Health and nursing encompass a wide range of dimensions, including the diagnosis and treatment of conditions like cancer. Gastric adenocarcinoma, or stomach cancer, is a type of cancer that affects glandular cells in certain organs, responsible for creating and releasing fluids like mucus and digestive juices (Cancer.gov). In this assignment, the focus will be on gastric adenocarcinoma since it is the 16th most common cancer in the UK (bsg.org.uk, 2021), causing around 6,700 new cases every year, or 18 per day (Cancer research.UK). Unfortunately, regular screening guidelines for stomach cancer do not exist, with screening tests being mostly inaccurate, making it challenging to diagnose in its early stages. As a result, stomach cancer can go undetected until its later stages (Ciupka, 2019).

Research has shown that stomach cancer is often linked to the presence of Helicobacter pylori (H. pylori), which triggers chronic low-level inflammation of the stomach lining (Shital, 2021). Stomach cancer risk factors include age, gender, smoking habits, and poor dietary patterns (Macmillan.org, 2019). This assignment will reflect on a patient who received end-of-life care, named "Amy" for this purpose, and the key component for her care - communication. We will analyze all aspects of holistic care, including any multidisciplinary team involvement, while using evidence-based frameworks and models to evaluate effective communication at the end of life.

Amy was a 45-year-old female who resided with her husband and two young children in a socioeconomically deprived area of the Northwest of England. Until her diagnosis, Amy was unemployed, due to her mental health issues and poor overall health, and had no other family. She enjoyed socializing with neighbors and had a habit of playing online bingo and poker, which led to significant debt. It is known that people in lower socio-economic groups tend to have more complex long-term health conditions that can be more severe than those in higher socio-economic backgrounds (Kingsfund, 2021).

Amy's stomach pains and rapid weight loss were connected to poor dietary habits, and she believed smoking cigars could help curb her appetite. Additionally, her primary medication for hypertension, high cholesterol, anxiety, and depression needed to be reviewed. After her initial symptoms, Amy attempted to visit her GP surgery, only to find it closed due to funding costs. She then had to travel two bus rides to reach the nearest GP practice, which was an economic burden. Eventually, she was diagnosed with gastric cancer, which had already reached its later stages, making it more difficult to treat.

Amy underwent several tests, including blood tests, CT scans, upper endoscopy, and biopsy, to diagnose her with gastric adenocarcinoma. Usually, treatment options like surgery or chemotherapy could prevent further cancer spread if found in the early stages (as stated by…). However, in Amy's case, her cancer had already progressed to stage IV and had spread to her liver and parts of her lungs. Her only option was palliative care. Her health deteriorated rapidly from this point on.

Overall, this assignment will analyze all aspects of Amy's end-of-life care, from her perspective and that of the multidisciplinary team involved. We will also review the care given, clinical decisions made, and any ethical issues that arose, drawing conclusions based on evidence-based research.

Maintaining Emotional and Psychological Wellbeing

Amy was understandably anxious about her rapidly deteriorating health, experiencing a sense of loss of dignity and self-control. To address her concerns regarding her family, social aspects, economic situation, debts, and the lack of life insurance coverage, the social team and McMillian nurses engaged with Amy and her family, reaching out to local charities and organizations to find any possible aid and support. The hospice healthcare team ensured that if Amy became fatigued or experienced significant pain, they would communicate with everyone involved with her care and provide continuous support before and after her passing, extending assistance to her family.

Multidisciplinary Team Approach for End-of-Life Care

The primary aspect of end-of-life care is the involvement of a multidisciplinary team that provides comprehensive treatment for the symptoms linked with life-limiting illnesses. Such teams typically include physicians, nurses, physiotherapists, occupational therapists, pharmacists, chaplains, social workers, and volunteers. The goal of end-of-life care is to alleviate suffering in all its aspects, whether physical, psychosocial, or spiritual, both for the patient and their caregivers. Despite being in a smaller hospice setting with more nursing staff available for each patient, Amy was assisted by a team of healthcare professionals, including two named nurses, a doctor, McMillan nurse, social care team, chaplain, complementary therapist, and mental health nurse.

My Role as a Student Nurse

As a student nurse, I contributed to Amy's overall care and supported the holistic aspect of her treatment. By establishing relationships with the clinical team and actively listening to Amy, I could read her cues and assist in pain management. I ensured to involve her in any discussions and took her wishes into account, liaising with the hospice therapies to arrange massage and aromatherapy sessions to reduce her anxiety and agitation. The role of student nurses is crucial in end-of-life care, and they should be allowed to attend pre-and post-briefing such as expert clinicians to transfer knowledge and provide guidance.

Effective Communication in End-of-Life Care

There are several approaches to effective communication in end-of-life care, including the SPIKES 6-step protocol by Baile et al. (2000). Complex patient needs and family support require individualized care, and patient involvement in their care is beneficial. Advanced care planning is integral to ensure documentation of the patient's wishes and to facilitate the provision of supportive care.

Challenges in End-of-Life Care

Staff shortages and lack of training can impede the delivery of crucial healthcare services and affect patient outcomes negatively. Adequate training and specific area expertise are essential to provide the necessary support for the patient's complex needs. Communication between healthcare staff and family caregivers is essential to avoid distress and dissatisfaction by patients and their families and minimize complaints regarding NHS services.

The ethical and legal considerations surrounding end of life care are numerous, including concepts such as patient autonomy, best interest, DNAR orders, mental capacity, dignity, withdrawal of treatment, and informed consent, as outlined in the NMC code of 2018.

In the final hours before her death, Amy's condition had deteriorated significantly due to progressive cancer and medications. As a result, she became unresponsive and was unable to communicate her wishes for end of life care. However, Amy had previously completed a respect form indicating her desire to not be resuscitated if she were to stop breathing. Despite being unable to create an advance care plan, Amy's wishes were respected and her oxygen and fluids were discontinued.

To improve the experience of cancer patients, a faster diagnosis standard was introduced in 2020, which aims to reduce anxiety by providing timely information and referrals. Additionally, the NHS long-term plan commits to investing £4.5 billion towards expanding community MDT and primary care networks to support early cancer diagnosis. The cancer workforce plan ensures that skilled health workers are available at every stage of a patient's care.

When caring for an end of life patient, it is important to consider not only medical needs, but also psychological, social, spiritual, and financial concerns. An interdisciplinary team should work collaboratively with patients and their families to provide the best possible care. Critical thinking can help to identify and address challenges, while reflection can lead to improved evidence-based nursing practices and individualized patient-centered care.