Care of patients with lung cancer: psychological aspects
1. Introduction
It begins with an introduction that provides background information on lung cancer and emphasizes the importance of addressing psychological aspects in the care of these patients. As the second most common cancer and the leading cause of cancer death in the United States, lung cancer is a major public health problem. It is estimated that about 14% of all new cancers are lung cancers. There are 2 main types of lung cancers: small cell lung cancer and non-small cell lung cancer. Moreover, only about 16% of patients are diagnosed at an early stage. They can be cured by surgery, but the vast majority of lung cancer patients are diagnosed at an advanced stage. For these patients, the only goal of lung cancer treatment is to control the symptoms. And palliative care becomes a very important part of caring for them. Also, there is a very low survival rate and a very high mortality rate for lung cancer patients. So, patients and their families carry a heavy emotional burden from diagnosis, throughout the illness trajectory, and into terminal care. In recognition of the high prevalence of psychological distress in lung cancer and the success of the mind-body therapies, this article provides an overview of how the emotional distress originates from the diagnosis of lung cancer and then leads to more serious psychological problems. It also describes various psychosocial interventions that have proved helpful for lung cancer patients, further to explore what the role of healthcare providers in addressing the psychological needs of lung cancer patients is. As a result, the insights in the article will facilitate the comprehensive understanding of the psychological aspects of caring for lung cancer patients.
1.1. Background of lung cancer
Lung cancer is one of the leading causes of cancer-related deaths in the United States and globally. It is the second most common cancer in both men and women (not including skin cancer) and is the leading cause of cancer death among both sexes. Every year, more people die of lung cancer than of colon, breast, and prostate cancers combined. The American Cancer Society estimates that in 2020, about 228,820 new cases of lung cancer will be diagnosed (116,300 in men and 112,520 in women) and there will be about 135,720 deaths from lung cancer (72,500 in men and 63,220 in women). The main risk factor for lung cancer is smoking, which is thought to be responsible for about 85% of all cases. People who smoke cigarettes are 15 to 30 times more likely to get lung cancer compared to non-smokers. The risk of lung cancer increases with the number of cigarettes smoked and the number of years of smoking. However, lung cancer also occurs in people who have never smoked and in those who have never had prolonged exposure to secondhand smoke. Other risk factors for lung cancer include exposure to radon, asbestos, diesel fumes, air pollution and certain genetic characteristics. It is important to note that lung cancer can occur in anyone, including those who do not have any identifiable risk factors.
1.2. Importance of addressing psychological aspects
The emotional and psychological impact of a lung cancer diagnosis cannot be overstated. Research indicates that addressing the psychological aspects of cancer not only improves quality of life, but may also lead to improved physical outcomes and possibly even longer survival. In the context of lung cancer, however, there is relatively little research on psychosocial interventions and the psychological impact of a lung cancer diagnosis, compared to other types of cancer. This is a crucial gap in our understanding of how best to care for these patients. It also means there are significant unmet needs, as patients with lung cancer report low rates of screening for emotional distress and relatively low rates of access to psychosocial interventions, compared to other cancer patients. On the other hand, research on cancer care generally finds that the majority of patients want interventions like counseling, but only a minority of patients accept and pursue such treatments. This suggests that improving patient education and destigmatizing the psychological impact of cancer may be an important aspect of caring for these patients. Yet, addressing the psychological needs of lung cancer patients is more than just ensuring the best day to day care for a patient. We need to do better to give the patients’ voice a chance to express the patient’s personal desire and autonomy in the decision-making process. This is even more so with regards to a disease that has such a high mortality as lung cancer. Clinicians should not become so focused on curing or prolonging life that they neglect the importance of allowing the patient to live well and have a good quality of life until the end. Specifically for lung cancer, it is something that patients are almost fearful to express to their treating clinician; as if indicating that certain psychological interventions may be beneficial will lead to the suggestion that their symptoms are ‘in their mind’ rather than the real physical symptom. However, the opposite may at times be true—psychosocial interventions may actually help patients obtain a better coping mechanism for the multitude of disease-related symptoms, especially for the pain and suffering that patients may experience. I feel that researching these aspects of psychological care and implementing findings into clinical practice is essential. I believe research will soon move not only towards identifying psychological symptoms and improving intervention techniques, but also towards discovering the potential risk and improvement therapy can bring about, or even the means in which it can augment survival. This will also further advocate the importance of addressing psychological aspects in lung cancer treatment and allow us to work towards integrating the treatment as a novel aspect of lung cancer care.
