked to accompany the treatment procedure. During her surgery, her cancer was found to non-metastatic Triple Positive Breast Cancer.  The name was because the patient had tumours positive for Estrogen and progesterone, and high level of HER2.

Based on her narration it was evident that she had disturbed communication with the staff and lacked empathy from the therapists. Sometimes she lacked detailed clarity over her symptoms and disease progress. It increased her anxiety and made her difficult to cope with illness on several occasions. It was also not constructive for her family to manage the feelings. One such incidence includes professional not informing the purpose of the “blood pooling test 3-4 times in 12 month time”. Further, Michelle also emphasised on the measuring day where she became highly anxious as the 5 radiation therapists argued amongst each other about where to begin. It was a situation of disgust and helplessness as she was lying naked. In Michelle’s words, this was the condition where, “no animal puts themselves into”. Further, rounds of helplessness, confusion and anxiety occurred as a new team was involved in her case in every session. She was at terrible discomfort when discussion occurred among staff due to her large breasts.  Such unprofessional behaviour and lack of compassion made her agitated and left dissatisfied. She was also verbally abused by receptionist for requesting change of schedule. Further, the patient also narrated that there was a lady from the radiation therapy team who was very polite and informed patient about every details of the procedure. It gave hope and courage to Michelle. Also there were other practioners she mentioned who at the time of bone scan showed compassion and provided sufficient information to address her concerns. Michelle liked their professional behaviour and her satisfaction was evident from phrase, “they were a great team…instilled confidence in me”.

At the end of the narration, I started to ponder what could have I done as the practioner that would have given a different experience to Michelle? I questioned myself about measures that could be taken in such situation to enhance the patient satisfaction.

After hearing the story of Michelle I felt a lump in my throat. Realisation dawned on me as I was pondering over her helplessness, anxiety, discomfort and disgust due to inappropriate communication with the therapists and staff, rude response of the receptionist, and negligence of the radiation therapists leaving naked patient on table. She has encountered poor empathy right from her day of mammogram tests.  I felt angry as I am making career in the field of radiation therapy. This not the kind of professional I wanted to be. I was imagining myself lying on the radiation table naked with raised arms.  I soon found myself in motion of tears as Michelle’s words echoed in my ear “can someone please talk to me?”  No human being can tolerate such animal like treatment with themselves or with their loved ones.  She was no wax model but a human being with ability speaks and feels. How can practioners neglect her like any other object in the room? I felt the patient’s dignity has been breached. Michelle and her partner were completely unaware of her disease. The behaviour of the practioners further added to their distress. It altogether worsened the quality of her life.  

Being a part of such profession it was disappointing to find the level of unprofessional behaviour existing. I could understand how lack of communication and reassurance can make a patient overanxious and apprehensive.  It was evident from the patient’s words, “there was this sense of vulnerability that really shocked me”. She was already unprepared for the consequences of such health debilitating disease. Michelle was subjected to grater vulnerability by professionals making her feel insignificant with growing intensity of her treatment.  She was not involved in the decision making or the intense medical discussion. It was thus obvious for any patient to feel unimportant. I too went under shock after narration of heart wrenching story and felt dismay.  I could now better understand the struggle of the cancer patients as I have personally neither encountered such story before nor had any person in my family with chronic illness.

Once gain I realised the importance of reassurance, empathy and effective communication to improve patient satisfaction.  Emotional support for patient is as important as the physical treatment.  It gives hope and reinforces the patient’s courage to cope up with the illness.  This was also evident from the positive communication style of one of the practioners in radiation therapy department, at Peter MacCallum Cancer Centre, who could instil sense of comfort in patient. This has positive impact on me after I had felt frustrated on hearing the negative experiences of Michelle. I felt inspired when Michelle mentioned about few practioners who were compassionate and understanding. She felt satisfied, motivated and encouraged with their behaviour as they informed of proceedings of the day, actions and treatment steps. I decided to conduct myself in the same manner in future practice to set good example for others.  

