Complete Guide To Mindfulness

Suja JohnkuttyHi there ! I’m Suja Johnkutty, MD a conscientious mom and neurologist . My one simple goal is to provide you honest, practical, simple action steps to experience better relaxation in your life. https://betterrelaxation.com

Sexuality During Cancer Treatment

This blog was originally published by Everyday Health by Diana Rodriguez on February 2, 2010, here.

You can still experience intimacy while undergoing cancer treatment. Understanding the changes you may be experiencing will help ease concerns about your sexuality.

Last Updated:  2/9/2010

Cancer treatment can have a huge impact on every aspect of your life, including your sex life. Although intimacy and sexuality may not be top priorities for cancer patients at first, as cancer treatment goes on, it’s likely to become an issue in your relationship. If you’re prepared for some possible changes in your body and your libido, you won’t be surprised by changes in your sex life.

Cancer and Sexuality: Intimacy Issues for Men

Cancer treatment may result in a number of different side effects, which will vary from person to person depending on the type of cancer and type of cancer treatment. Common sexual side effects that male cancer patients may experience during or following treatment include:

  • Low libido
  • Genital pain
  • Reaching orgasm too quickly
  • Nausea, fatigue, pain, and depression that can lead to sexual problems or loss of interest
  • Anxiety or concern about intimacy and sexuality, such as how you will perform or how you look
  • Infertility
  • Inability to release semen during orgasm
  • Erectile dysfunction
Intimacy issues for women will also depend on the type of cancer, its treatment, and the individual. Common sexual problems and concerns of female cancer patients during and after treatment include:
  • Low libido
  • Vaginal dryness
  • Pain during intercourse
  • Tightening of the vaginal muscles, preventing intercourse
  • Infertility and early menopause
  • Possible inability to have an orgasm if treatment has affected the spinal cord

For both men and women, some issues may only be temporary, like low libido and pain during intercourse. Other problems, like infertility, can be permanent. It’s important to discuss these potential long-term issues with your partner and your doctor to find out what can be done to alleviate them or find alternatives, like adoption or freezing eggs or sperm in case of infertility.

Cancer and Sexuality: Preparation and Communication

Many cancer patients may be unprepared for changes in their sexuality and sex life during or after cancer treatment, making these side effects or sexual problems more difficult to address. Before you undergo cancer treatment, talk to your doctor about possible long-term sexual side effects that you can anticipate and what steps can be taken to remedy them.

As you re-engage in sexual relations, be open to new types of sexual contact as well as new positions that may make intimacy more comfortable as well as more pleasurable. Keep in mind that you may need products like vaginal lubricant or moisturizer to help with intercourse.

A healthy sex life is an important part of a healthy relationship, but it is only one part. Communication is also necessary. Worrying about your sex life may only make any problems worse, so talk to your partner about your fears, concerns, and limitations. Realize, too, that there may have been problem issues in your sex life before you received a cancer diagnosis — your relationship might benefit from addressing any prior concerns now, as you and your partner return to intimacy.

Cancer Treatment Making you Feel Sick? Exercise Can Help!

This blog was originally published by Everyday Health by Denise Schipani on August 13, 2019, here.

Research has confirmed it: Staying physically active during cancer treatment can help you feel less tired and nauseous, tamp down anxiety and stress, and alleviate neuropathy pain.

Last Updated:  8/13/2019

 

For safety, you may want to consider exercising with a friend, caregiver, or trainer.
For safety, you may want to consider exercising with a friend, caregiver, or trainer.

If you’re being treated for cancer with chemotherapy, radiation, or both, you know how taxing this regimen can be. The side effects are well-known: fatigue, pain, nausea, and neuropathy (pain caused by nerve damage), not to mention stressdepression, and anxiety.

Exercise can help you cope, says the American College of Sports Medicine, which certifies cancer exercise trainers in a program it runs in collaboration with the American Cancer Society. Whether you have cancer or are a cancer survivor, exercise can have a positive affect on your body weight, overall fitness, muscle strength, flexibility, and quality of life.

Plus, it appears that exercising makes cancer treatment itself go more smoothly, with fewer side effects. Kerry Courneya, PhD, professor of kinesiology, sport, and recreation at the University of Alberta in Edmonton, Canada, has done numerous studies on the benefits of exercise for cancer patients. Remaining as active as possible during treatment, he notes, can prevent fatigue during and after treatment, and there’s evidence it can also alleviate depression, improve sleep quality, and lessen joint pain and lymphedema (the buildup of lymph fluids under the skin, typically caused by removal or damage to lymph nodes during cancer treatment).

Here’s more about what exercise can do for you during cancer treatment:

Ease Fatigue and Nausea

In a study published in June 2015 in the Journal of Clinical Oncology, researchers at the Netherlands Cancer Institute divided 230 breast cancer patients into three groups. The first group engaged in a moderate-intensity aerobic and strength program, guided by a trained therapist; the second group was assigned to a low-intensity program, done at home; and the third group did no exercise at all. The women in the first two groups, who exercised either a lot or a little, all experienced less fatigue, pain, and nausea during chemotherapy. The women who benefited the most — who were able to tolerate chemotherapy the best — were those in the moderate-intensity program.

Allay Anxiety and Stress

In a report published in June 2016 by the Norwegian Institute of Public Health, a review of more than 100 studies found that exercise can improve cancer patients’ overall quality of life during treatment. For another investigation, conducted in Taiwan, researchers enrolled 116 lung cancer patients in a home-based program in which participants walked for about 40 minutes, three days a week. The study, published in February 2015 in the British Journal of Cancer, concluded that even this moderate amount of exercise over the course of treatment reduced participants’ levels of anxiety and depression.

Alleviate Neuropathy Pain

Chemotherapy-induced peripheral neuropathy (CIPN) is a form of nerve damage that includes burning pain, tingling, numbness, and sensitivity to cold in the hands, feet, or other parts of the body. In a study published in May 2016 in the Journal of Clinical Oncology, researchers randomly assigned patients receiving chemotherapy treatment to either an exercise or no-exercise group. The exercisers did a six-week at-home walking program, supplemented by gentle resistance training, and ultimately reported fewer symptoms of neuropathy.

Prevent Lymphedema

Lymphedema is swelling caused by a build-up of lymph fluid and is a common side effect of cancer surgery, specifically the removal of cancerous or potentially cancerous lymph nodes. Women who’ve had underarm lymph nodes removed as part of treatment for early breast cancer are at risk for this complication (the risk goes up with the number of nodes removed), and doctors often advise them to avoid exercises such as lifting weights.

Unfortunately, this recommendation runs counter to the findings of the Physical Activity in Lymphedema Trial, published in the journal Contemporary Clinical Trials. For this study, women who’d had lymph-removal surgery undertook a year-long program of supervised weight training. The results showed that women at high risk for lymphedema who lifted weights were 70 percent less likely to develop the condition than women at similar risk who did not weight train.

Improve Overall Fitness and Ease Recovery

Someone accustomed to a regular workout routine will find it frustrating to give up exercising during treatment, but even people who didn’t work out regularly before cancer will feel the negative effects of a suddenly sedentary lifestyle, says Robert Steigerwald, an exercise physiologist and certified cancer exercise trainer in Huntington, New York. Chemo and radiation may decrease your endurance, aerobic capacity, and muscle strength, which makes treatment tougher on you physically. Any amount you can work out, Steigerwald says, “puts you in a better place as you recover.”

