As is our tradition, this issue of Cancer Nursing is filled with well-written and compelling articles about the experiences of children, adolescents, young adults, adults, and their families with cancer across geographic boundaries. One theme that emerges from the content of this issue is that oncology nurses attend closely to the potential and actual symptoms that cause patients and their families to suffer. Symptoms are conditions that are generally undesired, tend to be linked with specific illnesses, and noticed by patients. Cancer-related symptoms named in this issue include fatigue, sleepiness, sleep disturbance, uncertainty, nausea, distress, poor appetite, dry mouth, sadness, vomiting, numbness, shortness of breath, pain, difficulty with communication, restlessness, somnolence, and loneliness. This is an impressive though incomplete listing of known cancer-related symptoms. Despite the incompleteness, each symptom by itself and the list in toto are more than sufficient to command our attention and urge us to be mindful of the very great need to anticipate, prevent, control, and diminish cancer-related symptoms and the distress that they cause.
We cannot assess or manage a cancer-related symptom in a patient without our care becoming personal. There is an immediate intimacy when we ask patients about their symptoms. Our wording makes it personal, that is, asking a patient "How is your pain?" "How intense is your pain?" "Where do you hurt?" By asking persons with cancer what they feel and how they feel, we enter into-perhaps immediately but ultimately always-a committed relationship with our patients. Asking symptom questions implies to the person with cancer that we want to know their information and that we intend to use this information to improve their clinical situation.
To attend to a symptom, we must ask direct questions and ask those same questions over time to detect changes, listen well to the responses from patients and family members, intuit the meaning of the symptom to the patient and family, work to understand patients' symptom-related distress, discuss and establish shared goals of care, and implement and evaluate the agreed-upon strategies to alleviate or diminish the symptom. Listening, assigning meaning, and developing mutual goals of benefit are exactly what occur in relationships- taking these steps means that we are deeply engaged in relationships with our patients.
What also makes symptom care personal is that when we assess a cancer-related symptom, we invite a patient to do what might be seen in other life contexts as complaining or as focusing a conversation only on the suffering of self. More accurately, however, this discussion is a collaboration intended to identify as many aspects about the symptom as is possible to guide subsequent care and to do so without the patient being concerned that he or she will be seen by the nurse as weak and whining. Symptom assessment is personal, but the patient ought never feel degraded by it. Importantly, this kind of symptom assessment can be achieved only in the context of a relationship.
Efforts to relieve a symptom become even more personal than the actual assessment of the symptom. Symptom care is individualized for each patient and that patients' unique clinical context. Disease, demographic, and treatment variables are all relevant considerations, and the combination of these variables will be unique to each patient. Clinically useful and valid practice guidelines may be implemented as part of the total symptom care approach, but such guidelines will be personalized to match the suffering patient's situation, values, and care preferences. Relatedly, symptoms have certain meaning for each suffering patient and family. The meaning that a patient or family assigns to a symptom, which could be of advancing disease, worsening, or improving condition, also merits symptom care, and this care is likely to be even more personal than the symptom assessment and relief efforts. It, too, occurs within the context of a relationship and calls upon us to have and convey regard for the patient's desire for and definition of health and normalcy in the midst of cancer.
The contents of this issue guide us in the personal approach to symptom care. Active listening to the suffering patient is described as likely the most important of healing strategies that we could employ. Having good relationships is the second strategy given a solid analysis in this issue. Special note should be made of this as the good relationships are not limited to nurse-patient (family) or to staff-patient but also include staff-staff relationships. Patients' symptom suffering is reported to be reduced or less when the members of the healthcare team are skilled in collaborating with each other. Cancer-related symptom care is embedded in effective, committed relationships and is indeed personal.
My very best to you.
Pamela S. Hinds, PhD, RN, FAAN
Editor in Chief, Cancer Nursing(TM)