On evaluating the professional behaviour of the practioners during radiation therapy, it can be concluded as lack of compassion, and poor demonstration of empathy. The patient could not be dependent on them.  It could be considered as non compliance to the code 1.2 of MRPBA, which states the practioners to demonstrate high integrity and show compassion and to be dependable. All the three elements were missing in the radiographers. However, other workers complied with this code who spent time with Michelle to explain her purpose of the medical procedure and reassured that she was in safe hands. This behaviour demonstrated professionalism and was in alignment with the standards and codes of effective communication as per Medical Radiations Practice Board of Australia (2014).

Michelle has been subjected to poor communication, vulnerability and negative response by range of people including therapists, radiographers, and nurses. According to Song, Hamilton & Moore (2012) poor communication during treatment and negative experiences increases the patient psychological distress and negatively impacts the recovery process. Anxiety and depression increases with lack of informed and inclusive decision in health care (Aning et al., 2012).  The confidence on the outcome of treatment and hope to survive diminishes with physical and psychological impact of the treatment. In such situation vulnerability may be further exacerbated if anxiety is unaddressed. Vulnerability can be reduced if the practioner builds therapeutic relationship with the patient right from the day of diagnosis. Demonstrating the patient centered care is a good way to reduce overwhelming feelings of the patient during treatment (Tsianakas et al., 2012). The practioners must adhere to the section 2.3 and 3.9 of code of conduct that emphasises on shared responsibility between patient and practioner as well as care inclusive of family members. In contrast to this the radiographers did not involve Michelle’s partner. The patient was neglected on table while the professionals were busy in decision making.  As per section 3.3 the practioners must engage in active listening to carefully address the patient’s worries as it may impacts the health perspective of the patient (Medical Radiation Practice Board of Australia, 2014).  In the screening department, the professionals neglected the patient’s query for lump in breast.

Conclusion  

It can be concluded that the unprofessional behaviour of the therapists and staff was preventable by complying with the professional standards. The reflective framework suggested by Gibbs helped identify the areas of improvement for promoting the patient satisfaction. It involves active listening to patient’s concerns, and responding respectfully. It also includes taking into consideration the patient’s rights, self respect and maintaining dignity. Provision of compassionate care and being empathetic is an important determinant of positive patient outcomes and recovery. Further, practioners must inform patent about every detail of treatment and include in decisions to reduce anxiety. Family members should be involved for promoting greater support. Based on evaluation and analysis, it can be concluded that patients remember the   negative experience more than the positive ones. It can be concluded from the reflection that self awareness of skills, attitudes and knowledge is essential for professionals to drive high quality and safe care.

My future plan is to develop active listening skills to address the patient queries diligently. I will spend adequate time with the patient to develop therapeutic, compassionate relationship and ensure dependability. I will work on my verbal and nonverbal skills to ensure positive outcomes through communication. I will be transparent, honest and maintain integrity so that the patient can develop faith and trust in health care service. To provide emotional support I will reassure her safety, involve family members and partners in decision making. To address their anxiety and confusion, I would detail the purpose of the procedures and state the numbers and relevant facts/figures. These measures will improve the emotional and physical wellbeing of the patient as evident from literature. The reflection helped to understand effective communication could improve the recovery of cancer patient, give them confidence, satisfaction and increase health outcomes.  It plays a great role in coping mechanism during cancer treatment. Therefore, I will cater to clients needs, rights, preserve dignity and deal respectfully.  I will take patient’s feedback and apologise for any fault from my end.

Conclusion

In conclusion reflection plays a significant role in evaluating and analysing a situation to identify the areas of improvements. Refection increases self awareness and ability to perceive others concerns. It is an effective tool to update personas skills, attitude and knowledge based on the current demand of profession. At personal level it is effective method to deal with real life situations by developing critical thinking and problem solving skills. Hence, all the students and professional must adopt reflective practice.  Such practice helps us tune our behaviour as per patients needs even though we cannot control the disease and it impact. However, responding to the disease is under our control. The practioners could have behaved professionally which would not have exacerbated Michelle’s anxiety already caused by treatment. Lack of communication, compassion and empathy affects a cancer patient’s recovery more than the side effects of illness.   One can eliminate these elements by adhering to professionals standards of code of conduct.  My future plan is to overcome such communication issues.

References

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