The effects of exercise on cancer may have even more far-reaching impact, says Dr. Courneya. Researchers are investigating whether exercising improves responsiveness to treatment and long-term survival. “If exercise during treatment were shown to improve these cancer outcomes, I think that would be a game-changer,” Courneya says.

Advice to Keep in Mind Before You Lace Up

All cancers are different, as are all patients. Before you begin or resume exercising during treatment, be sure to talk to your oncologist or consult a cancer exercise trainer, and consider the following:

  • Allow for “down” days — scaling back your workouts, for instance, when you’re experiencing the worst side effects of treatments.
  • If you haven’t been regularly active before your diagnosis, begin with very low-intensity exercise; you might try taking a slow walk most days.
  • Avoid public facilities, such as pools or locker rooms, that may expose you to infection.
  • Avoid exercise or dramatically pull back if you are anemic (your red blood cell count is very low), neutropenic (your white blood cell count is very low), or thrombocytopenic (your platelet count is very low).
  • Consider exercising with a trainer, friend, or caregiver, for safety.
  • Stop working out and seek medical help if you become disoriented, dizzy, nauseated, short of breath, or feel any pain, such as muscle cramps or, particularly, chest pain.

 

6 Nutrition Tips to Protect Your Brain and Balance Your Mood

With 25 percent of adults and 10 percent of children experiencing mental illness each year and major depression burgeoning into a leading cause of disability around the world, it’s easy to feel stressed about the state of stress. However, recent research is revealing a new line of defense against mood disorders that’s a little bit different from the traditional approach of medication and therapy: the diet.

A growing body of data suggests our gut health directly influences brain development and mental health. It’s believed that the microorganisms residing in human guts, known as the microbiome, impact the generation and metabolization of neurotransmitters like mood-boosting serotonin and dopamine, along with other neuroactive chemicals.

Unfortunately, when people are experiencing mental illness or otherwise feeling down, they’re far more likely to reach for comfort foods that are high in fat, sugar, and refined carbohydrates than health food. But it turns out that comfort foods aren’t so comforting after all: Simple carbohydrates and processed foods have been shown to increase the risk of depression, while a diet rich in fruits, vegetables, and other whole foods seem to protect the brain.

So if you’re experiencing depression, anxiety, or other mood problems, and want to stop them before larger problems occur (or, if you just want to help prevent these issues from starting in the first place), how can you tailor your diet for a healthy brain?

  • Limit alcohol consumption. While it’s tempting to reach for a glass of wine after a tough day, heavy alcohol consumption can lead to addiction and actually exacerbate mood disorders by interfering with the body’s metabolization of tryptophan, an amino acid that’s critical in the production of serotonin.
  • Stick to complex carbohydrates. Simple carbohydrates like sugar, corn syrup, and refined grains cause blood sugar fluctuations that can lead to mood swings and brain fog. And while simple carbohydrates can provide a short-term serotonin boost, complex carbs like legumes, whole grains, and fibrous vegetables are much more effective at providing your brain lasting, stable serotonin.
  • Eat tryptophan. In order for carbohydrates to effectively boost serotonin, they need to be consumed alongside tryptophan. Tryptophan is an amino acid that gets converted into serotonin, and you’ll find it in proteins like turkey, duck, eggs, and beef.
  • Get your vitamins. Deficiencies of B12, folate, selenium, and vitamin D have all been linked to higher rates of mood disorders like depression. To make sure you’re getting enough of these important nutrients, consume plenty of seafood, lean meats, dairy, and eggs (B12, selenium, and vitamin D), and legumes, nuts, and dark leafy greens (folate). And spend plenty of time outdoors, even in the winter months, because sunlight is one of the best sources of vitamin D. Supplements can be a great tool, especially for vegetarians and vegans, but too much selenium and vitamin D can be toxic, so consult with your doctor before adding supplements to your diet.
  • Look for antioxidant-rich foods. Antioxidants have been connected to reduced cognitive decline and cancer risk, and evidence suggests that they can even help with moods. Deeply pigmented fruits and vegetables like berries, dark leafy greens, sweet potatoes, and carrots are all great sources of antioxidants, as are nuts, whole grains, legumes, and fish rich in omega-3 fatty acids.
  • Consume probiotics. Lactobacillus and bifidobacterium have been shown to reduce anxiety-like behavior in mice, and scientists believe the mood-enhancing benefits of these probiotic bacteria extend to humans. And while these beneficial bacteria may be difficult to pronounce, they’re easy to find. Look for fermented foods like yogurt, kefir, miso, tempeh, kimchi, sauerkraut, and kombucha that contain active cultures.

Eating well can go a long way toward promoting good mental health, whether you’re currently experiencing a mood disorder or just want to protect your cognition as you age. And while diet alone may not be enough to manage a mental illness, it’s an invaluable tool in the fight for a healthy, happy brain.


Image via Pixabay by Foundry

How To Cope With Cancer-Related Fatigue

We all know what it’s like to feel tired – physically, mentally and emotionally, but usually after some relaxation and a good night’s sleep, we are ready to take on the world again. When you have cancer, though, rest often isn’t enough. Fatigue caused by cancer and its treatments takes a toll on your stamina along with the emotional effects of cancer. Being diagnosed with cancer is highly stressful and we know that stress affects your state of mind, your sleep, and your energy levels too. Even after adequate sleep or rest, you still feel tired and unable to do the normal, everyday activities you did before with ease. You experience a persistent, whole-body exhaustion. You may find it hard to concentrate or to engage in your usual activities.

What is cancer-related fatigue?

Cancer-related fatigue (CRF) is increasingly recognised as one of the most common and distressing side effects of cancer and its treatments. It has a negative impact on work, social relationships, mood, and daily activities and causes significant impairment in overall quality of life.  It has been estimated that from one quarter to nearly all cancer patients experience fatigue during and after treatment. Although CRF generally improves after therapy is completed, some level of fatigue may persist for months or even years following treatment.  Studies of long-term breast cancer survivors suggest that approximately one-quarter to one-third experience persistent fatigue for up to 10 years after cancer diagnosis.

Some symptoms of cancer-related fatigue, according to the American Cancer Society are:

  • A constant feeling of tiredness that doesn’t ever go away or get better
  • Being more tired than usual before, during, or after activities
  • Feeling too tired to perform normal routine tasks
  • Feeling general weakness or lethargy
  • Lacking energy
  • Being tired even after a good night’s sleep
  • Inability to concentrate or focus
  • Inability to remember
  • Being sad, irritable or depressed
  • Easily frustrated or angered
  • Trouble sleeping/insomnia
  • Difficulty moving arms or legs

What medical help is available for cancer-related fatigue?

A lot of cancer patients do not report fatigue to their doctors because they think that nothing can be done for it. In fact, there are things that can be done to alleviate the debilitating effects of CRF.  If left untreated, fatigue may lead to depression and profoundly diminish your quality of life, so it’s important that you speak to your doctor if fatigue is an issue for you.

