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Nursing implications: Managing pain in the geriatric oncology patient
J O U RN A L OF GE RI A T RI C O NC OL O G Y 3 ( 2 01 2 ) S 1 0 –S2 5
moment for the assessment of pain in the cognitively impaired. To overcome difficulties in auditing cancer-related pain several questions related to pain measurement need to be answered. 1
Not all the biographies were available at time of printing.
doi:10.1016/j.jgo.2012.10.146
F13 Nursing implications: Managing pain in the geriatric oncology patient1 M. Routt. James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA Pain in the older adult with cancer is often under reported and under treated.1 It is estimated that as many as 80% of older persons diagnosed with cancer experience pain at some point during the cancer care continuum.2 Oncology nurses perform pain assessments, administer pain medications, educate patients and families, and implement nonpharmacologic interventions, and are therefore vital members of the multidisciplinary oncology team. Nurses are with the patient twenty four hours a day/seven days a week and are often the first responders with regards to pain management. There are many barriers in effective pain management in the older adult. Barriers exist across all levels of care starting with the patient extending upward through to hospital systems. Older adults with cancer present unique challenges in terms of pain assessment and management. Nurses' understanding of pain management has been shown to be insufficient across many studies.3,4 Inconsistent and inappropriate use of assessment tools contributes to poor pain management of the patient with cancer. Optimum management requires a comprehensive treatment program involving functional restorative and psychosocial modalities. Nurses are in a unique position to contribute to effective, individualized pain management plans. References [1] Beck SL, Towsley GL, Caserta MS, Lindau K, Dudley WN. Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nursing 2009;32(5):359–369. [2] Rao A, Hill HJ. Symptom management in the elderly cancer patient: Fatigue, pain and depression.. Journal of National Cancer Institute Monogram 2011;2004(32):150–157. [3] Klassen BL, Liu L, Warren SA. Pain management best practice with older adults: Effects of training on staff, knowledge, attitudes and patient outcomes. Physical &Occupational Therapy in Geriatrics. 2009;27(3):173–196. [4] Al-Shaer D, Hill P, Anderson M. Nurses' knowledge and attitudes regarding pain assessment and intervention.. Med Surg Nursing. 2011;20(1):7–11. 1
Not all the biographies were available at time of printing.
S15
worldwide. In most countries caregiving to sick elderly is provided by family members, usually women. In the US, it has been estimated that 90% of elderly patients are cared for by relatives who provide assistance in the form of financial support or of help in daily activities, or both. Caregiving to elderly patients with cancer poses many physical, psychological, financial, social and ethical challenges, as many patients suffer from concomitant illnesses or frailty, while caregivers tend to be themselves older and often not in good health. Understanding and studying the needs of elderly cancer patients and their caregivers, and meeting them adequately, is becoming an integral part of patient– family-‐centred medicine. Many social and ethical ramifications accompany the shift toward patient-‐family-centred cancer care. Among them, we find issues of patient autonomy, privacy, crosscultural differences and balance in addressing both the needs of elderly cancer patients and those of their caregivers. Respecting and fostering elderly cancer patient autonomy is a key ethical issue in geriatric oncology. Elderly cancer patients may suffer from several physical, mental or functional limitations that may create ethical dilemmas for oncology teams and caregivers with regard to respecting patient autonomy, while also providing full and adequate support to those elderly who need it. It has been reported that many family caregivers tend to substitute themselves to their elderly sick relative in the communication and decision-‐making processes, even when the patient capacity is not diminished. Furthermore, not all elderly cancer patients wish to have the same degree of family involvement in their illness and life. Cultural differences play a central role in determining people's perceptions and attitudes toward life and death as well as toward caregiving for a sick relative. Culturally sensitive communication and the practice of cultural competence are ethical requirements for geriatric oncology professionals. Traditionally, in most western societies health professionals carried responsibility only toward their patients. In other cultures, centered on traditional family, community and religious values, health professionals attend to the patient and his or her family as a unit of care. In today's practice of global oncology, also in western cultures, there is a shift toward assuming broader responsibility for the cancer patient’ families during the illness course and in the grieving stage. The patient-‐family-‐centered oncology requires a reappraisal of the roles of oncology professionals as they shape the new partnership with patients and their caregivers. For example, ethical issues related to privacy are going to become increasingly common. Caregivers often require medical, psychological and social support, including financial and legal assistance. Geriatric oncology professionals must learn to integrate and tailor interventions toward the needs of both care recipients and caregivers. Providing psychosocial support to caregivers of elderly cancer patients has become an ethical duty of oncology professionals and policy makers and an integral part of geriatric cancer care. 1
Not all the biographies were available at time of printing.
doi:10.1016/j.jgo.2012.10.148
doi:10.1016/j.jgo.2012.10.147
Nutritional issues Caring for carers F14 Ethics of caregiving for elderly cancer patients1 Antonella Surbone. Department of Medicine, New York, NY, USA Parallel to the aging of the world population and the consequent increase of chronic illnesses, including cancer, we are witnessing a rapid growth in the number of informal caregivers to elderly cancer patients
F15 SIOG 2012 — Nutritional issues — Screening for malnutrition1 Zeno Stanga. Department of Endocrinology, Diabetes and Clinical Nutrition, Department of General Internal Medicine, University Hospital, Bern, Switzerland Objectives of my presentation: 1. To learn the principles and practice of nutritional screening; 2. to interpret the results of several
moment for the assessment of pain in the cognitively impaired. To overcome difficulties in auditing cancer-related pain several questions related to pain measurement need to be answered. 1
Not all the biographies were available at time of printing.
