Discharge Plan and Self-Management of Bowel Cancer: A Report

This report focuses on developing a comprehensive discharge plan and self-management strategies for a patient, John, who has undergone treatment for bowel cancer. It emphasizes the importance of effective communication, education, and a structured follow-up regime to monitor for recurrence and address potential survivorship issues. The report outlines recommended follow-up protocols, including regular examinations, imaging, and blood tests. It also covers physical, psychological, social, and spiritual needs, providing practical advice on managing side effects, addressing psychological distress, and accessing support services. The report stresses the importance of patient education, tailored to the patient's needs, to improve the quality of life and overall outcomes.

Running Head: BOWEL CANCER 1
Discharge Plan and Self-management of Bowel Cancer
Name:
Institution:

Discharge Plan and Self-management of Bowel Cancer 2
Introduction
After the diagnosis, John admits that he had been having some occasional pains and a
feeling of tiredness. Furthermore, he had suffered a high anterior resection for a tumor that got
found during a colonoscopy which is a procedure used to evaluate the inside of the colon. The
high anterior resection is the removal of the last section of the large bowel before it connects to
the rectum thus reducing any chance of recurrence in primary bowel cancer. Moreover, the
history results indicate ACPS B which was poorly differentiated adenocarcinoma infiltrating the
serosa. Also, all the 17 lymph nodes were negative, and the margins were clear which was
essential in determining whether there was further management need. Hence, this information is
crucial to the Cancer Care Coordinator before deciding whether John needs additional adjuvant
chemotherapy (Ong, 2016). The essence of this article is providing John with the necessary
information regarding his discharge from the hospital, and self-management plan that should get
followed after completing his active treatment. Furthermore, the article evaluates the signs and
symptoms that got associated with bowel cancer recurrence and the strategies that prevent
survivorship issues which John may encounter.
Principles of Communication and Strategies in Effective Discharge and Self-management
As the Cancer Care Coordinator, it is vital to outline strategies that will facilitate
effective education regarding the discharge of John from the hospital and self-management plan
he would use after that (Goodman, 2016). The Cancer Care Coordinator should prepare on how
to explain the treatment summary and follow-up care plan that John is to use. Furthermore, the
coordinator should provide information about the signs and symptoms of the bowel cancer
recurrence. Also, the coordinator can provide information regarding secondary prevention and
how John can live a healthy life. Moreover, the coordinator should ensure timely, regular and

Discharge Plan and Self-management of Bowel Cancer 3
two-way communication with John and his family regarding the potential late effects and the
progress of John. Furthermore, the follow-up care plan should get put into consideration and the
supportive and palliative care requirements (Thomas, 2015). It is also essential that the
coordinator identifies if John has any complex needs and this will enable the coordinator to know
whether there will be the need for John to change his residence to increase chances of having an
excellent social and healthy life (Lees, 2013).
Discharge Plan
Recommended Follow up Regime
After John receives curative treatment due the bowel cancer, the patient often has a high
chance of acquiring adenomatous polyps and metachronous primary Colorectal Cancer.
Therefore, the possibilities of a new development of primary tumor and adenomas may reoccur
after about four years. It is crucial that there be an early post-discharge review which should be
followed by a three to six monthly review for two years then six months to the year after that. It
is vital that this review consists of the examination and history of John's medical condition.
These examinations may include the rectum getting examined, and sigmoidoscopy should also
get done. The sigmoidoscopy is essential for patients who have had an anterior resection of the
rectum just like John (Tjandra, 2007). Also, regular CEA (Carcinoembryonic Antigen) measures
and CT (Computed Tomography) should get considered in the follow up because they may
provide needed clinical information (Young, 2014). The CT should be carried out on the chest,
pelvis, and abdomen and colonoscopy should get done at least three to five years after the
resection. According to Tjandra (2007), CT scan can be used to scan the liver which is useful in
detecting liver metastases. The Meta-analysis is randomized as a follow-up protocol that shows
any detection of any extramural diseases using the CT (Primrose, 2014). The Chest x-ray scan is