Before you can address CRF specifically, your doctor needs to determine if there are any underlying medical issues which may be contributing to your fatigue.  For example, if you are anaemic, you may need to take nutritional supplements like iron. Sometimes fatigue is confused with depression. It’s important, therefore, to be evaluated to distinguish between the two. You may experience one or the other, or both at once. But they are not the same. You may need treatment for depression before you can adequately deal with your fatigue.

6 Everyday Strategies To Cope With CRF

 

Making some adjustments to your everyday routines can also help you cope with CRF. Here are 6 ways to do this.

1. Make deposits in your ‘energy bank’

Don’t expect to be able to do what you could do before cancer. Know your limits and don’t expect too much of yourself. You may find it helpful to think of your energy reserves as your ‘energy bank’. Whenever you do an activity you make a withdrawal. And when you rest you make a deposit. It’s important to balance withdrawals with deposits. If you keep doing too much whenever you feel like you have energy, you’ll run out completely and not have any reserves left for the things that are important.

2. Plan your day

Planning is key when you have fatigue.  Write a ‘To Do’ list each evening so you can prioritize the things you need to do the next day.  By prioritizing in this way, you can use your energy on the activities most important to you. Spread your activities throughout the day during times when you feel best and take rest breaks in between activities.

3. Keep a fatigue diary

Keeping a fatigue diary – where you score your fatigue each day on a scale from 1 to 10, and record your activities – can help you think about patterns in your energy levels throughout the day.    This can make it easier to plan your activities for the times when you have more energy.

4. Do some regular light exercise

Although exercising may be the last thing you feel like doing, if you don’t exercise, you’re more likely to experience fatigue. In fact, a new study found that exercise and psychological interventions may be powerful tools in combatting cancer-related fatigue. Research has shown that there are many benefits to exercise. Not only does it help reduce the symptoms of fatigue, exercise encourages your body to release endorphins – often called ‘feel good hormones’. When released, endorphins can lift your mood and sense of well-being.

5. Eat healthily

When we are exhausted, we tend to gravitate towards processed, junk food which depletes our energy reserves further.  Follow a well-balanced diet (high in protein and carbohydrates, low in sugar) and drink plenty of fluids to avoid dehydration.

6. Adjust your work schedule

Talk to your employer about making adjustments to your work schedule. Discuss the possibility of flexible working hours, reduced working hours or working from home.  Ask colleagues to help you with some of your work.  Talk to your occupational health adviser if you have one. They have a duty to support you doing your job and help you with any health problems that may affect your work.

Though fatigue is a common symptom when you have cancer, there are steps you can take to reduce or cope with it. There’s no one way to diagnose or treat cancer-related fatigue. Try some or all of these coping tips until you find what works for you.

How Your Lifestyle Can Affect Genes That Cause Cancer

There are two schools of thinking about cancer.  School one says that cancer is a hereditary disease, passed from generation to generation.  A good example of this are women who possess the BRCA1 and BRCA2 gene mutation.  Women with this mutation have a 70% lifetime risk of developing breast and/or ovarian cancer.  Angelina Jolie, for example, lost her mother and aunt to cancer and was subsequently found to have the same mutation.

The second school says that cancer can occur due to lifestyle choices.  A good example of this is cigarette smoking. It is the number cause of lung cancer, linked to 80 – 90% of lung cancer cases.

Recently, researchers at the Boston University School of Medicine have introduced another theory about the development of cancer.  They proposed that there are processes within our cells that activate certain sequences of DNA.  Those processes act as on/off switches for the development of cancer.

This idea is based on the evolving science of epigenetics. Epigenetics looks at the way genes express or don’t express themselves as we age.  Those gene changes are thought to be influenced directly as a result of our nutrition and behavior, as well as exposure to toxins in our environment.  In a sense, it’s a hybrid of hereditary disease and lifestyle choices.

Epigenetics is a normal process in our bodies.  For example, all of our DNA is the same, yet cells develop into liver cells, brain cells, muscle cells, etc. because of the way epigenetics turns on and off different cell processes.  But our lifestyle choices can impact the way genes express themselves as well.

Perhaps you’ve heard the expression “Sitting is the new smoking.”  The reason for this is due to research on lifestyle and cancer.  The results of dozens of surveys found that a sedentary lifestyle increases the risks of cancer, specifically colon cancer.  Subjects who spent most of their day sitting were 24% more likely to get colon cancer.  People who watched the most television had a 54% greater risk than those who watched fewer hours.  Uterine cancer was also affected by sitting; women who were the most inactive experienced a 32% great risk.  The female T.V. watchers fared worse; those who watched the most television has a 66% risk of developing uterine cancer.

In all these cases, it’s not the inactivity per se that causes cancer to develop.  It’s the processes of epigenetics that are affected by inactivity that can cause cancer.

It’s a complicated and exciting time.  Next month, more on how unhealthy habits are incorporated into our DNA and passed onto our children.


Sources:

https://blogs.scientificamerican.com/guest-blog/lifestyle-choices-could-affect-gene-sequences-that-code-for-cancer/

http://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895

http://www.whatisepigenetics.com/fundamentals/2/

Reducing Your Risk of Cancer

The American Institute for Cancer Research (AICR) estimates that approximately one-third of cases of the most common cancers in the U.S. could be prevented, which accounts for about 374,000 cases of cancer per year. Cancer prevention is action taken to lower the chance of getting cancer therefore reducing the burden and deaths from cancer each year. Since February is Cancer Prevention Month, we wanted to highlight some ways to reduce your risk and protect yourself from cancer.

1. Eat a healthy diet & Stay active

Eating a balanced plant-based diet filled with a variety of vegetables, fruits, soy, nuts, whole grains, and beans can help lower your risk for many types of cancer and will help you maintain a healthy weight.

Adults should get et at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each day (or a combination of these), preferably spread throughout the week. While children and teens are recommended to get at least 1 hour of moderate or vigorous intensity activity each day, with at least 2.5 hours of moderate intensity aerobic activity each week.

2. Protect yourself from the sun

Sun exposure at any age can cause skin cancer. Be especially careful in the sun if you burn easily, spend a lot of time outdoors, or have any of the following physical features:

  • Numerous, irregular, or large moles
  • Freckles
  • Fair skin
  • Blond, red, or light brown hair

To block UV rays try covering-up, wearing sunscreen, wearing a hat, using UV-absorbent shades, and limiting you exposure time.

3. Get immunized

The human papillomavirus (HPV) vaccine helps prevent most cervical cancers and several other kinds of cancer, and the hepatitis B vaccine can help lower liver cancer risk.

4. Avoid risky behavior

Another effective cancer prevention tactic is to avoid risky behaviors that can lead to infections that, in turn, might increase the risk of cancer. Some behaviors to avoid:

  • Excessive alcohol consumption
  • Tanning beds
  • Tobacco use
  • Unsafe sex
  • Sharing needles

5. Get regular medical care and screenings

Along with regular check-ups with your physician to maintain an open health dialogue, cancer screenings should also be scheduled. These include the following:

  • Pap smear – Most women ages 21 to 65 should get Pap tests as part of routine health care. Even if you are not currently sexually active, you should still have a Pap test
  • Colonoscopy – Colon cancer screening should begin at age 50 for most people. If a colonoscopy doesn’t find adenomas or cancer and you don’t have risk factors, the next test should be in ten years.
  • Mammogram – Women should should get mammograms every year starting at age 40, for as long as a woman is in good health
  • Checking skin for irregular moles, etc.