2. Psychological impact of lung cancer diagnosis
In addition, the psychological impact of a lung cancer diagnosis can be very significant. A cancer diagnosis is a life-changing event, not only for the patient, but also for the family and friends. Most patients and their loved ones will experience a wide range of emotions – from shock and disbelief to anger, sadness, and frustration. Patients may feel overwhelmed and panic about the consequences of their illness. They may also worry about what the future holds, both for themselves and for the family. These feelings can lead to emotional distress and anxiety, which refers to the physical and emotional symptoms that can occur when a person faces continuous stress from a cancer diagnosis. For example, some patients may have sleep disturbances, find it difficult to focus on everyday tasks, or have changes in appetite and weight. Patients with lung cancer have been found to have higher levels of anxiety compared to other cancer patients. Anxiety levels were found to be particularly high when patients were first told about their diagnosis. This is not surprising, given that lung cancer is often diagnosed at an advanced stage. In one study, patients with lung cancer reported higher levels of anxiety and symptoms of depression, as well as a lower quality of life, compared to the general population. This suggests that lung cancer patients may be at risk of developing clinically significant anxiety and depressive disorders. Such psychological suffering can affect the physical well-being of a person. For example, stress and anxiety can weaken the immune system, which will make the person more susceptible to infections and illnesses. It may also impact the body’s ability to heal and recover from treatment. High levels of anxiety, with associated tension and avoidance of physical and emotional experiences, may prolong suffering and delay effective treatments. So, it is important for healthcare providers to recognize anxiety symptoms and support patients in managing them effectively. Cognitive-behavioral therapy and medication are common and effective interventions for anxiety in cancer patients. However, given that lung cancer patients often have high levels of both anxiety and depressive symptoms, it is also important for healthcare providers to explore patients’ experiences fully and to identify suitable treatment options for each individual. This will help maximize the likelihood of successful recovery from psychological distress.
2.1. Emotional distress and anxiety
The psychological impact of emotional distress and anxiety exists in lung cancer patients. The moment the patients receive a diagnosis, the emotional distress and anxiety start to take over, and it is worth noting that it does not only affect the patient but also the family. Patients may experience a wide range of distress, from normal feelings of vulnerability and sadness to disabling panic and anxiety. They may also experience physical symptoms of anxiety, such as a pounding heart, feeling lightheaded or short of breath, as well as intense fear and dread. When healthcare providers perform mental assessments and psychiatric symptom screenings on these patients, they can find that the majority of the patients do suffer from anxiety disorders. Patients often reason with themselves when they are told they will undergo medications or treatments like chemotherapy. However, as the physical side effects like hair loss and vomiting start to happen, patients’ fear of a much unknown future becomes stronger. Moreover, lung cancer patients can start to feel a lack of sense of security and daily isolation which, in psychological terms, could develop into anxiety. It is thoroughly accepted that a patient with lung cancer at any stage will need a properly managed overall approach to health and wellbeing. If a patient is identified as needing supportive care for emotional distress and/or anxiety, the initial method of treatment is to register and refer them for psychological treatments. For example, through using cognitive or behavior therapy, patients can be equipped with the knowledge and skills to help them overcome their anxieties. Emotional distress and anxiety are common in cancer patients, and it can be severely disabling. The author suggests all healthcare providers should have a sensitive approach for the avoidance of labeling a patient as “anxious” or “distressed”. Instead, an open discussion about the patient’s worries and the possible treatment options should be encouraged. The willingness to understand the patient’s own approach to his conditions is deemed as the key to good treatment. It is also important for the families to be involved in the treatments and care planning since psychological support is always more effective if facilitated in a family context. In conclusion, effective treatments for emotional distress and anxiety can significantly improve the patient’s quality of life. Also, in the long run, patients’ reliance on medical interventions and the possibility of referral to specialist mental health services may be reduced. These will also have benefits in terms of financial savings to the health services, as a result of a more efficient and timely use of the limited resources.
