Beruflich Dokumente
Kultur Dokumente
Joan Hamilton
CNS Cancer Care
QEII Cancer Care Program, Halifax
Joan.hamilton@cdha.nshealth.ca
902-473-5407
11/26/2013
Learning Objectives
Click
edit Master
text styles
Identifyto
screening
& assessment
tools for CRF.
Second level
Identify
different
Third
level topic areas relevant to the teaching of CRF.
Fourth level
Fifthfor
level
Describe content
selected topic areas that should be
11/26/2013
Third level
0
1
2
3
No
Fourth level
tiredness
Fifth level
10
Worst possible
tiredness
Worst possible
drowsiness
No drowsiness
11/26/2013
The Click
Fatigueto
Pictogram
Fitch, Bunston,
Mings, CONJ
Winter 2012
edit Master
title
style
11/26/2013
Conduct
a focused
Second
level assessment if patient rates fatigue
>4 (moderate
Third levelor severe fatigue)
CPAC
Fourth level
Fifth level
11/26/2013
11/26/2013
Fifth
level
Describe
what
fatigue
is like: physically, your
Q Quality
(intensity)
What would
you rate itthe
at its worst/best
thru day?
(If person cant quantify: rate as better/worse than before, or mild/mod/severe)
thoughts,
your
feelings,
in how
you
T
Treatment
What ways have
you found
to manage yourchanges
fatigue(what is helpful).
Not helpful?
How are
effective are they? What advice have you been given (worse /best advice)?
U
Under-behaving.
Beliefs re: cause of fatigue? Concerns? E.g., What about it concerns you the most?
standing
How bothered are you by your fatigue?
V
Values Other
Goalsymptoms
for this fatigue? What level
of fatigue is acceptable
to you?fatigue(ie.sleep,
associated
with
R Radiating
What would be livable?
Also consider:pain,
past historymood,
of symptom, disease
status, anemia, infection,
treatment history,
medications,
depression,
appetite,
nutritional
intake)
other possible stressors, nutritional intake, appetite/wt changes, family perspectives
Physical Exam:
gait, posture, range of motion,
eyes (conjunctival
pallor if anemic), hypothyroidism,
Day-to-day
effects(eg:
socializing,
relationships,
Reference: O,P,Q,R,S,T,U,V Assessment System, Fraser Health Report. in Pan-Canadian Practice Guidelines
(fatigue) February
2011. Adapted
for Therapeutic
Practices in Distress Management Course. Spring 2013.
ADLs,
memory,
concentration)?
IPODE Project/EDOPI Projet http://www.capo.ca/ipode-project
O Onset
Click to editfocused
Master title style
11/26/2013
Fifth
level
(intensity)
What would you rate it at its worst/best thru day?
(If person cant quantify: rate as better/worse than before, or mild/mod/severe)
standing
you
the
most? How bothered are you by your fatigue?
T
Treatment
What ways have you found to manage your fatigue(what is helpful). Not helpful? How
are they? What advice have you been given (worse /best advice)?
Goal foreffective
this
fatigue?
What
level
fatigue
is acceptable
V Values U UnderBeliefs
re: cause
of fatigue? Concerns?
E.g., What
about of
it concerns
you the most?
standing
bothered are you by your fatigue?
to you?How
What
would
be
livable?
V
Values
Goal
for this fatigue?
What level
of fatigue
is acceptable to you?
S
Click
to
edit
Master
title
style
Fatigue/Tiredness Protocol (COSTaRS)
Tell me what number from 0 to 10 best describes how tired
Click
edit Master text styles
you areto
feeling.
How
worriedlevel
are you about your fatigue/tiredness? (0-10)
Second
Third level
Do you have the following: shortness of breath at rest, sudden
Fourth fatigue,
level
onset of severe
excessive need to sit or rest, rapid
Fifthblood
level loss, or pain in your chest?
heart rate, rapid
How would you describe the pattern of fatigue?
(intermittent/constant)
Does your fatigue interfere with your daily activities at home
and/or at work? Describe.
Are there times when you feel exhausted? Describe.
Stacey D for the Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Steering Committee.
Remote Symptom Protocols for Individuals Undergoing Cancer Treatment. University of Ottawa School of
Nursing and the Canadian Partnership Against Cancer, Ottawa, Ontario, Canada,March 2013.