Sources:

https://www.cdc.gov/cancer/dcpc/prevention/

http://www.mcancer.org/cancer-prevention

http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/cancer-prevention/art-20044816

https://www.osha.gov/Publications/OSHA3166/osha3166.html

17 Tips For Patient Engagement

To kick off 2017 and new year of patient engagement and empowerment, we are showcasing 17 tips from patients, caregivers, and leaders throughout the industry. A special thanks to our partner, The Conference Forum and their Patients as Partners US program, for helping to obtain a few of these excellent testimonials. Their tips and advice are as follows.

 

1. Jack Aiello

“Patients and their care partners need to get educated about their disease and become their own best patient advocates.  The internet can be a great resource where disease specialists create videos on topics from disease overview to treatments and side effects.  And by getting 2nd and 3rd opinions from disease specialists, you put yourself in the best possible position to make good decisions with your doctor.”


2. Randy Broad

One very important aspect of treatment, especially at the time of diagnosis, is to understand what treatment options your oncology team is recommending and why.  Many providers have ‘pathways’ which determine how a specific cancer (and stage) be treated.  Be sure to fully understand what’s behind and underneath this directive.  Many times it can be determined based upon cost, not best options currently available.”


3. Matthew Zachary

“Patients have the right to survive with dignity and quality and we deserve to be treated age-appropriately. More so, they also have the right to be made aware of the relevant support resources they are entitled to so they can get busy living. This is what it means to face cancer.”


4. Cindy Chmielewski

“Knowledge is power. Educated patients are empowered. Educate yourself. Join a support community either in-person or online; follow the #mmsm hashtag on Twitter; subscribe to disease appropriate YouTube channels, listen to webcasts/podcasts presented by patient advocacy organizations and engage in meaningful discussions with your healthcare team.

Be a partner in your care. “


5. Jennifer Ahlstrom

“Don’t be afraid to speak up. Patients who ask their doctor questions, ask for explanations and treatment rationales get better outcomes. Myeloma is a very complicated disease and there are now an incredible number of treatment options available for patients. If you don’t feel comfortable asking your doctor questions, it’s time to find another doctor, preferably a myeloma specialist who treats hundreds of myeloma patients.”


6. Marie Ennis-O’Connor

“Becoming an empowered patient means taking personal responsibility for your health. You engage with health care providers and systems in ways that are proactive, rather than reactive. You take positive steps in the direction of the care that is right for you.”


7. Scott Riccio

“Remember that YOU get to define value for your own care.  Nobody can read your mind, though, so you have to share what you value, how it impacts you, and what tradeoffs you are willing to make to get the outcomes YOU want.”


8. Andrew Schorr

“Ask your doctor questions! How can we be sure my diagnosis is 100% accurate? How much experience do you have treating this illness? Are there other tests that can help me get the most on-target treatment for my case? What are all the approved medicines for my situation? Why would you recommend one over another? What clinical trials could be right for me, whether or not you have them at this clinic/hospital?”


9. Esther Schorr

“As a care partner, it really is a time to be hopeful as the advances in cancer treatment are moving very, very fast. As it is for the patient you love, it is key to stay educated about advances in treatment options that might be right, and be actively involved in discussions about genetic testing and clinical trials.  It’s also critical to lean on your personal community…friends, family, counselors…in order to “keep it in the road” and retain realistic optimism. As more and more survivors and care partners reach out to each other and share stories, we all gain insights and perspective – and you will hopefully feel supported along the cancer journey. We are all in it together, and we are here for each other.”


10. Amy Ohm

“Caregivers need self-care to effectively care for a loved one – always make sure to put on your oxygen mask first! It can be incredibly challenging to focus on ones health with the daily demands of care-giving. Make 2017 the year you assess your own health and strive to reduce daily stress. Connecting privately with those who relate and to share experience to learn from others can help. We want you to be health in the New Year!”


11. David Wallace

“It is imperative that you gain a solid understanding of your disease so you can become your own advocate.  Connecting with other knowledgeable patients via social media or online forums to learn what has worked or failed to work for them is a good start.  Understand the treatment options that are available to you.  See an MPN specialist who will work with your local hematologist.  If you are not being treated with care and respect, don’t hesitate to seek a 2nd opinion and change doctors until you receive the level of care you deserve.”


12. Carol Preston

“NEVER hesitate to ask questions.  In fact, write down your questions in advance, take them with you to your appointment and go through them one by one.  Be sure to write down the answers (or get your care partner to take notes) as a short pencil is far better than a long memory.  Better yet, record the QA on your smart phone so that you can listen later to the answers as you’ll retain only about 10% of what the doc tells you during your appointment.”


 13. T.J. Sharpe

“Patients and caregivers can be better engaged in 2017 by reaching out to their patient community and actively becoming involved in the support of fellow patients through person to person and group interaction.  Patients and their caregivers can raise the bar for everyone involved in healthcare so that the expectations of patients as a partner in their care is not just accepted, but standard and demanded by patients.”


14. Marilyn Metcalf

“Set our goals together in the New Year, and then work together on our plans and make them happen.”


15. Durhane Wong-Rieger

“Patients are basically a heterogeneous lot, coming with all types of experiences and talents, as well as desires and needs.  Some patients want to have a voice in high-level  policy and system decision-making; some want to extend a personal hand of support.  The more diverse the channels and opportunities for involvement, the more patients can take active and meaningful roles. Every person naturally wants to feel respected and empowered so it doesn’t take much to engage patients: provide a portal, support, information, acknowledgement and most important action.”


16. Deb Maskens

“Patients and caregivers get information from a wide variety of sources, from personal anecdote to television advertising to medical journals. Empowerment and engagement for patients and caregivers in 2017 needs to start by providing them with more information that is trusted, balanced, and objective. Information is power. Let’s give patients and caregivers the information they need as the first step for them to be empowered and engaged in treatment decisions that are right for them as individuals.”


17. Jeff Folloder

“Resource management.  I’m not talking about managing the funds to pay for treatment or care.  I’m talking about managing you.  I got great advice from a lady in a waiting room at MD Anderson.  She told me that every day we wake up with a bucket of energy that we can spend on anything we want and it’s gone at the end of the day.  We can spend that energy on quality things and be tired and fulfilled.  Or we can spend it on silly things like worry and regret and go to sleep tired and empty.  She’s right.  And I remember her words every day.”

The Benefits and Pitfalls of Blogging About Your Illness

In his book, The Wounded Storyteller, Arthur Frank, Professor Emeritus of Sociology at the University of Calgary, writes that when we are ill we are wounded not just in body, but in voice. He describes how illness can radically alter how a person relates to the world and how we need to find a way to restore our fractured identity. When I was diagnosed with breast cancer over a decade ago, writing a blog, Journeying Beyond Breast Cancer, helped me express myself, reconnect to a new sense of self, and find my voice again.