2.2. Depression and mood disorders
At the end of the day, depression and anxiety are the most common and overwhelming psychological challenges that normally follow a lung cancer diagnosis. In fact, one in five people with lung cancer will suffer from clinical depression within two years after their diagnosis. Depression is a serious mood disorder characterized by persistent feelings of sadness, hopelessness, worthlessness, and the inability to experience pleasure. On the other hand, we realized there is this condition called dysthymic disorder where it is a less severe form of depression, but its symptoms are long-lasting and they can eventually become disabling. As opposed to depression, patients with dysthymic disorder generally do not experience a complete loss of interest in pleasurable activities. Rather, they go on being capable of experiencing some degree of joy but their ability to enjoy themselves is definitely diminished. However, it is important to bear in mind the adjustment disorder with depressed mood where it is a syndrome with symptoms that are similar to depression but it occurs within three months of a particular stress. But as I mentioned earlier, depression is a massive challenge, but largely under-recognized in patients with lung cancer. It is often due to the lack of recognition of the symptoms and its psychological nature. However, this is the very reason it needs to be addressed as part of holistic care for lung cancer patients. It is a fact that once again I can prove the significance of integrating psychological care with medical treatment for lung cancer. Remember, taking mood as well as emotions into consideration is completely crucial when managing cancer patients. Because a study has shown that the screening program had managed to diminish the level of under-treatment of depression by more than 50% in cancer patients. More than that, it could also enhance the closing of those under-treatment cases by 92%. Such finding is definitely promising towards the improvement of managing depression cases in cancer patients. Well, we have to admit that we could not jump to the conclusion but. As the saying goes, the proof of the pudding is in the eating. It will be interesting to see the quality of life of the patients that are under the screening program. Anyhow, there is no harm for cancer patients to go for screenings as it is both for their psychological and physical benefits. And this is the reason why many healthcare providers have been stressing on the integration of such screening program in the cancer care provision. Last but not least, the collaborative care between psychologists, psychiatrists, and oncologists is important to give the treatment process a smooth sequence and enhance effective management of cancer patients. Well, what do you think? I would say the roles of psychologists and psychiatrists in the management of mood disorders can be fruitful. On the other hand, the knowledge of oncologists towards psychological needs in cancer diagnosis and treatment is definitely important as they are likely to be the attending clinicians seen by the patients most often. So, this well-organized interdisciplinary collaboration means a much better chance to provide comprehensive quality care to those cancer patients. I noticed this part of the show is really impressing as they appreciated the importance of each member of the team. It is the awareness of mutual dependence and respect to each profession’s specialty that has created the most optimum conditions in the treatment team. All team members have significant roles to play as to maintain the balance and relationships of all professionals in the team. As a result, they hold their clinics every day!
