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Most Stage III cancers reach the outermost layer of the esophagus wall or metastasize to other organs or tissues, including the vast majority of cancers with regional lymph node metastasis. Since Jim’s cancer had already spread to his lymph nodes, he was in Stage III and was experiencing unbearable pain. Ultimately, many factors impact a patient’s decision to undergo cancer treatment. Various reasons may influence why a person undergoes cancer treatment, including symptom relief through local disease control, improved survival odds, or all three. Optimal treatment for patients with stage III esophageal cancer may require a combination of approaches. One of those approaches may be in a facility with the resources to provide comprehensive care involving multiple disciplines. There are two main treatment options for patients with stage III esophageal cancer: chemotherapy plus radiation therapy before surgery or chemotherapy and radiation therapy alone (Ma et al., 2021). Patients with stage III esophageal cancer rarely benefit from surgery alone unless it is to alleviate symptoms related to swallowing. Patients with stage III cancer and little disease progression to lymph nodes or nearby tissues may be an exception to the rule.
In this case, the client had undergone numerous treatments, including chemotherapy, radiation therapy, and surgery. None of these treatments were without risk and likely were carefully balanced against one another. For instance, the combination treatment offered to the client did not alleviate his pain or mitigate his cancer. Treatments for esophageal cancer have progressed partly because of patients’ increased involvement in clinical trials, and improvements in the treatment of esophageal cancer will result from continued involvement in relevant studies. With the redundancy of medication offered to the client, he is showing no signs of improvement and does not want life-prolonging treatment. He wants the pain to stop. With the client giving up on treatment, the doctors catering to his desire cannot offer more help apart from the pain management medication, which presents various challenges in managing cancer. Since the patient understands the impact of not proceeding with the proposed intervention modalities, the doctors must respect his decision and offer their help to stop his pain (Mao et al., 2019). Through two theoretical frameworks (CBT and Solution Focused Therapy), one could understand the patient’s decision and develop proper intervention modalities to help him cope with his decision.
Understanding the Client
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a type of psychotherapy that strongly emphasizes one’s thoughts’ role in shaping one’s emotions. In this case study, the client is in much pain after undergoing numerous cancer treatment therapy. CBT offers insight into why he would manage his pain through medication rather than life-prolonging treatment. CBT aims to modify feelings by first influencing behavior and thought patterns. The cancer survival rate has increased dramatically with the development of early detection methods and innovative therapies like individualized medicine and immunotherapy (Liu et al., 2020). However, this comes with its own set of complications. Severe psychological and physiological adverse effects are possible for patients undergoing continuous, long-term treatment for cancer. In addition, the long-term effects of cancer-related and treatment-related illnesses, such as worry about recurrence, fatigue, insomnia, and weight gain, can significantly impact a patient’s quality of life. (Aminnasab et al., 2018).
Consequently, long-term cancer therapy presents a unique opportunity to monitor and mitigate therapeutic side effects. CBT employs various psychological and behavioral therapy to alter the patient’s dysfunction. Evidence suggests that CBT is the most effective psychological treatment for cancer therapy-related fatigue and can also improve cancer survivors’ quality of life (Addison et al., 2021; Ma et al., 2021 & Peoples et al., al., 2019).
Training in behavioral stimulation, exposure treatment, mood regulation, and relaxation are only some behavioral interventions included in CBT. Evidence suggests that CBT helps treat various psychiatric problems, such as depression (associated with cancer treatment). Atwood and Friedman (2019) posit that CBT is a treatment method supported by empirical research. Combining CBT with medication is one of the best-producing treatments in clinical practice. Growing clinical research has found a positive correlation between cognitive behavioral therapy and cancer (Deng et al., 2021; Mao et al., 2019 & Xian et al., 2021). In interviews with researchers, most people who had survived cancer said they had never even considered or talked to their doctors about the possibility of using psychological therapy (Mohr et al., 2018). Even though CBT has influenced a better prognosis and aided in cancer patient tracking, it remains underutilized. CBT would improve coping mechanisms with cancer treatments in this client’s case. However, he does not care for the intervention modality; Jim only wants the pain to go away rather than gaining the relevant coping mechanism to ensure his full recovery.