Throughout her life, the writer Virginia Woolf maintained that her work was incomplete until it was shared with readers. And I think this is also true of being part of a blogging community. When we share our writing, someone else has heard our voice. Someone else cares and understands. So often, illness causes us to feel isolated and cut off from others. Blogging is a way for us to find a shared sense of connection and community.

the-benefits-and-pitfalls-of-blogging-about-your-illnessYet sharing our story online is not without its pitfalls; the most obvious of which is a loss of privacy. You should consider how revealing your medical history online might have an impact on your family and professional circumstances. How will your employer, co-workers, or other family members view you? Do you risk being over-identified with your illness? For me, disclosure of my own story has evolved from initial anonymity to a point where I now choose to share more openly. However, the degree to which I share information still depends on the space where I share it and the degree of trust I have with the people I share with (for instance I consider my blog a safe space to tell my story, but I am more cautious on Twitter). But what happens if that safe space is violated and our expectations of trust are shattered? When our words are taken out of context or used for a purpose we didn’t intend? Is information shared publicly implicitly available to everyone just because it is in the public domain? What are the ethics of research that includes collecting and analyzing patient stories or observing online behaviour without individuals knowing they are being included in research? In an age when technology has outpaced the ethical underpinnings of research and the culture surrounding privacy has changed profoundly, these are questions we need to find answers to.

Although we understand that what we share online is in the public domain, we nevertheless trust each other to maintain a collective sense of privacy, which includes not having our words reproduced without our knowledge or taken out of context. The issue of maintaining privacy in the public domain was brought into sharp focus two years ago when blogger Lisa Adams became the subject of an online debate. Adams, who blogged and tweeted about her experience of living with end-stage cancer, came to the attention of two journalists who strongly criticised what they called “Adams dying out loud.” Their opinions ignited a firestorm of debate about the public disclosure of illness, and the sharing of personal choices surrounding treatment and death and dying.

Illness makes us vulnerable and learning to navigate the digital landscape while also managing our vulnerability is a skill that we need to master if we are to protect ourselves online. Think carefully about what the process of online disclosure entails. Weigh up what you expect to gain from it and what implications sharing this information might have on your career or family life. If you are a parent or carer who writes about a patient, do you have their permission to share this information? In the case of writing about a child, what future effect might this have on one who cannot give consent or understand the significance of their story being shared so widely?

People have always gathered together to share what they know about health and illness, hoping to help and learn from others. What’s new is that we now have the ability to expand the reach of our conversations at internet speed and at internet scale. What happens in real life happens on line, but faster. This has many benefits, but it also means there is a higher potential for unintended consequences when we have less control over who sees our stories. It’s a good idea to periodically review the privacy settings on your social media accounts to decide if you are comfortable with the level of control you have over the information you share. Ask yourself, if your intended audience were sitting in front of you now, how comfortable would you feel sharing this information? How do you think you’ll feel after sharing it? Are you ready for feedback (positive or negative)? Remember sharing your story online doesn’t have to be all or nothing. Go slowly at the beginning, allow trust to build over time, and share only when you feel ready to do so.

Above all, be courageous in sharing your story. I am filled with gratitude for those who bravely blazed the trail in opening the discussion and decreasing the isolation connected with serious illness. I continue to be in awe of the connections and communities forged in the digital space and I look forward to seeing how this will evolve over time.

 

 

Chronic Illness: Oh, the Stress of It All!

(Melissa is a patient, advocate, and runs her own website www.curegp.com)

Everyone must deal with stress from time to time, and that is not necessarily a bad thing. Stress can actually be beneficial when it is short-term and low-level. It can boost your energy and memory, act as a motivator, and even enhance your physical strength. But those of us with chronic illness often battle prolonged stress, with few or no breaks, and this can be quite detrimental to our health. There is a growing body of evidence that indicates this type of stress can lead to serious health issues such as heart disease, migraines, stomach problems, high blood pressure, and depression. In order to avoid, or at least minimize these possible risks and effects, it is important to know how to recognize and manage potentially harmful stress.

Coping with stress can be particularly difficult for those of us living with chronic illness because of its long-term and serious nature. It comes with additional stressors that most other people do not face, and there is rarely a respite from these. Diagnosis is often accompanied by fear, confusion, and disbelief. Some of us experience apprehension because we feel we have not been given a proper initial explanation of our condition or enough information to manage it effectively. Conversely, there is commonly an overload of information to process regarding our numerous medications and the complex medical routines we must follow. We are often shocked by the overwhelmingly difficult lifestyle changes required of us. Upon initial diagnosis, many of us are confused and upset about the nature of our illness, its causes, its symptoms, our prospects for treatments or a cure, and the measures that will be required of us to accommodate the effects of our illness. We fear what the future holds.

There are other complications that concern us as well. It can be difficult to find a doctor who can (or will) treat us, and we must sometimes interact with several different physicians who manage our care. On occasion, we receive conflicting advice and recommendations from the medical professionals providing for our treatment. In times of medical crisis, we face decisions about whether it is appropriate to treat our illness at home, see our doctor, or perhaps visit the emergency room. Many of us struggle to find medications and treatments that work for us and must determine this through trial and error. Once we find helpful medications and treatments, we may face difficulty in gaining access to them and at times must battle with insurance companies who deny us coverage or physicians who hesitate to prescribe them. It can all be pretty overwhelming.

In addition to the hardship of dealing with the day-to-day management of the actual symptoms themselves, there are long-term concerns. Severe symptoms can eventually interfere with one’s social life and even jeopardize one’s career. Friends and family members may have unrealistic expectations about what a chronically ill person is capable of, and often, we ourselves have these same unrealistic expectations. We are regularly too sick to participate in social activities, and we feel much guilt over our withdrawal from social functions and gatherings we once found enjoyable. We may begin to feel increasingly cut off and isolated from the friends and family members we once knew. If serious enough, symptoms can result in missed days of work and eventual unemployment, which can lead to monetary woes. The loneliness, seclusion, and financial strain associated with these factors act as additional stressors and make it all the more difficult for those of us who are chronically ill to cope.

Indeed, life with chronic illness can be burdensome and stressful. Nonetheless, there are methods of averting or minimizing many of the factors that contribute to our stress. For starters, we can make an effort to prevent stress from occurring in the first place by educating ourselves. Searching the Internet, reading articles, asking questions of our doctors, and seeking out others with the same condition helps provide us with insight into our illness. It minimizes the fear of the unknown that accompanies our diagnosis and gives us an idea of what to expect in terms of symptoms, treatments, possible complications, and prognosis. It helps us recognize what is “normal” for our condition and what is cause for concern and aids us in preparing for what might be coming down the road.

We can also do our best to maintain a healthy lifestyle. (I am not suggesting we can attain perfect health; I am simply recommending doing whatever we can to be as healthy as possible given the limitations of our illnesses.) This might mean taking vitamins and supplements, exercising, making the most nutritious food/drink choices possible, getting adequate rest, and taking our medications as recommended.

In addition, we can work toward strong mental health. Rather than expecting “perfect” lives, we can focus on the good we have and be grateful for the small, joyful moments. Likewise, we can learn to manage the circumstances in our lives that can be governed and adapt to the ones beyond our command. (We may not be able to attend courses on a college campus, for example, but perhaps we can take online classes. Maybe we cannot make it to the movie theater, but we can view videos in the comfort of our own homes.) We can also forgive ourselves for our perceived shortcomings and pardon others for not acknowledging our limitations. We cannot control missing an event due to illness, but we can refuse to feel guilty and accept that we cannot “will” ourselves to be well. Our illnesses are real, and they come with genuine physical limitations.