Discharge Plan and Self-management of Bowel Cancer 4
also necessary for detecting any lung metastases where three prospective trials are randomized;
using the Chest x-ray helps in identifying most resectable diseases (Pita-Fernández, 2014).
Furthermore, the Positron Emission Tomography (PET) scans should not get used if it is
not recommended at the medical facility by a certified medical practitioner (Meyerhardt, 2013).
The colonoscopy is essential because it helps in detecting the presence of any metachronous
tumor, then the repeat should get done at an interval of three to five year after that (Rose, 2014).
It should also get considered that if a colonoscopy does not perform before diagnosis, it must get
done after completion of the adjuvant therapy (Freeman, 2013). The essence of this is that most
metachronous cancers are unlikely to be detected earlier than three years following the surgery
was done due to the bowel cancer that got discovered more previously. According to Meyerhardt
(2013), secondary prevention may also get recommended for maintaining the body weight and
active lifestyle of John. The role of the Fecal Occult Blood Test (FOBT) remains contentious
with the optimal schedule. Some signs and symptoms that the patient may encounter are fatigue
and pain syndromes which John agrees to have previously encountered during his diagnosis.
Moreover, John may have a fear of the recurrence of cancer which may cause psychological
distress and sexual dysfunction (Alfano, 2012).
Education and Self-Management Plan
1. Physical Needs
John may experience weight loss due to the change in taste and decrease of appetite, and this
can be a significant issue which may require John to see a dietitian before, during and after
receiving treatment. Moreover, sometimes John may get nausea and experience a vomiting
feeling due to the severe side effects of the chemotherapy. It is crucial that such side effects are

Discharge Plan and Self-management of Bowel Cancer 5
managed to ensure John's quality of life is improved. Also, diarrhea and constipation are serious
issues that John should take into considerations in case they occur. It is essential that the
coordinator educates John on noticing such symptoms and how he can manage them to improve
the quality of his life (Jansen, 2015). In spite of that the treatment of rectal cancer may cause
urinary incontinence, and in case it occurs it is essential that John seeks medication as soon as
possible so that he may improve his life. John may also get odors and flatus due to stomas or
urinary fistulae, and it is crucial that John seeks medical attention. Therefore, John should get
educated on how to identify such conditions in case they occur because he will be able to find
medical care as soon as possible. Furthermore, the chemotherapy may reduce sexual interest and
cause sexual dysfunction, and in case John experiences the same, it is crucial that he seeks
medical attention (Alfano, 2012). The medical personnel will be in the position to give sensitive
and credible medication that will help improve John’s condition.
2. Psychological Needs
The coordinator should provide John with the necessary relaxation techniques and medication
that John can use to keep him calm, and in case the symptoms persist it is important that he sees
a psychologist or a psychiatrist. Most of the cancer patients have a fear of the recurrence of
cancer especially after the treatment phase, and it is essential that if John faces the same, he
should see a psychologist. Moreover, the post-traumatic disorder gets sometimes associated with
bowel cancer due to the tedious chemotherapy procedures that John has undergone, and it is vital
that he seeks medical attention from the psychologist (White, 2012). If any of the psychological
problems persist, it is advisable that John sorts psychiatrist intervention. It is essential when John
faces difficulty in communicating with his family and struggles with the metastatic diagnosis.
Moreover, John meets difficulty in transitioning from palliative care and difficulty in quitting

Discharge Plan and Self-management of Bowel Cancer 6
alcohol use. Observations got made when John goes out with his friends to drink on weekends,
and he eats a lot of beef and neglects the greens that his wife gives him. Furthermore, John
becomes isolated and stops going out with his friends and socializing its essential that the family
gets a psychologist for him.
3. Social Needs
Most of the patients may have a change of interest in relationships and the people they associate
with, and this may cause trouble when he goes back to work and tries to live a healthy life. Most
of the time the depression and stress lead to this lonely feeling, and if this happens, John is
advised to see an occupational therapist who would help him recover (Zhang, 2014).
4. Spiritual Needs
John and his family may seek spiritual support that would help them during the recovery of John.
Furthermore, they may get qualified spiritual caregivers who will help them in moving forward
from the cancer treatment.
Conclusion
The article details the follow-up regime that John is to follow to ensure that he recovers
after the completion of his chemotherapy. Furthermore, the report describes the importance of
having an excellent discharge plan that will help John to recover fully physically,
psychologically and socially. It is also essential to provide John with the necessary education that
on how he may get to understand the signs and symptoms of recurrent bowel cancer. As such
patients take on new roles in their lives, ongoing support from the health professionals become
equally important. Assistance may be in the form of education with regards to their disease, its
treatment, potential side effects, rehabilitation and putting up a self-management plan for the

Discharge Plan and Self-management of Bowel Cancer 7
patient after being discharged. The positive results drawn from patient education are a lower
prevalence of depression and anxiety, enhanced coping mechanisms, reduced decisional
conflicts, improved performance status and quality of life of the patient in general.

Discharge Plan and Self-management of Bowel Cancer 8
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