2.3. Fear of recurrence
The fear of cancer returning or progressing can be very common after the treatment. However, with a lung cancer diagnosis, this fear can be particularly strong. This can be because lung cancer is identified by many people as a very severe and life-threatening condition. However, it might also be that as lung cancer is often linked with smoking, some people with the condition might blame themselves for having caused it. This can occasionally lead to feelings of shame or guilt, especially where relevant advice on lifestyle changes, such as smoking cessation, had not been considered before the diagnosis. These types of emotional responses can contribute to the fear of cancer returning or progressing. Knowing who to turn to for individual support can be very important. For example, some patients may prefer assistance from their family or friends. Others may feel better after seeking help from healthcare professionals. It also helps if people around can provide psychological support. This can be in the form of different ways. For example, healthcare professionals might suggest activities, such as meditation and relaxation, to help reduce levels of stress and lower the possibility of depression. On the other hand, family or friends should offer emotional support, such as talking to you and listening to your feelings, to help you feel supported in an emotional way. However, it is not enough in most cases. Psychological support from specialists, like Clinical Psychologists, is often required to help individuals overcome the problem. This approach is crucial, as specialists will look at not only the psychological impact but also how the fears may lead to changes in the physical/personal aspects in the daily life as well. For patients with these fears of disease progression or recurrence, especially related to a severe disease like cancer, recovery patterns often involve high levels of anxiety. It is often difficult to predict specific timelines for fear reduction. However, the research has suggested that preoccupation with the fear, which may impact decision-making and strategies to help manage current difficulties or to reduce the chance of the cancer to recurrence, can be common in the early stage of the recovery. Also, it is said that compared to other cancer types, cancer survivorship in lung cancer is linked with higher rates of fear of disease progression. This suggests that the fear may persist longer over time. Nevertheless, it is important to have in mind that the gradual reduction of the fear of cancer recurrence can be achieved even in cases of severe diseases. The model of fear of cancer recurrence shows it to be a natural reaction to a serious life event, and that with a comprehensive understanding from both the patients and the healthcare professionals, a structured recovery path with gradually reduced fear levels can be expected.
3. Psychosocial interventions for patients with lung cancer
Psychosocial interventions are an integral part of comprehensive care for patients with lung cancer, aiming at helping patients cope with the challenges of the disease and improve their quality of life. There are a variety of psychosocial interventions available for different groups of lung cancer patients, in which individual counseling and therapy have been most commonly offered though also such treatments as relaxation techniques and mind-body approaches are increasingly provided. Studies looking at the effectiveness of psychosocial interventions in lung cancer care, however, are scarce and very few well-designed randomized trials have been conducted. But according to the American College of Chest Physicians, psychosocial support should be offered to all the lung cancer patients. As an advanced practice nurse or physician assistant who cares for this group of patients, we should pay attention not only to patients’ physical health but also their psychological needs. Every patient is a unique individual and should receive a personalized care plan. We need to make sure that treatments offered to our patients are in line with the current best practice. The role of healthcare providers in addressing the psychological needs of patients is discussed, including the importance of communication, empathy, education, information provision, and a collaborative care approach. Every contact with the patient is an opportunity to develop an empathetic and supportive relationship. Adequate time and privacy is essential collecting information from the patient. Promoting effective communication and patient education are fundamental strategies in psychosocial care for lung cancer. And we need to ensure that patients have access to reputable sources of online health information and feel confident to discuss any queries with their healthcare providers. For late stage lung cancer, end of life issues may generate a lot of anxiety. From the NICE clinical guideline of end of life care, we need to create a care plan focusing on the person’s potential needs and wishes. It may also be helpful to discuss patients’ preferences with death and record these in a form of advanced directive or living will. By analyzing and measuring the effectiveness of psychosocial care between different methods, we can build up an evidence-based best practice, which is also an important aspect of clinical governance.
3.1. Individual counseling and therapy
Individual counseling for lung cancer involves working one-on-one with a trained counselor to help patients identify and work through specific psychological and emotional issues. Counseling enables patients who are living with lung cancer to explore at their own pace the emotional and psychological impact of their condition. It can help to identify and manage feelings of anxiety, depression, and fear. A typical course of counseling might involve 6 to 10 weekly sessions, with each session lasting 50 minutes to an hour. The focus and content of each counseling session varies from person to person; however, many patients work through a number of common issues, including the emotional adjustment to diagnosis and understanding the different emotions experienced following a diagnosis. Many will move on to consider matters surrounding their treatment and longer-term issues related to their condition. Studies show that patients with lung cancer who undergo individual psychotherapy experience a reduction in the trauma, anxiety, and depressive symptoms that were initially reported. Furthermore, the effectiveness of therapy for lung cancer patients has been shown to improve not just their mental health. In a recent review, it was revealed that patients receiving individual psychotherapy may also have longer survival periods which could be partly attributed to how patients were found to have improved adherence to treatment plans and fewer incidences of self-destructive health behaviors such as smoking. This is interesting as it suggests that therapy not only improves a patient’s mental wellbeing but may also positively impact upon their physical health. It is important that healthcare professionals signpost patients living with lung cancer to counseling services that are reputable and experienced in cancer care. On this page, we provide guidance on identifying and accessing a suitable counselor and explain the processes and steps involved in arranging counseling support. It can feel like a big decision to start counseling, as patients may not be sure about what the sessions will involve or how it could help. However, the initial step is simply to arrange an assessment with a counselor. These are often fairly informal chats that will usually take about an hour. The assessment is an opportunity for patients to talk through their issues and concerns and help the counselor to understand if and how treatment could help.
