Article 1
Quality of life in patients with Cushing’s Disease
This article provides an overview of Cushing’s Disease (CD) and Cushing’s Syndrome (CS) disorder and the quality of life in patient living with the condition. Cushing’s Disease, also known as Cushing’s syndrome, is a relatively uncommon illness by appalling cortisol excess, dramatically influencing the quality of life (QoL). The conditions may lead to comorbidities that disrupt an individual’s daily life, such as myopathy, fatigability, osteoporosis, depression, and cognitive alternation (Santo et al., 2019). The critical point to note in people suffering from this condition is that signs such as altered psychology encompassing depression and anxiety are very common and are good indicators for impaired quality of life. In addition, even after the people living with these conditions are treated, their quality of life remains jeopardized. It may not be fully restored since their recovery after treatment is not always complete, and in most cases, the comorbidities will persist. Cushing disease is prevalent among women, with a women/men ratio ranging between 3 to 5.
Santos et al. (2019) have demonstrated that several tools can measure the quality of life. However, it is critical to choose one with better psychometric properties and validated when selecting a tool. Most researchers have always used questionnaires to measure the health-associated quality of life (Santo et al., 2019). Questionnaires are the most preferred because they are easy to use and administer in research and clinical practice. The generic questionnaire may be used on any person, both the healthy and the sick. This may provide a baseline of comparison between the fit and the ill population studied.
Tritos and Biller (2019) posit that the QoL is significantly impaired amongst patients with an active illness. In Cushing’s Disease (CD), quality of life is worse than in control and patients with pituitary edema. In pituitary-dependent Cushing’s Disease, the quality of life is impaired. Moreover, this research study has also revealed a negative correlation between the mental component score of SF36 amongst patients with CD and urinary free cortisol. Medical treatment can help improve patients’ health outcomes and quality of life. For instance, a patient suffering from CD and who was administered pasireotide had improved quality of life compared to those who were not. The improvement in the quality of life was linked to lowering the urinary-free cortisol level.
Article 2
Giving Voice to Patients Values Throughout Cancer: A novel Nurse-Led Intervention
According to this article, optimal care plans enable patients to elucidate their values as a foundation for making prudent decisions in healthcare. Nonetheless, this may not happen when the patients are unstable health-wise. According to Epstein and colleagues, their research objective in this study was to test the feasibility and accessibility in highly occupied oncology care units, especially the novel program of systematic nurse-led values regarding oncology care and a discussion with all new cancer patients. This study methodology employed in this research involved the oncology nurses in this study were trained on how to specific questions and how to be empathetic when dealing with patients with such conditions to retrieve the best information suitable for the research study. The training of the nurses on how to use the communication framework of empathy helped the ineffective collection of even sensitive health information from the research participants. A total of 177 discussions was conducted. Of the number, 67 were new cancer patients (50 with gastrointestinal malignancies and 17 hematologic). No patients declined to discuss their health issues during the discussion. Therefore, this research study revealed that discussions led by nurses on patients’ values immediately after examinations are acceptable and feasible in a busy oncology unit. According to Epstein et al. (2019), no measure of quality care for cancers is immensely important than providing care with fundamental health-associated values. In this case, it is what is essential providing better meaning to life. Epstein et al. (2019) state that the best healthcare service should be patient-based, and failing to streamline treatments with values is considered a medical error.
Article 3
Integration of Genomics in Cancer Care
This article mainly introduces nurses to how genomic genetics are integrated into cancer care from prevention to complete treatment and influencing the oncology nurse. According to this study, cancer is considered heterogeneous at the molecular level, with the etiology of cancer underlined. According to Maria and Colleagues (2013), having a better understanding of the treatment and development of both hereditary and sporadic cancers is critical in assessing cancer risk, prevention, diagnosis, and treatment. In addition, the paper also explains that rapid development and advancement in the genomics of genetics is revolutionizing all the aspects of cancer care, something which has a more significant implication in the practice of nursing. In addition, this article has a strong belief that nurses have the ability and technical capacity of educating the patients as well as their families on the advancement of the genetic genome hence advocating for the application of evidence-based genetic genome practice in reducing cancer risks while making sure better health outcome for cancer patients all the time. According to the article, finishing the Human Genome Project in 2003 changed scientific research focusing only on single genes like BRCA1 and BRCA2. Consequential to the change, the human genome project has made it possible for scientific research to focus on multiple genes and factors that regulate and modify the expression of genes. Notwithstanding, the article has also pointed out that genomic and genetic factors are the causes of all cancers. The accumulation of altered genes has been a significant contributing factor to carcinogenesis’s complexities. Continuous cell genome instability results in the abnormal proliferation of cells, cancers, and tumors.