Solution-Focused Theoretical Framework
The solution-focused approach asserts that fixating solely on issues prevents practical problem-solving. Instead, SFT examines the clients’ default solution patterns, evaluates their usefulness, and helps them develop alternatives. At its core, SFT is a method for facilitating the development and maintenance of optimistic, upbeat, and future-oriented alterations in behavior (Aminnasab et al., 2018). Solution-focused professionals discuss with their clients several ways to address their problems and what will change. The change benefit is discussed before they even begin working on a solution. Together, the therapist and patient investigate the problem’s origins and the client’s present behavior to develop a sustainable, tractable solution. Deng et al. (2021) argue that this approach often involves identifying and thinking about “exceptions” in the client’s past, such as when the client overcame or dealt with obstacles. SF therapists and their clients frequently develop goals reflective of clients’ highest aspirations and satisfactory solutions through a naturally respectful and practical interview process.
Chronic fatigue may have a profound impact on many parts of a person’s life, including their vitality, feeling of control, daily routines, aggravation of underlying ailments, significant distress, and social isolation, to name just a few. Fatigue is a common side effect of cancer treatment that can negatively impact a patient’s quality of life and potentially shorten their lifespan. Cancer-related fatigue (CRF) is a more accurate indicator of a patient’s overall health and quality of life, as shown by research by Liu et al. (2020). Solution-focused therapy has been utilized to treat patients with long-term conditions such as esophageal and breast cancer. The results of studies such as Mohr et al.’s (2018) research showed that SFT could improve mental health by decreasing depression, increasing self-efficacy, and raising the quality of life.
Active psychological intervention is the focus of solution-focused treatment, with the ultimate aim of helping patients realize their full potential. Significant challenges are presented to medical professionals when dealing with CRF because of its high complexity and the likelihood that it will include the interaction of various physiological and psychological processes (Xian et al., 2021). Patients can learn more about their options and strengths by reflecting on previous times when they overcame fatigue. In-depth plans that consider the patient’s abilities and aspirations are developed with nurses’ aid. A patient’s quality of life and resilience can benefit from this approach. Consistent with the findings of Liu et al. (2020)., Xian et al. (2021) found that SFT significantly reduced fatigue in individuals with inflammatory illnesses (2018).
Clinical Intervention Strategies
There are numerous avenues open to oncology for incorporating CBT into their practices. Research suggests that scheduling CBT sessions during regular doctor visits is an excellent way to include it in patient care. Using books, manuals, and handouts to teach oneself CBT has been studied as a self-help method. Researchers have found that this method is more effective in lifting depressed patients’ spirits than conventional treatment alone. An evaluation of the efficacy of cognitive behavioral therapy in primary care concluded that primary care providers need not need substantial specialized training to give CBT to their patients suffering from anxiety and depression (Fenlon et al., 2020). The evaluation covered traditional media like television and radio and newer methods like the internet and self-help books. Consistent with the results of an independent research, CBT under the guidance of an informed friend or family member improved patients’ sense of agency and alleviated their pain (Ma et al., 2021).
While cognitive-behavioral therapy for cancer shares many similarities with standard treatments for depression and anxiety, there are times when adaptations must be made to account for the unique challenges presented by the disease, its treatment, and the patient’s body. Sessions are often required to occur in locations other than the therapist’s office, such as the patient’s home or a hospital ward for cancer or hematology patients (Whiteside et al., 2019). Disease symptoms, side effects, and the requirement for hospitalization can fluctuate in intensity, which can throw off the treatment plan. This means that therapy sessions are shorter and have more specific goals and that the therapy is more open, encouraging, and modifiable based on the patient’s physical condition (Mohr et al., 2018). The ultimate objective is to effect as much change as possible with as few practical interventions as possible. A patient’s family and the healthcare team’s participation are also associated with a successful therapeutic outcome.