11/26/2013
video on CRF
By Mike Evans
Goggle: cancer related fatigue Mike Evans
11/26/2013
10
Description of CRF
Second
Thelevel
Difference Between CRF & Usual Fatigue
Third
level of CRF
Symptoms
Fourth level
Rating/Measuring CRF
Fifth level
Patterns of CRF
Causes of CRF
Things that Contribute to CRF
Results, Consequences & Cost of CRF
Depression & Fatigue
11/26/2013
12
11/26/2013
13
11/26/2013
14
Click to
edit
Master
title
style
Depression and Fatigue
Depression contributes to fatigue & fatigue contributes to
Click to edit Master text styles
depression.
Second level
Third level
Not uncommon for someone with fatigue to have depression.
Fourth level
Fifth level
11/26/2013
15
Click to
edit
Master
title
style
Depression and Fatigue
Questions that may help determine if you are depressed:
Click to edit Master text styles
Are you feeling sad/empty? How much of the day are you sad?
Second level
How long have you been feeling this amount of sadness?
Third level
(or is it more frustration because you are too tired to do what
Fourth level
you want to do)?
Fifth level
Are you feeling helpfulness, hopeless, worthless, lacking
confidence?
Are you getting enjoyment from things that usually give you
pleasure?
Do you think they are depressed?
11/26/2013
16
Click to
edit
Master
title
style
Depression and Fatigue
Have
Clickyoutothought
edit Master
text
styles
about killing
yourself?
Second
Doyou
have alevel
plan of how you would do it?
Third level
Fourth level
Fifth level
11/26/2013
17
11/26/2013
18
From
Cap Map
in CPAC
Fatiguetitle
Guidelines
Click
to edit
Master
stylep.42
11/26/2013
19
From
Cap Map
in CPAC
Fatiguetitle
Guidelines
Click
to edit
Master
stylep.42
11/26/2013
20
Click
edit
title
style
Topic to
Areas
for Master
CRF Patient
Teaching
11/26/2013
21
to your
HCP about
yourtext
fatigue.
Talk
Click
to edit
Master
styles
Dont assume that it isnt as important as other symptoms
Second level
or nothing that can be done to help ease it.
Third level
Fourthtolevel
May be helpful
keep track of or log your fatigue.
Fifth
level or log.
Consider using
a journal
Is there a pattern? When is it worst/least thru day?
How fatigued are you after different activities?
How long does it take you to recover from doing activities?
Rate how severe it is every couple of weeks (not daily).
This information can be helpful in planning your activities.
11/26/2013
22
ClickExercising/Physical
to edit MasterActivity
title style
Research shows that exercise will improve fatigue symptoms.
Click
to the
editmost
Master
textproof
styles
(Probably
convincing
there is for improving
symptoms
fatigue).
Secondoflevel
Third level
Often, exercise
the last thing people feel like doing.
Fourth is
level
Fifth level
23
Second level
Third level
Goal: Gradually work up to 30 minutes of moderate exercise
Fourth level
most days of the
week.
Fifth level
24
Second level
Third level
Over time, gradually push yourself to increase that 10 mins .
Fourth level
Fifth level
11/26/2013
25
will probably
you
Moderate
Click to exercise
edit Master
text make
styles
sweat a bit.
Second level
Third level
Moderate
exercise can cause you to be
Fourth level
slightly out of breath
but still be able to
Fifth level
talk. If you get too winded, slow your pace
down but keep moving to keep your heart
rate up.
26
Second level
Third
levelyou are doing your full 30 mins of exercise
Can start
it before
Fourth level
most days of week.
Fifth level
27
ClickExercising/Physical
to edit MasterActivity
title style
Exercise should be done during day when you have the most
energy
Click to
Master
text
(notedit
end of
day when
yourstyles
usually tired).
Second level
The exercise
should not make you feel like you want to go to
Third level
bed for the
rest of
the day. Pace yourself.
Fourth
level
Fifth level
28
Second level
Third level
If you are unable to stand or walk you can modify an exercise
Fourth level
program with
a PT (ie. like low intensity seated exercises)
Fifth level
11/26/2013
29
Click
to
edit
Master
title
style
Education, Counseling &Support
Including(incorporating) helpful strategies in your daily life.
Second
level
Learning
skills/techniques
to manage stress & fatigue.
Third level
Fourth level
Exploringways
of managing different feelings & thoughts
Fifth level
around fatigue.
Distracting yourself.
11/26/2013
30
Click to edit
Master
title
style
Conserving Energy
conservation (EC) is an approach used to manage CRF.