Key Concepts Learnt from Article 2: A Research Study by Epstein and Colleagues (2019)
Epstein and colleagues conducted research on the Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention. From the study, important concepts regarding patient care, especially the new oncology patients have been discussed. Some people believe that conducting a feasibility and accessibility test in a busy oncology health care unit is never possible. However, this research has shown that it is possible. No quality level of cancer care is very significant than providing care with the core healthcare values. Cancers compromise the basic identity and dignity; hence there is a need to discuss the various treatment options and their benefits and related healthcare burden they have on patients. Patient value exploration is important in affirming patients’ autonomy and personhood. More often than not, patients are interested in seeing clinicians discuss their values so that their treatment and care plan may be done accordingly.
Based on this article, it is evident that patients’ values are not frequently addressed. If discussion of patients’ values continues to be made at the tail ends when incapacity and inability may limit patients from getting involved directly in their care plans, surrogates and clinicians will continue to struggle to make patient-centered discussions. Advanced directives may not benefit patients and their care plans; however, they only depict end-of-life preferences. According to Lynch et al. (2022), a comprehensive conversation of values early enough in the treatment line is critical in informing ongoing decisions regarding the treatment and care for newly diagnosed cancer patients.
The study also revealed that most clinicians are not well trained in eliciting values, which poses a significant challenge when discussing sensitive care information with patients (Lynch et al., 2022). Even though physicians normally spearhead the discussion concerning the acromegaly and treatment plans for patients, an oncology nurse may be suited to engage patients early enough as far as values discussion is concerned. Oncology nurses are adequately trained to spearhead values discussions. Their training is well incorporated with a better communication framework full of empathy that enables patients to be free to participate in the debate concerning their care plan. The past efforts in promoting patients’ advanced care plans have focused on specific preferences for interventions mainly given towards the end of life, hence reaping minimal success to cancer patients.
The concepts learnt from this paper were not very new, even though there were several concepts that I learnt from it. The article enlightened me enlightened my understanding of patient value discussion. I have always believed that nurses have a limited role in patient value discussion and planning of care. However, this article has unearthed my potential and role as a nurse inpatient value discussion. Since most physicians have little training on patient values discussion, nurses are the best suited to engage in this course. This is because of the empathetic communication framework they are subjected to during their training. The information presented in this article remains poignant to oncology nurses’ treatments and care plans. Patients are always interested in seeing physicians discuss their treatment plan and values as early as possible; nonetheless, the discussions are typically towards the end stages of life, which has never been quite beneficial to patients due to the limited health outcome on the patients. A team makes treatments decision of oncologists who need to understand a patient as a human being and what they value highly in life as a requirement for patient-based and goal-oriented decision making.
Molloy’s value system encompassing community, service, spirituality, and study is closely related to this article in the following ways. Regarding the community as a value, Molloy embraces new faces and acknowledges diversity. This is closely related to the article because new oncology patients are welcomed. The patients’ values are discussed indiscriminately (Molloy College, 2022). Study season at Molly College represents a period for growth and new life. The intellectual life is well expressed in the ability to be curious and open to nurturing budding new ideas. The paper encourages open discussion of patients’ values and care plans in the early stages to help better decision-making. The spirituality aspect brings people’s reflection and ability to appreciate the beauty in their surroundings (Molloy College, 2022). Notwithstanding, spirituality directs people into having a more profound knowledge of self. The reading encourages open discussion between patients and care providers to understand better their challenges, which then informs their direction of care.
References
Epstein, A. S., Desai, A. V., Bernal, C., Romano, D., Wan, P. J., Okpako, M., Anderson, K., Chow, K., Kramer, D., Calderon, C., Klimek, V. V., Rawlins-Duell, R., Reidy, D. L., Goldberg, J. I., Cruz, E., & Nelson, J. E. (2019). Giving voice to patient values throughout cancer: A novel nurse-led intervention. Journal of Pain and Symptom Management, 58(1), 72-79.e2. https://doi.org/10.1016/j.jpainsymman.2019.04.028
Lynch, K. A., Bernal, C., Romano, D. R., Shin, P., Nelson, J. E., Okpako, M., … & Epstein, A. S. (2022). Navigating a newly diagnosed cancer through clinician-facilitated discussions of health-related patient values: a qualitative analysis. BMC palliative care, 21(1), 1-9.
Molloy College. (2022). Molloy college: Four pillars of Dominican life. Molloy College: Affordable undergraduate and graduate degree programs at one of the top colleges in America. https://www.molloy.edu/about-molloy-college/mission-statement/four-pillars
Santos, A., Resmini, E., Martínez Momblán, M. A., Valassi, E., Martel, L., & Webb, S. M. (2019). Quality of life in patients with Cushing’s Disease. Frontiers in Endocrinology, 10. https://doi.org/10.3389/fendo.2019.00862
Tritos, N. A., & Biller, B. M. K. (2019). Current management of Cushing’s Disease. Journal of internal medicine, 286(5), 526-541.
WHO. (2020). WHOQOL – Measuring Quality of Life| The World Health Organization. WHO | World Health Organization. https://www.who.int/tools/whoqol
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