Most cancer treatments oncologists use also have an emotional and psychological impact on the patient, leading to suffering and symptoms that diminish the quality of life. Nonpharmacologic treatments, like cognitive behavioral therapy (CBT), may be useful in managing symptoms following a cancer diagnosis. Although there may be challenges in implementing CBT, any help given to this population in improving their health is appreciated. There are both formal and unofficial training options for oncologists interested in learning more about CBT. Many CBT manuals are accessible for oncologists who may not have formal CBT training (Topalian et al., 2020). These guidelines are written to offer a speedy therapeutic strategy that can aid in speedy training. In addition, the Beck Institute for CBT offers comprehensive training programs, including on-site individual and group instruction and counseling for your facility.
Solution Focused Therapy
During a solution-focused therapy session, the therapist and client will collaborate to identify the issue at hand, set treatment goals, and generate potential approaches to achieving those goals. The therapist probes to learn about the individual’s latent but potentially useful strengths and assets. The practitioner also uses complimentary language to bring awareness to and encourage the qualities the client has to shift their emphasis from dwelling on the problem without realizing that they can solve it (Aminnasab et al., 2018). Several methods are used in solution-focused brief therapy (SFBT) to help clients shift their attention back to the future and the path forward. Some examples include the miracle question, coping questions, issue exceptions, compliments, and scales.
Miracle Question
In this context, the doctor tells the patient to picture themselves sleeping through the night with their problems solved. After the visualization, the therapist will ask the client how they know the problems or issues have been resolved and what has changed. This type of question can be helpful in gaining insight into the nature of the problem, the extent to which it is affecting the person’s life, and the motivation to take action toward resolving it after engaging in a daydream about waking up free of the issue (Deng et al., 2021).
Coping Question
In this case, the practitioner will inquire about the patient’s coping mechanisms to gain insight into the individual’s response to adversity. For example, those who have suffered from depression or anxiety for an extended period may wonder how they have managed to keep going through life despite their difficulties. These questions encourage the client to take stock of their current situation and appreciate the strengths they already possess, such as the inner strength that has brought them this far, even if they were unaware of it before.
Preferred Intervention Framework
Solution-focused therapy is the best of the two intervention modalities as it provides a solution-based intervention framework to help cancer patients cope with pain and CRF. This would be the preferred therapeutic model for Jim as it involves his entire family in his recovery journey. Within the SFT model, clients are so accustomed to dealing with problems that they often miss the signs that there are none to be found. The client ranks the issue higher than the exemption. The focus of solution-oriented therapy is on the positive outcomes rather than the problems (Liu et al., 2020). To help clients find a workable solution, interventions are planned to encourage a shift in perspective. Due to the episodic nature of cancer-related crises, a short-term, solution-focused therapy model is well-suited to cancer care. Furthermore, the family has a history of coping before the onset of the illness, and there are significant periods during the disease course when they can do so. Solution-focused brief therapy helps families recognize and make use of their strengths, as well as their current and historical coping skills and their ideas for a better future.
The first step in every intervention is establishing a specific, attainable objective by thinking about the client’s life after the complaint has been resolved. In addition, the enlargement of solution sequences facilitates the rediscovery of problem-solving abilities (exceptions) (Mohr et al., 2018). The role of the solution-focused therapist is to aid families in recognizing these outliers and persuading them to engage in more of the behavior that these outliers indicate. The presumption here is that there will always be conditions where problems are uncommon or nonexistent.
Cancer treatments often include unintended psychological side effects, such as increased anxiety or depression. The importance of cognitive behavioral therapy (CBT) in minimizing the distress caused by prolonged cancer treatment has only increased over time. CBT is beneficial for treating tiredness, sadness, anxiety, fear of cancer recurrence, and other side effects during protracted cancer treatment. It is also vital for tailoring CBT for specific problems. On the other hand, SFT and other types of favorable psychological treatment have been shown to mitigate weariness. Consequently, SFT is a proper psychological technique for enhancing the quality of life and reducing fatigue experienced by cancer patients undergoing chemotherapy. The comparative analysis of the two theoretical frameworks shows that SFT is more effective for treating cancer patients than CBT.