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Empowering patients to manage their own health

Watch this video case study to view how the GP talks to his patient about managing her own her own health post cancer treatment
Hi, Martina. How are you? Really good. Yeah, I’m feeling much better than I expected to a few months ago. I’ve been exercising and looking after my diet. Barry and I have even actually got out and actually done exercise together, which is pretty cool. We both lost weight, which is kind of a weird, happy bonus. I’m feeling really positive, but it’s also that nagging feeling that stays with me about, what happens if the cancer returns? Will I know, how do I know? And then feeling kind of bad for thinking that, because it’s actually going really well. First of all, Martina, you’re looking really good, and I’m really pleased to see you today. Thank you.
I just heard you said you were exercising and eating well. I think Jackie organised some of these support services last time through the care plan. So who have you seen? I’ve seen the exercise physiologist and the dietitian, and yeah, getting benefits from both. I didn’t realise that healthy food could taste so good. Yeah, so really, we’ve been paying much more attention to what we’ve been consuming, which is good. And also, it’s been really helpful for us, just in terms of our relationship, too, to kind of come back to a level of normal, which is nice. You’ve obviously linked in with the dietitian and the physiologist. I guess part of it now is you and Barry.
And you said Barry’s lost a little bit of weight. Is that right? Yes, he has. Wow. But part of this year, what we should focus is that you really are promoting this change and making sure that it sticks. And I think it’s really important that you maintain good diet, good exercise. Now, you mentioned about recurrence and your worry about that. I know I shouldn’t be, because things are going well. But if I could have a scan every morning, I’d be really happy. Because I’m just worried that if I miss something, what if something’s changed and I don’t notice, and I don’t know what I should be looking out for. And if I do, what do I do about it?
Well, I think a lot of patients go through exactly the same thing. The good news is that you don’t have to have a scan every day. But I guess some of the things that we might watch out for, and I’ll mention a few of them, first of all, around the breast area. We’re concerned if you noticed a new lump on the left side and also on the other side, as well. If you noticed any nipple changes. for us, that’s a flag for you come in and speak to me, and I’ll do a history and examination. You mentioned loss of weight, but if there is unexplained loss of weight, that’s a concern.
If you’ve lost some appetite, we need to know about that. I guess, lastly, if you feel a little bit more short of breath, tired, just something’s not right, do come in. We’re always here to have a look and make sure everything’s going OK. So is it the minute I see changes? Like, I don’t want you to be running scared every time I see you, going, she’s here again. But do I contact you straight away if I see something change? I think initially that’s probably something you might want to do. And obviously, you’ll get a feel about what’s normal for you, but something’s not right. I guess it’s a fantastic linkage that we have between general practitioner and a patient.
When I was with Jackie, we’ve done all the diet stuff and exercise. She also mentioned a psychologist. I guess talking about recurrence, surveillance, watching out for any cancer coming back, people are worried. And I think for us, that’s where a psychologist can help with your thinking about what you’ve gone through over the last period of time. It’s about just going through a grading process, talking about your feelings, the effect on you, work. We want you to feel back to normal, get back to work, all of that, and obviously making sure that you’re feeling you’re actually on top of things. I think a psychologist would be a wonderful idea. I think Jackie mentioned last time a name of psychologists nearby.
What are your thoughts about seeing a psychologist? I am keen to do whatever. And I don’t want my negative thinking to create problems that are not there, and I’m worried I’m going to talk myself into having cancer again. So I’m happy to say yes to anything at the moment. Yeah, so we work with psychologists. We think they’re valuable to patients with cancer. So I’ll write that referral. We’ll actually make that appointment, as well, so they’re first up. And I think we’ll touch base obviously when I see you next time and how those sessions have gone. Any other questions about the psychologist? No, just let’s get it started, I guess.
OK, so I’m going to go to the computer, type away, OK?

As you will have seen in the video above, after Martina’s last consultation with Jackie (the practice nurse) she was asked to check back with her GP (Justin) about ways to manage her own health. In this activity, we’ll be exploring self-management in more detail.

Self-management is the process through which survivors take control of their lives after undergoing the mental and physical stress of a cancer diagnosis. Although self-management can be defined in various ways, all definitions share a common need for extending care beyond just medical advice. Self-management allows patients to take back their self-efficacy, independence and empowerment.

Self-management as defined in the article by Barlow et al (2005) describes this process as:

  • Improving the health and wellbeing of the patient
  • Reducing the patients need to have constant visits to health professionals
  • Empowering the patient to take responsibility for their own health

As a PCP you will first need to understand the demands of cancer survivorship for the individual patient. Communicating this to the patient and their supportive care teams is paramount in introducing self-management skills. Survivors need to acknowledge:

  • The need for regular participation in routine visits but less frequent oncology visits
  • The ability to be able to understand the signs and symptoms of disease recurrence
  • The importance of managing and adjusting to the late-term effects of cancer and cancer-treatment
  • Adapting back into normal routines and becoming more involved in social roles is important going forward, and
  • Being able to deal with residual psychological distress in order to minimise negative impacts on their quality of life.

This is not a one-size-fits-all approach, which is important to remember. And as a PCP, it is vital to support patients by educating them about the concept of self-management, and the importance of self-management throughout the survivorship phase.

By helping to empower patients throughout the survivorship phase, they will feel more in control of their own ongoing health and wellbeing. They can acquire the skills and be made aware of the resources to help them problem-solve, make better informed decisions, and enable them to take action and form stronger partnerships with their healthcare providers.

To discover more about self-management, read the article Self-Management: Enabling and empowering patients living with cancer as a chronic illness and consider how you would apply aspect of this model to your care of cancer survivors.

Do you agree that when put together, these elements result in a productive partnership between informed and engaged patients aligning with well-prepared and proactive practice teams? Share your thoughts with others by posting your response in the comments section below.

References: McCorkle, R., Ercolano, E., Lazenby, M. Schulman-Green, D., Schilling, L.S. Lorig, K., & Wagner, E. H. (2011). Self-Management: Enabling and empowering patients living with cancer as a chronic illness. CA: A Cancer Journal for Clinicans, 61(1), pp50-62

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Cancer Survivorship for Primary Care Practitioners

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