3.2. Support groups and peer support
Support groups are a form of psychosocial intervention in which patients can connect with other individuals who are going through a similar experience. Led by a professional, these groups provide an opportunity for patients to share their thoughts and emotions and learn from one another. They may focus on specific issues, such as developing coping strategies or sharing experiences with different treatments. Patients in a support group become each other’s support. It gives patients an opportunity to be with people who understand how they feel because they are going through the same experience. In support groups, patients would benefit from the experiences and wisdom of others. By hearing how others cope and what others may have done in a similar situation, it may give patients optimism for the future and provide hope that there are many things they can do to boost their lives. Although peer-led support groups have given strong evidence of improvement in coping strategies and the quality of life, the support from those who have better experience in certain situations, the evidence of improvement in mental health is still inconsistent. Also, it is necessary to remember that support groups are not for everyone. Some might find themselves uncomfortable and others may find that they are too busy to fit another obligation into their schedules. Most importantly, research evidence supports the benefits of support group in many disease scenarios. It is better to communicate with healthcare providers to find the most suitable intervention based on personal mental health condition. Patients who have difficulty finding support group can discuss with the healthcare providers because there might be other support plans that would meet individual needs. Various methods connecting patients to clinical trials and new treatment information are also available. For example, the American Lung Association (ALA) and Lung Cancer Alliance (LCA) offer easy-to-access, reliable and up-to-date informational resources for lung cancer patients. By providing the information of ongoing and current clinical trials, the patients would benefit from the clinical community support and most importantly, the hope of advancing treatment alternatives. Modern treatment such as targeted therapy and immunotherapy constantly changing the standard of lung cancer care. Through receiving the information and support from the community, it may give patients a sense of empowerment and advanced awareness on the constantly changing landscape of lung cancer treatment. Finally, patients who may feel difficult to physically transport themselves to a specific location for support group or those who need immediate consultation at any time can choose the internet-based online support groups. Studies have shown patients tend to be more open and less discomfort expressing themselves in the online environment. However, it is also important to verify the quality of different internet discussion sites and make sure health information provided would not lead to any potential risk of personal health. Online support group may serve as a valuable supplement in providing peer support network and foster communication between patients. The benefits of exercise, psychosocial support and having a positive healthy lifestyle and a balanced diet are still largely unexplored for reducing the risk of lung cancer and for those who would suffer from lung cancer. The evidence of the effectiveness of support group is growing and started to gain recognition in the community, modern medicine still has much to discover about how and why support groups help many people. The mental health system has provided strong support for incorporating peer support and emphasizing greater re-use of personal experiences and resulting empathy as powerful tools for recovery. However, the practical application of support group may not be the future replacement of traditional therapeutic intervention as it is not for everyone and research shall continue to investigate an optimal model of mental health delivery for different groups of patients with lung cancers.