Energy
Click to
edit Master text styles
Second level
31
11/26/2013
32
Click to edit
Master
title style
Conserving
Energy
Usually need to place more attention on EC when a person is
Click
to edit
Master
textorstyles
experiencing
moderate
fatigue
greater (rating of 4 or >).
Second level
Third
level
An OT
can help
with energy conservation strategies.
Fourth level
Fifth level
33
then
Clickcontinue.
to edit Master text styles
Second level
Break tasks
Thirddown
level or take a number of breaks.
Fourth level
Fifth
level your body & mind for a period of
Resting means
resting
34
Avoid rushing.
11/26/2013
35
your
Include
others
in your
planning & share your
Plan
Click
today.
edit
Master
text
styles
plan with those who need to know.
Second level
Third level
Plan activities
when you are least fatigued.
Fourth level
Rest when you
arelevel
most fatigued.
Fifth
36
most
important
things
you want to do in your
What
Clickaretothe
edit
Master
text
styles
day?
Second level
Third level
What is realistic
to get done?
Fourth level
Fifth level
11/26/2013
37
Click toPosition
edit Master
title
style
and Posture
while standing
& sitting.
Keep
Clickgood
to posture
edit Master
text styles
Use good body positioning.
Second level
Make sure your work area is at a height good.
Third level
Avoid reaching.
Keep what is needed handy.
Fourth level
Use walking aids.
Fifth level
Dont do heavy lifting .
Slide (push or pull) objects instead of carrying them.
It takes 25% less energy to sit rather than stand, so sit when
you can.
11/26/2013
38
who experience a
Group
Clickoftopeople
edit receiving
Master treatment
text styles
period of really intense fatigue.
Second level
It often occurs with dose dense chemo ---ie, treatment for
Third level
some blood
cancers, intensive chemo, BMT, with major
Fourth level
complications.
Fifth level
People with this severe fatigue have difficulty doing basic
activities of daily life.
It is not understood why some people can become so
severely fatigued.
Sometimes treatment can be delayed or discontinued.
11/26/2013
39
Click
to
edit
Master
title
style
Energy Conservation with Severe Fatigue
Conserve energy for the simplest of tasks.
Click to edit Master text styles
An OT helps people learn how to conserve energy for
Second level
everyday activities.
Third level
Important to keep doing some activity.
Fourth level
Fifth level
If you dont work at it, push yourself a bit, you will get weaker.
Often takes baby steps to begin getting out of bed and
spending time in the chair.
Building stamina is a gradual process.
11/26/2013
40
heart
a muscle
& it gets
outstyles
of shape like other muscles
The
Click
toisedit
Master
text
when
it isnt being
Second
level worked as much as usual.
Third level
The heartgets
out
of shape quickly by lying down for most of
Fourth
level
Fifth
level& circulation problems)
day. ( risksfor
lungs
41
edge
of the bed
Sitting
Click at
tothe
edit
Master
text
does
not provide
Second
levelback or arm
support.
It can
be very tiring.
Third
level
styles
Fourth level
Fifth
So when sitting
up,level
42
Click toImproving
edit Master
title style
Your Sleep
Improving sleep can improve feelings of fatigue.
Second
levelthe same routine for going to bed.
Develop
& follow
Third level
Fourth
leveldo quiet things like read or listen to calm
Before going
to bed,
Fifth level
music, have hot
milk, have a bath (lukewarm not hot).
Go to bed & get up at same time every day. (helps the body get
into a rhythm & relax). It may take a while to get into a
bedtime routine. People say it is worth it.
11/26/2013
43
Click toImproving
edit Master
title
style
Your Sleep
Dont spend time in bed unless sleeping. reading or TV in
bed.
Click
to lay
edit
Master
text
Dont
in bed
once you
arestyles
awake in the morning.
Second level
Third level
Napping
Fourth
level
Limit naps.
(Taking
a number of small naps thru the day often
Fifth
level
interferes with
night
time sleep, as does taking a nap in late
afternoon nap or napping too long).
Goal: avoid napping thru the day.
Try to only have one nap, early afternoon
Stop all the cat naps
20-30mins? 1 hour?
11/26/2013
44
you cant
sleep Master
when youtext
go to styles
bed, dont toss & fret for
IfClick
to edit
hours. Get up after 15 mins. Try doing a quiet activity & when
Second level
you get sleepy, do the bedtime routine again & go to bed.
Third level
Fourth level
If you wake in the
Fifthmiddle
level of the night & cant get back to
11/26/2013
45
on, avoid
caffeine
& other stimulation like
From
Clicklate
toafternoon
edit Master
text
styles
exercising.