doi:10.1016/j.jgo.2012.10.146
F13 Nursing implications: Managing pain in the geriatric oncology patient1 M. Routt. James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA Pain in the older adult with cancer is often under reported and under treated.1 It is estimated that as many as 80% of older persons diagnosed with cancer experience pain at some point during the cancer care continuum.2 Oncology nurses perform pain assessments, administer pain medications, educate patients and families, and implement nonpharmacologic interventions, and are therefore vital members of the multidisciplinary oncology team. Nurses are with the patient twenty four hours a day/seven days a week and are often the first responders with regards to pain management. There are many barriers in effective pain management in the older adult. Barriers exist across all levels of care starting with the patient extending upward through to hospital systems. Older adults with cancer present unique challenges in terms of pain assessment and management. Nurses' understanding of pain management has been shown to be insufficient across many studies.3,4 Inconsistent and inappropriate use of assessment tools contributes to poor pain management of the patient with cancer. Optimum management requires a comprehensive treatment program involving functional restorative and psychosocial modalities. Nurses are in a unique position to contribute to effective, individualized pain management plans. References [1] Beck SL, Towsley GL, Caserta MS, Lindau K, Dudley WN. Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nursing 2009;32(5):359–369. [2] Rao A, Hill HJ. Symptom management in the elderly cancer patient: Fatigue, pain and depression.. Journal of National Cancer Institute Monogram 2011;2004(32):150–157. [3] Klassen BL, Liu L, Warren SA. Pain management best practice with older adults: Effects of training on staff, knowledge, attitudes and patient outcomes. Physical &Occupational Therapy in Geriatrics. 2009;27(3):173–196. [4] Al-Shaer D, Hill P, Anderson M. Nurses' knowledge and attitudes regarding pain assessment and intervention.. Med Surg Nursing. 2011;20(1):7–11. 1
Not all the biographies were available at time of printing.
S15
worldwide. In most countries caregiving to sick elderly is provided by family members, usually women. In the US, it has been estimated that 90% of elderly patients are cared for by relatives who provide assistance in the form of financial support or of help in daily activities, or both. Caregiving to elderly patients with cancer poses many physical, psychological, financial, social and ethical challenges, as many patients suffer from concomitant illnesses or frailty, while caregivers tend to be themselves older and often not in good health. Understanding and studying the needs of elderly cancer patients and their caregivers, and meeting them adequately, is becoming an integral part of patient– family-‐centred medicine. Many social and ethical ramifications accompany the shift toward patient-‐family-centred cancer care. Among them, we find issues of patient autonomy, privacy, crosscultural differences and balance in addressing both the needs of elderly cancer patients and those of their caregivers. Respecting and fostering elderly cancer patient autonomy is a key ethical issue in geriatric oncology. Elderly cancer patients may suffer from several physical, mental or functional limitations that may create ethical dilemmas for oncology teams and caregivers with regard to respecting patient autonomy, while also providing full and adequate support to those elderly who need it. It has been reported that many family caregivers tend to substitute themselves to their elderly sick relative in the communication and decision-‐making processes, even when the patient capacity is not diminished. Furthermore, not all elderly cancer patients wish to have the same degree of family involvement in their illness and life. Cultural differences play a central role in determining people's perceptions and attitudes toward life and death as well as toward caregiving for a sick relative. Culturally sensitive communication and the practice of cultural competence are ethical requirements for geriatric oncology professionals. Traditionally, in most western societies health professionals carried responsibility only toward their patients. In other cultures, centered on traditional family, community and religious values, health professionals attend to the patient and his or her family as a unit of care. In today's practice of global oncology, also in western cultures, there is a shift toward assuming broader responsibility for the cancer patient’ families during the illness course and in the grieving stage. The patient-‐family-‐centered oncology requires a reappraisal of the roles of oncology professionals as they shape the new partnership with patients and their caregivers. For example, ethical issues related to privacy are going to become increasingly common. Caregivers often require medical, psychological and social support, including financial and legal assistance. Geriatric oncology professionals must learn to integrate and tailor interventions toward the needs of both care recipients and caregivers. Providing psychosocial support to caregivers of elderly cancer patients has become an ethical duty of oncology professionals and policy makers and an integral part of geriatric cancer care. 1
Not all the biographies were available at time of printing.
doi:10.1016/j.jgo.2012.10.148
doi:10.1016/j.jgo.2012.10.147
Nutritional issues Caring for carers F14 Ethics of caregiving for elderly cancer patients1 Antonella Surbone. Department of Medicine, New York, NY, USA Parallel to the aging of the world population and the consequent increase of chronic illnesses, including cancer, we are witnessing a rapid growth in the number of informal caregivers to elderly cancer patients
F15 SIOG 2012 — Nutritional issues — Screening for malnutrition1 Zeno Stanga. Department of Endocrinology, Diabetes and Clinical Nutrition, Department of General Internal Medicine, University Hospital, Bern, Switzerland Objectives of my presentation: 1. To learn the principles and practice of nutritional screening; 2. to interpret the results of several