3.3. Mind-body therapies and relaxation techniques
Patients who choose mind-body medicine as their treatment of choice are encouraged to participate in stress management, meditation, and relaxation techniques classes. Mind-body medicine focuses on the interactions between the mind, body, and spirit and the powerful ways in which patients can reduce stress. Relaxation techniques, such as progressive muscle relaxation and deep breathing, can reduce the stress response, and many studies have demonstrated the beneficial effects of relaxation techniques in individuals with anxiety or mood disorders. Progressive muscle relaxation involves tensing and then relaxing muscles throughout the body, and deep breathing can be done by slowly breathing in through the nose, holding the breath for a few seconds, and then slowly and steadily breathing out through the mouth. These techniques can be done anywhere and at any time; the only requirements are a few quiet minutes and a place to sit or lie down comfortably. In addition to relaxation techniques, acupuncture has also been popular as a treatment for stress as well as for the nausea associated with chemotherapy. Developed in China over 5,000 years ago, acupuncture has been used in both prevention and treatment of many diseases. By inserting needles into different points on the body, the body’s own natural healing response is stimulated. This is referred to as the “vital energy” of the body which flows through very small pathways, or meridians, in the body. Studies have shown that acupuncture has the ability to relax the nervous system and reduce stress. Also, acupuncture has been shown to cause the body to produce endorphins, or natural painkillers. Acupuncture treatment is most often given two to three times a week and can continue for a few weeks to a few months. Neuropsychological effects of mind-body medicine and relaxation techniques have been studied in patients with lung cancer. Modern imaging machines such as a positron emission tomography (PET) scan demonstrate that relaxation techniques have the ability to reduce brain activity in the part of the brain called the “anterior cingulate”. This area of the brain is responsible for the emotional and physical aspects of a patient’s stress response. Furthermore, studies have observed decreased heart rate, blood pressure, muscle tension, and increased endorphin levels as a result of relaxation techniques. By reducing activity in the brain and the physical symptoms of stress, patients are able to feel more in control of their body and emotions. Overall, research studies done worldwide have shown that mind-body therapies and relaxation techniques are safe, noninvasive, and popular complementary approaches for patients with cancer to reduce stress and anxiety. These techniques can help patients cope with pain and can lead to a better quality of life.
4. Role of healthcare providers in addressing psychological needs
This continuous duty of care has made it imperative for healthcare provider teams to have a proper understanding and realization of the psychological impact of lung cancer on patients. Effective communication, which is more focused and empathic with shared decision-making strategies, has the potential to address many issues that patients face during their pathway through lung cancer. A good communication is not only about a well-established contact with a patient, but it is also about providing a standard of care and exchanging information, emotions, feelings, and concerns. As the word “cancer” strikes the patient, their family, and significant others, there could be an immense level of distress or even some devastating psychological outcomes. The immediate impression is very common in this regard, and when the patient is in a state of shock, the healthcare provider’s good communication strategy and empathic behavior can help to minimize the gap between stress and adaptation that one may have to confront. There are various forms of communication that a healthcare professional can make with the patient; however, shared decision-making and empathic communication could play a vital role in addressing some potential psychological issues. The most important thing is genuine emotional focus and allowing a patient to feel and express their distress. The empathic style of communication can have a big positive outcome on psychological symptom improvement and litigation, and it can minimize complaints and medical errors.
4.1. Communication and empathy
Such professional and safe communication of concerns and potential issues in ethical and legal practices will effectively safeguard the quality of healthcare services and ultimately promote better patient experience and optimal standards of care for lung cancer.
But it is essential that such care culture should enable healthcare providers to raise concerns and empower them with opportunities to address barriers obstructing effective care communication. For example, the staff should not be prejudiced from raising legitimate concerns about the standard of care that patients have received when certain conditions are not met. Also, regulatory and supervisory bodies should recognize and actively ensure that appropriate action is taken conformably with the best interests of the patient and at no time compromises the welfare and safety of the patient.
Coordinated communication among healthcare providers and active engagement of patients in their care can promote more patient-centered and efficient management of lung cancer at different stages. Complementary to this, a successful lung cancer strategy that aims to deliver good patient experience and quality care should include empowering healthcare staff by providing education on good consensual patient communication and effective team-working skills in a follow-up environment. This will help to sustain high morale and motivation of healthcare professionals, which is beneficial to ensure continuing progress in standards of care for patients with lung cancer.