Finally, we can learn to recognize the signs of harmful stress (i.e., mental confusion, anxiety, worry, depression, fatigue, altered sleep patterns) and seek help when we feel discouraged and defeated by joining support groups; talking to trusted friends, family members, and neighbors; or pursuing professional counseling. We can engage in pleasurable activities – such as reading, writing, listening to music, playing board games, etc. – that momentarily distract us from our debilitating symptoms. We can read encouraging books or practice relaxation techniques like yoga and meditation. We can ask loved ones for assistance or consider employing home helpers/aides to lend a hand with household chores or other tasks we have difficulty completing. Perhaps we can identify government and charitable programs (for prescription aid, low-income housing, reduced-cost medical care, and the like) that might ease our financial burdens.

We may not be able to entirely avoid the stress that results from our complicated and sometimes overwhelming circumstances, but we can learn to manage it. As chronic illness warriors, we face a constant, daunting battle against stress – but it is not one we must necessarily lose.

Mental Health & Cancer

Anxiety, fear and depression are commonly associated with life-changing events – especially cancer. People with cancer may find the physical, emotional and social side effects of the disease to be stressful. This stress may result from changes in body image, changes in family or work roles and physical symptoms due to treatment. Family members and caregivers often feel these same stressors, as they fear the loss of a loved one. They may feel angry because someone they love has cancer, frustrated that they “can’t do enough,” or stressed because they have to take on more at home. So many of these feelings are completely normal, but what is typical and when may outside help be needed?

According to The American Cancer Society, signs that the patient or a loved one may need help are the following:

  • Suicidal thoughts (or thoughts of hurting himself or herself)
  • Unable to eat or sleep
  • Lacks interest in usual activities for many days
  • Is unable to find pleasure in things they’ve enjoyed in the past
  • Has emotions that interfere with daily activities and last more than a few days
  • Is confused
  • Has trouble breathing
  • Is sweating more than usual
  • Is very restless
  • Has new or unusual symptoms that cause concern

If you or a loved one have experienced one or more of the above symptoms, there are many options for help.

Speak with your cancer team

If you find any of the above symptoms to be true, one of the first steps may be talking with your cancer team. Your team should be able to answer any questions, talk about your concerns, and, if needed, refer you to a mental health professional. Anxiety occasionally stems from the fear of uncertainty from treatment or medication side effects, so knowing what to expect may be the first step in coping.

Seek support

Once you have spoken with your cancer team and support system to determine a treatment plan, put it into action! Any of the below activities may supplement the treatment prescribed by your doctor in making both you and your loved ones feel less alone and anxious during this difficult time:

  • Training in relaxation, meditation, or stress management
  • Counseling or talk therapy
  • Cancer education sessions
  • Social support in a group setting
  • Online support groups
  • Medications for depression or anxiety

Get moving

Exercise has been proven to improve individuals’ quality of life and physical functionality. Though rest and relaxation are crucial to maintaining a healthy mind and body, regular exercise may help maintain and even improve your health. Exercise may help during treatment by improving balance and physical abilities, lowering the risk of osteoporosis and heart disease, and lessen nausea. Even more importantly than physical health, exercise may improve patients’ self-esteem, mental health and quality of life.

Every individuals’ physical needs and potential are different, so it is important to speak with your doctor about what exercises are best for you. Because the stage and treatment plan for cancer patients differ, so may each patients’ stamina and strength. Staying as active and fit as possible is essential to maintaining physical well-being during treatment, so tailoring an exercise program that fits your ability and preference is essential.


Resources:

cancer.org

cancer.gov

Seven Steps to a Successful Digital Advocacy Strategy

MEO SeptDigital advocacy concerns the ways in which you engage your audience online and inspire them to take action around your cause. Using digital tools and applications can amplify your issue, while giving you new opportunities to listen and engage with supporters, and monitor your progress.

Creating a digital strategy will help you focus on your goals more clearly, choose the right digital tools, promote key messages, and measure outcomes more effectively. Ultimately, the right strategy gives you the best chance of using digital channels (like Facebook, Twitter, Instagram, etc.) to reach the right audiences with the right messages at the right times to advance your advocacy.

Step One: Set Your Communication Goals

The first step to any advocacy strategy is to establish clear objectives and goals that you hope to achieve. What are you trying to accomplish? For example, you might want to increase public understanding of the issues you advocate for, mobilize supporters to take action, or raise funds to support your cause. You will need to set SMART goals, which are:

  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Timebound

Specific – define your goals as clearly as possible.

Measurable – put figures on what you want to achieve e.g. increase visits to the website by 40%; gain 100 new Twitter followers or Facebook Likes.

Attainable – make your goal attainable in terms of the resources and capabilities you have.

Realistic – to be realistic, a goal must represent an objective toward which you are both willing and able to work.

Timebound – your goal should be grounded within a time frame.

Step Two: Define Your Target Audience

Who does your message need to reach? Obviously, you want to reach as many people as possible, but by choosing which audience to prioritize in your digital communications you will improve your reach, enhance relevance and put your resources to the best possible use. Find answers to basic demographic questions about your audience, what issues they are concerned with, alongside which online communities inform, inspire, or influence them. You can then tailor your content more specifically to match your audience.

Step Three: Choose the Right Social Channels

Once you’ve identified your target audience, map this information to social media behavior to help determine which social channels to concentrate on. Publically available reports, like Pew Research Center The Demographics of Social Media Users, can help you with this step. Social media are dynamic and constantly changing. When you develop your digital advocacy strategy, be prepared to be flexible. As new networks emerge you might want to add them to your strategy, but it’s important to always relate this back to your goals and your audience to ensure it fits your plan.

Step Four: Create Compelling Content

What is the key message(s) you need to convey to your target audience? How will you communicate it? Sharing the stories of
real people affected by your cause will be the most powerful and compelling content you can create. Share this content via blogs, videos, podcasts, email, etc. Bear in mind the content that works best on the platforms you have chosen. The continuing growth of visual platforms, such as Pinterest, Snapchat and Instagram mean that incorporating visual content into your digital strategy is important. Whichever type of content you create include a clear call-to-action. Make it clear and unambiguous what the next step is after reading or viewing your content; for instance, sign a petition, share on Twitter and Facebook, or donate to your cause.

Step Five: Implementation

Time is probably the biggest challenge in implementing your strategy. To achieve results and credibility you have to be prepared to commit time regularly to producing and promoting content and engaging with your audience. Decide on how much time you can realistically devote to implementation. Do you have time to write regularly for a blog? Would it be better to make short videos instead? Create an editorial calendar and list the dates and times you intend to post blogs, Facebook posts, Twitter updates, etc. Use a scheduling tool, like HootSuite or Buffer, to schedule you social media updates in advance. There are numerous tools and applications, many of them free, which can help you spend your time more efficiently and productively on social media.