Second level
Third level
Getting daily
exercise tends to help a person sleep better.
Fourth level
Fifth level
11/26/2013
46
Click
to
edit
Master
title
style
Contact a Health Professional immediately if:
if
Click
CRFtosuddenly
edit Master
getstext
much
styles
worse
Second
levelloss of balance (new)
feeling
dizzy,
Third level
suddenly
get
SOB
at
rest
(or
SOB
gets
worse)
Fourth level
Fifth
level
rapid heart
rate
pain in chest
loss a lot of blood
11/26/2013
47
Patient Resources
11/26/2013
48
Sources
& Resources
Click to edit
Master
title style
A Pan-Canadian Practice Guideline: Screening, Assessment and Care of Cancer-Related Fatigue
in Adults with Cancer
Howell D, Keller-Olaman S, Oliver TK, Hack T, Broadfield L, Biggs K, Chung J, Esplen MJ,
Gravelle, D, Green E, Hamel M, Harth T, Johnston P, McLeod D, Swinton N, Syme A, and
Olson K on behalf of the Cancer Journey Advisory Group of the Canadian Partnership
Against Cancer.
Toronto:
Canadian Partnership Against Cancer (Cancer Journey Advisory
Third
level
Group) and the Canadian Association of Psychosocial Oncology, Feb 2011.
Fourth level
http://www.capo.ca/Fatigue_Guideline.pdf
Fifth level
A Pan-Canadian Practice Guideline: Prevention, Screening, Assessment and Treatment of Sleep
Disturbances in Adults with Cancer
Howell D, Oliver TK, Keller-Olaman S, Davidson J, Garland S, Samuels C, Savard J, Harris C, Aubin
M, Olson K, Sussman J, MacFarlane J, and Taylor C on behalf of the Cancer Journey Advisory
Group of the Canadian Partnership Against Cancer. A Pan-Canadian Practice Guideline:
Prevention, Screening, Assessment and Treatment of Sleep Disturbances in Adults with Cancer,
Toronto: Canadian Partnership Against Cancer (Cancer Journey Advisory Group) and the
Canadian Association of Psychosocial Oncology, December 2012.
http://www.capo.ca/pdf/Sleep_Disturbances_Guideline_Eng.pdf
11/26/2013
49
Second level
Howell D, Keller-Olaman S, Oliver T, Hack T, Broadfield L, Biggs K, Chung J, Esplen M-J, Gravelle D,
Green E, Gerin-Lajoie C, Hamel M, Harth T, Johnston P, Swinton N, Syme A. A Pan-Canadian
Practice Guideline: Screening, Assessment and Care of Psychosocial Distress (Depression,
Third level
Anxiety) in Adults with Cancer, Toronto: Canadian Partnership Against Cancer (Cancer Journey
Action Group)
and
the Canadian
Fourth
level Association of Psychosocial Oncology, August 2010.
http://www.capo.ca/ENGLISH_Depression_Anxiety_Guidelines_for_Posting.pdf
Fifth level
Exercising/Physical Activity
http://www.evolute.ca/oncology_research_project/
Kristina Karvinen kristina@nipissingu.ca
Learning modules : Physical Activity for Cancer Survivors
11/26/2013
50
Click toSources
edit Master
title style
and Resources
Fitch,M. , Bunston,T. & Mings,D. (2012). The fatigue pictogram: assessing the
psychometrics of a new screening tool. Canadian Oncology Nursing Journal, Winter,
22(1), 42-46.
Fitch,M
(2011).Systematic
Second
levelreview and meta-analysis of the correlates of cancerrelated fatigue. Evidence Based Nursing. 8: 191-201.
Third level
Fourth level
National Comprehensive
Care Network(2011). Clinical practice guidelines in oncology:
Cancer-related fatigue.v.1.
Fifth 2011.
level www.nccn.org
National Cancer Institute. Fatigue-Health Professional Version. www.cancer.gov
Oncology Nursing Society. Putting Evidence Into Practice: Evidence Based
Interventions for Fatigue During and Following Cancer and its Treatment. Clinical
Journal of Oncology Nursing. 2009.Vol 11(1).
Reif,K, de Vries,Ul, et al; (2013) A patient education program is effective in reducing
cancer-related fatigue: a multi-center randomised two-group waiting-list controlled
intervention trail. European Journal of Oncology Nursing, 17(2), 204-213.
11/26/2013
51