In certain situations, patients may also be involved in the communication process. For example, patients can take an active role in developing specialist services by contributing to research or quality improvement projects in which the patient’s personal experience of lung cancer is closely considered. He or she can also provide feedback and suggestions to help the specialist teams enhance the patient’s experience and satisfaction. Many patients like to have access to their GPs and specialist teams through emails and mobile messaging for questions and advice on managing their condition and treatment. Such convenient communication not only helps to meet individual health needs but also maximizes the capacity, accessibility, and responsiveness of healthcare services.
For example, the primary care doctor might play a key role in a patient’s diagnostic process by initiating early investigations, referring to specialists, or providing the patient with psychological support. On the other hand, a respiratory physician who generally manages the disease in the secondary care setting may need to communicate with surgeons and other professionals in a multi-disciplinary team in order to develop the most appropriate treatment plan for the patient. A radiologist’s prompt and accurate communication of imaging findings is fundamental to patient management, and so is the communication and handover among different shifts of hospital healthcare staff that include nurses, junior doctors, and specialists.
A collaborative care approach requires effective communication among all healthcare professionals involved in a patient’s care. These group of individuals usually includes thoracic surgeons, general practitioners, respiratory physicians, radiologists, pathologists, oncologists, specialist nurses, pharmacists, psychologists, and other professionals like social workers, occupational therapists, and physiotherapists. This team will also communicate and work with patients and their family members. Inter-professional communication is essential for timely diagnosis and effective seamless care provision.
4.2. Education and information provision
Healthcare professionals need to make sure patients with lung cancer are provided with education and information about their diagnosis and treatment to minimize their distress. Educational interventions mainly benefit patients as they are helped to restore their sense of control over their illness and develop active coping strategies. Information in a range of formats is acceptable and what a patient may respond to one day might not be appropriate the next. For some, providing detailed cancer and treatment-related information is important, whereas for others, psychological support to manage the emotional distress is a priority. It is also crucial to identify and address any language or communication barriers to successful information provision. For instance, a patient might not speak English as their first language or they might have a hearing or sight impairment which is not well-managed. I believe education and providing information to the patients will also improve their trust and mutual understanding with the healthcare professionals. For example, a study has shown that patients ask fewer questions and are less likely to be undecided about a treatment decision if they perceive that communication is good. This would likely decrease patients’ anxiety and distress. It could also reduce the healthcare costs due to the more efficient use of medical resources and facilities. On the other hand, less time and fewer resources are needed for managing psychological distress for healthcare professionals if they can focus on and invest time and effort in education and information provision. Given that lung cancer is the most common cause of cancer mortality and patient acceptance of health services, I would argue that understanding patient needs and investing in healthcare training and practice to promote patient education will be the most effective way to reduce patients’ psychological distress and improve their quality of life.
4.3. Collaborative care approach
The collaborative care approach, as the name implies, involves the coordination of medical professionals from a range of disciplines, for example the patient’s specialists, nurses, psychologists, and counselors, in order to ensure that the patient’s physical and psychological needs are adequately met. This approach has been found to be particularly effective in treating a broad range of psychological conditions in patients, including depression, anxiety, and other mood disorders. Under a collaborative care regimen, the patient typically receives ongoing assessment and feedback from their healthcare team as to their treatment progress; medical professionals are able to share notes and insights into the specific case and to devise treatments bespoke to the individual patient; and finally, the patient is assured that their care is constantly under review and that any impediments to their successful recovery will be rapidly identified and addressed. The article concludes that lung cancer is seen as a particularly arduous affliction due to the intense stigma that persists regarding the disease, the low survival rates associated with lung cancer, and the fact that treatment can often be uncomfortable and distressing for patients. The authors suggest that this makes the collaborative care approach particularly suitable for lung cancer patients, because its combined focus on physical and mental well-being is uniquely positioned to deliver effective care that addresses both the direct symptoms of the disease and the more nuanced psychological changes patients may encounter. From a practical perspective, the article notes that collaborative care approaches to psychological care are especially important in the modern medical context, where individual medical services increasingly operate in isolation and without immediate reference to other health professionals. By contrast, the combined and patient-focused model of care raises both the quality of the care delivered and patient satisfaction; while at the same time providing a meaningful way for different medical services to dovetail and support each other’s aims and objectives.

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