Step Six: Monitor Social Media

It’s important to monitor social media on a regular basis to keep on top of what people are saying about you, your organisation, campaign, or issue. It also gives you an opportunity to find relevant online discussions related to your cause, allows you to adjust your strategy in real time and guides you to key online influencers and opinion leaders who can help amplify your message. Setting up a simple Google Alert (email updates of the latest relevant Google results based on your queries) with relevant keywords is a good place to start. Use a tool like Hashtracking to monitor a particular hashtag, related hashtags, and the top influencers of that hashtag.

Step Seven: Measure and Evaluate

The final step is to measure and evaluate your progress, adjusting your strategy if necessary. Some key metrics to track are the number of followers you attract and retain, which social media channels drive the most traffic to your website, the number of comments you get, and how many times your updates have been shared. Google Analytics will provide you with detailed analytics to measure your website performance. Each of the main social platforms also has their own analytics built in. Other useful tools include:

  • TweetReach measures the reach and exposure data for your tweets
  • SumAll measures your Twitter follower growth, mentions, and engagement
  • Klout measures your online social influence via a “Klout Score”, which is a numerical value between 1 and 100.
  • Spredfast measures data gathered from Facebook, Twitter, YouTube, and Flickr, to show how many people you’ve reached and whether or not your target audience is engaging with you.

Final Thoughts

Digital advocacy helps amplify advocacy efforts by potentially reaching more people, in more places, faster than ever before. It works best when it is aligned with your existing offline tactics. Think about how you can integrate your everyday advocacy activities with your digital strategy to maximize impact. Don’t expect digital advocacy to work right away. It is a strategy that will succeed long-term, rather than be a quick success. If you want to see real results, you must be prepared to commit to it long-term. Finally, keep in mind that social media are constantly changing and evolving, and you will need to keep evaluating your strategy to ensure you are maximizing your opportunities to engage meaningfully with your supporters.

Engagement For Seniors

As the healthcare industry moves towards a more patient-centered model, they cannot forget about the fastest growing segment of our population, the older adults. According to the US Census Bureau, 72 million Americans will be 65 or older by 2030. With this growing and aging population, how can offices, hospitals, and healthcare professionals engage seniors? It’s no secret that engaging people in their own health care, especially through shared medical decision making, results in improved health outcomes, improved patient satisfaction, and cost savings. Below are several examples for how senior engagement can be achieved.

Clarify medical communication

With age comes the natural decline of hearing and seeing, so keeping educational tools more visual and basic is crucial. That coupled with avoiding medical jargon will help older patients become more engaged. According to Solution Reach, keeping it simple is best:

“Although the senior community desires to be more technologically savvy, they are often still learning; they require guidance to catch up to the knowledge and experience of the younger generation. It may seem obvious, but sticking to the basics will ensure that landing pages, advertisements, emails, and other promotional materials are easy to read and understand.”

Engage beyond the office

Going beyond the doctor’s office and utilizing digital technology has been proven to improve the patient experience, such as follow-up prescriptions/appointments, treatment discussions, access to EHRs, and medical reminders. Capstrat highlights adherence problems (i.e. taking medications, exercising, following a specific diet, attending therapy, etc) as a main problem that gets worse with age. Reminders, tips, or motivation via email, snail mail, or social media can help to combat these issues. Understanding and honoring their preferred means of communication is one of the first steps. However, healthcare professionals should still realize they have the same ethical responsibility with these methods as they do in the office.

Don’t forget the caregiver

The need to include the patient’s caregiver is essential for older adults. The caregivers are often times the children of the patient and are the ones handling the finances, medications, transportation to appointments, etc. The caregivers spend a substantial time with the patient, while the doctors and other HCPs time is limited, demonstrating this need to include them. Capstrat suggests incorporating them by adding caregiver contact information onto new-patient forms online and offline, and sending treatment information directly to the caregiver.

Utilize technology

According to Welltok’s Senior Health and Technology Survey, more than 50% of seniors use tech to improve health. This survey also pointed out that most seniors do not use wearable, but would be willing to use a health program accessible on a computer or mobile if recommended by a doctor. What does this mean? Older patients are relatively tech-savvy and are looking for resources that are both useful and useable.

Organize resources

Keeping track, organized, and up to date on all your medical records is a big undertaking. According to MedCity News:

“… there are a lot of resources available from AARP, Medicare, retail pharmacy programs, but it is a lot to manage and navigate. Seniors need help organizing everything they need to accomplish their goals in one place. This population requires a consumer-designed platform offering a single channel for presenting benefit, health-related and other resources to support them.”

The senior population is an expanding group with their own specific needs for engaging in their healthcare. Healthcare entities would be wise to understand, honor, and cater to those needs.


For those older adults that don’t quite have it all figured out yet, Patient Empowerment Network is excited to launch its first Digital Sherpa Workshop this fall in Florida with the hopes of expansion in the future. This workshop is designed to parter the tech-savvy, college students with the not so tech-savvy, older patients with each other for tips and tricks on how to navigate the internet and social media to better their healthcare. Sherpa Logo

References:

www.healthwise.org/insights/healthwiseblog/mmettler/september-2014/2264.aspx

www.solutionreach.com/COMPANY/blog_viewer/are-senior-citizens-engaging-in-healthcare-technology

http://medcitynews.com

Running From Cancer – And Towards Lower Risks

As you head out for your run, walk, or swim of the day, it’s good to know that in addition to the widely known cardiac benefits, exercise also brings documented results in lowering cancer risks. A recent study from researchers at the National Cancer Institute and the American Cancer Society found evidence that the current recommendation of moderate-intensity activity, now a little more than 20 minutes a day, is also a key component of cancer prevention. Steven C. Moore, Ph.D. noted, “Leisure-time physical activity is known to reduce risks of heart disease and risk of death from all causes, and our study demonstrates that it also associated with lower risks of many types of cancer.”

This may not be news to many because there have been literally hundreds of studies linking physical activity and cancer risk. This new study took a much larger look at the data, pooling information on 1.44 million Americans and Europeans ages 19 – 98 and followed the data for a median of 11 years. What stood out particularly was the reduced risks for breast, colon, and endometrial cancers.

Most studies targeting breast cancer show that physically active women have a lower risk of developing this kind of cancer. Depending upon the study, the risk reduction varies widely, between 20 to 80 percent. Activity starting in adolescence is found to be the most beneficial; however, that doesn’t let older ladies off the hook. No matter when an exercise program is started, active women enjoy reduced breast cancer risks when compared to sedentary women.

It is also estimated that daily sessions of moderate physical activity has a protective effect against both colon and endometrial cancers, from 30 to 40 percent reduced risk. One overarching question on all these studies is how does exercise reduce cancer risk? There seem to be a number of mechanisms in place including the lowering of hormone levels and insulin growth factors, improving the immune response, and reducing the time certain organs are exposed to potential cancer-causing substances. Exercise also seems to lower inflammation, which could play a role in cancer development. So, tie up those walking/running/cross training shoes and have a go at it! No matter how you look at it, exercise provides significant benefits on many levels in cancer prevention.

 

Sources:

http://www.cancer.gov/about-cancer/causes- prevention/risk/obesity/physical-activity- fact-sheet#q4

https://www.nih.gov/news-events/news- releases/increased-physical- activity-associated- lower-risk-13- types-cancer

A Person Centered Approach To The Care Of Chronic Illness

The World Health Organization has called chronic conditions ‘the health care challenge of this century’. According to the latest figures released by the Centers For Disease Control and Prevention about half of all adults have one or more chronic health conditions; and one of four adults have two or more chronic health conditions. Long-term diseases, such as heart disease, stroke, cancer, type 2 diabetes, and obesity are the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. A landmark paper, published on 9 July 2016 in Nature Reviews, reports the prevalence of global diabetes has been seriously underestimated by at least 25 per cent.

