|
COPYRIGHT 2004 Jannetti Publications, Inc.
Screening for prostate cancer is controversial. Treatment choices for verified cases of prostate cancer provide another level of controversy as to which treatment, if any, is best. This controversy and uncertainty create a dilemma for the newly diagnosed patient. A great deal of information must be assimilated if the patient is to make an informed decision to pursue any treatment. A metropolitan Veterans Affairs hospital has created a model to assist the newly diagnosed prostate cancer patient in acquiring this information, while helping him through the decision tree. This model, which utilizes the skills of the advanced practice nurse, strives toward maintaining the patient's autonomy while clarifying these uncertainties, introduces the concept of shared decision making, and provides a potential support group.
**********
Prostate cancer is the second most prevalent cancer among American men and is the second leading cause of cancer deaths. Estimates of incidence range from 1 in 11 to 1 in 5 men who will be diagnosed with prostate cancer at some point in their lives. Approximately 220,900 new cases were diagnosed in 2003, with an estimated 28,900 deaths (American Cancer Society, 2003). Prostate cancer is a disease that usually affects men age 50 and older. African-American men have the highest incidence of prostate cancer in the world. These men are more likely to be diagnosed at later stages of the disease and have a higher death rate from prostate cancer than Caucasian men (Centers for Disease Control and Prevention [CDC], 2003).
A new diagnosis of any illness may provoke feelings of uncertainty and anxiety. A diagnosis of cancer carries with it a particular sense of dread and may magnify those feelings. An individual with a new diagnosis of cancer is likely to feel frightened, confused, anxious, and/or vulnerable. Prostate cancer is no different in eliciting such tumultuous emotions. In fact, the controversy over the efficacy, and even necessity, of prostate cancer screening and treatment only adds to the patient's dilemma of uncertainty (Woolf & Rothemich, 1999).
Uncertainty as a conceptual component of illness has been studied (McCormick, 2002). The shock of a newly diagnosed illness may leave the patient in a cognitive state in which the value, meaning, or outcome of a particular event cannot be perceived or predicted. This uncertain state can leave the decision maker, in this case the patient, in an ambiguous fugue (Mishel, 1988) in which he finds it difficult to discern any clear path towards health. The patient's thinking may be clouded by the fact that he is now a "victim" of a disease state.
Probability, temporality, and perception are all attributes of uncertainty in a disease state (Morse, 2000). Probability refers to the likelihood of something happening. Temporality refers to duration, pace, and frequency of the condition. Perception refers to the individual's impression or interpretation of the given situation. For example, the patient, upon hearing of his diagnosis, may be thinking: What are my chances of survival? (probability), How long do I have? (temporality), and What does this all mean? (perception). A high level of uncertainty is positively correlated to a high level of emotional stress. However, uncertainty can be "a door to hope, an opportunity to challenge," not just a threat (Babrow, Kasch, & Ford, 1998, p. 9). The basic way of opening that door for opportunity is to provide the information that the patient is lacking. This information gives the patient a frame of reference, which begins to dispel the uncertainty (Maliski, Heilemann, & McCorkle, 2002; McCormick, 2002).
Educating the patient and spouse, or other family members, about prostate cancer facts/treatments becomes of paramount importance. Much of the prostate cancer information obtained is from nonmedical sources, such as family, friends, and lay literature (O'Rourke & Germino, 1998). This can result in many conflicting opinions and misinformation, may increase the patient's uncertainty, become a barrier in the decision-making process, and can delay treatment altogether.
Review of Literature
Sources of uncertainty. There is lack of clinical consensus on which treatment, if any, is best for...
Read the full article for free courtesy of your local library.
|
Bookmark this article
Print this article
Link to this article
Email this article
Digg It!
Add to del.icio.us
RSS