These figures are alarming, but what is equally alarming is that despite the prevalence and seriousness of the situation, our medical system is not structured to adequately respond to chronic illness. Our current health systems are designed to prevent, diagnose and treat acute medical conditions. The problem is not that people with chronic diseases do not receive care; rather, the acute care model ignores the fundamentally different approach that is needed to care for people with chronic conditions. Furthermore, this model leaves little room for the psycho-social dimensions of chronic illness; it addresses parts of diseases or small sub-parts of the body, but it does not address the person in a holistic way.

How can we begin to address this disconnect in a healthcare system which cares for pieces of people, rather than the whole person?

I believe the answer lies in adopting a person-centered approach to the care of the patient (while you may find the term patient-centered care is more widely-used, I prefer to use the more all-encompassing person-centered care as it focusses on the whole person). Describing the person-centered care approach, Dr Ronald Epstein, MD and Dr Richard Street, PhD characterize it as one in which “patients are known as persons in the context of their own social worlds, listened to, informed, respected, and involved in their care.”

Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions, was recognised as a dimension of high-quality health care in the 2001 Institute of Medicine (IOM) report Crossing The Quality Chasm; An New Health System for The 21st Century as one of six quality aims for improving care. The IOM report drew on research conducted in 1993 by the Picker Institute in conjunction with the Harvard School of Medicine 1 which identified eight dimensions of patient-centered care.

These eight principles provide a roadmap for a person-centered approach to the care of chronic illness.

1. Respect for patients values, preferences and expressed needs

A fundamental tenet of person-centered care concerns putting people and their families at the center of clinical decisions. Each patient brings his/her own unique preferences, concerns and expectations to a clinical encounter and these values should be integrated into decisions if they are to serve the patient. Patients have a right to be part of the decision making process. This is best achieved through the model of shared decision making, the conversation that happens between a patient and their health professional to reach a healthcare choice together. At the very heart of shared decision making is the recognition that healthcare providers and patients bring different but equally important forms of expertise to the decision-making process. Patients and their families will bring their experience of living with a disease, their social circumstances and preferences. This is particularly relevant in chronic health conditions where the patient may have many years of experience of their symptoms and responses to treatments.

2. Co-ordination and integration of care

Research shows that patients highly value coordination of their care, seeing it as an important component of overall quality, especially when they have chronic health problems and complex needs. The reality however, is a patient with a chronic condition often receives care from multiple healthcare providers who may work independently from each other. This fragmented system affects the follow-through and co-ordination of care patients receive.

3. Addressing patients’ information, communication and education needs

Patients differ in their views about how much information they want. In some cases, patients want a lot of information and in other cases patients may delegate decision making entirely to healthcare professionals. The goal of patient-centeredness, according to the IOM report, is to customize information to the specific needs of each individual; that is, to modify the care to respond to the person, not the person to the care. Information needs to be much more easily available and understandable and a concerted effort made to strengthen health literacy for all patients.

4. Physical comfort

Attention to physical comfort implies timely, tailored and expert management of symptoms such as pain or other discomfort. Person-centered pain management takes into account not just the physical aspect of pain, but also the psychological, social, and spiritual aspects of health and disease.

5. Emotional support and alleviation of fear and anxiety

Fear and anxiety associated with illness can be as debilitating as the physical effects. As defined by the Institute of Medicine, patient-centered care attends to the anxiety that accompanies all injury and illness, whether due to uncertainty, fear of pain, disability or disfigurement, loneliness, financial impact, or the effect of illness on one’s family. Chronic illness affects every aspect of our lives and patients face a range of stressors from medical management of our illness, to dealing with changes in family life, work life or student life. The psychological effects of chronic illness can be profound. Individuals with chronic illness are more likely to be depressed, especially those who experience greater levels of pain and disability. In a paper published in the Western Journal of Medicine authors Jane Turner and Brian Kelly examined the emotional dimensions of chronic disease. They concluded that:

  • The emotional dimensions of chronic conditions are often overlooked when medical care is considered
  • Doctors may be well equipped for the biomedical aspects of care but not for the challenges of understanding the psychological, social, and cultural dimensions of illness and health
  • Clinicians can play an important part in helping their patients to maintain healthy coping skills

6. Involvement of family and friends

The sixth dimension of patient-centered care recognises the key role of families and friends in supporting and caring for a chronically ill person. It focuses on accommodating family and friends on whom patients may rely, involving them as appropriate in decision making, supporting them as caregivers, making them welcome and comfortable in the care delivery setting, and recognizing their needs and contributions.

7. Continuity and transition

Every episode of care involves various individuals and oftentimes multiple transfers between different health care settings. Poor communication during transitions leads to increased rates in hospital readmissions, medical errors, and poor health outcomes. Most patients and family caregivers are not encouraged to play an active role when a transition in their care occurs, even though they are often the only constants in the transition.

8. Access to care

Patients need to know they can access care when it is needed. In interviews conducted by Picker, patients indicated the following areas were of importance:

  • Access to the location of hospitals, clinics and physician offices
  • Availability of transportation
  • Ease of scheduling appointments
  • Availability of appointments when needed
  • Accessibility to specialists or specialty services when a referral is made
  • Clear instructions provided on when and how to get referrals.

Ideally patients should have access to the right service at the right place at the right time. This may take place outside the traditional healthcare setting, as Meredith Dezutter, who applies human-centered design to improve the lives of patients, caregivers and providers through her work at Mayo Clinic’s Center for Innovation, points to: “It may mean making medical knowledge more accessible and supporting local care decisions, offering online support or video appointments or even connecting the patient with resources in his or her community.”

For too long, patients have been grouped into a single homogenized category, and treatment approaches to care generalized. This ignores the reality of chronic illness which presents in different ways. Treatment of chronic conditions requires an individualized, multifaceted approach. Care is enhanced when there is sensitivity for the context of the illness experience. Person-centered care is a method of care that treats the patient as a person within the context of their lives, family and community support, mental and emotional state, beliefs and preferences. It is based on good communication and a partnership approach between clinician and patient with the aim of improving patient self-management, care outcomes and satisfaction. PhD student and health researcher, Doro Bechinger-English, who was diagnosed with breast cancer in 2010, believes that person-centered care facilitates a closer connection between a patient and healthcare provider. “The healthcare professional shows their presence by connecting with me as a patient and a person”, she says. “Person-centered care also means being open to my values, anxieties, concerns and preferences however small or alien they seem to be.”

Redesigning our healthcare systems to adopt a patient-centered perspective is not without its challenges in an acute care system that is primarily reactive, but ultimately doesn’t every patient deserve to be treated in a system in which he or she feels known, respected, involved, engaged, and knowledgeable about their own care?

1 Gerteis M, Edgman-Levitan S, Daley J, Delbanco T. Through the patient’s eyes: understanding and promoting patient-centered care. San Fransisco: Jossey-Bass; 1993