A diagnosis of cancer changes everything. It portends coming days and months of challenges. Most obvious perhaps are those related to treatment: What therapy, drug or approach is most likely to succeed, to eradicate the cancer and return that person to health?
But the physicality of cancer is just one aspect of a larger picture. Every facet of a person’s well-being must be addressed. It can be a task made more daunting if the prognosis is not good.
Scott A. Irwin, M.D., Ph.D. is a colleague. He is director of psychiatry and psychosocial services and patient and family support services at UC San Diego Moores Cancer Center and director of palliative care psychiatry for the UC San Diego Health System. He has spent his career working to improve psychiatric and psychosocial assessments and treatments for patients with progressive, potentially life-limiting illnesses, as well as support and care for their families.
I asked him to talk about the idea of “whole person care.”
Dr. Irwin: Some questions I often ask the people I care for are — What is most important to you? What brings you joy and makes you feel fulfilled? — many people respond with answers of family, friends, good health, work, contributing to society and spirituality. There are many, many other answers.
Next I ask: What if you were told you only had a few months to live, how might that change your answer? What now would be most important to you? What would bring you joy and make you feel fulfilled?
Some responses might remain the same, but often they would be different. Patients frequently reply that what they care about most is family, friends, mending fences, leaving a legacy, controlling symptoms, being able to care for themselves, engaging in pleasurable activities for as long as possible and maintaining mental clarity.
You’ll note most of these answers are not “medical” in nature; nor are there any effective “high-tech” interventions for them. These are desires that make us human. They define us as persons. They are unique to each of us.
They are the important things.
Whole person care is a concept that has been around for a while. It best describes care that is mindful of the things that matter most to us, as individuals with unique points of view and needs. At its essence, whole person care addresses every important facet of our lives — as individuals, as members of families, as parts of social circles and beyond. Comprehensive whole person care must seek to check-in with, bolster, and, when necessary, address distress in all domains of our lives that are important to us.
Many issues qualify. Among them: How will the illness will be managed and with what interventions? How will physical symptoms be dealt with, from pain to nausea to fatigue? In what ways will emotions like joy, sadness, depression, fear or anxiety emerge? How can resilience be reinforced?
There may be social consequences to address as well, such as a patient’s standing in the community, interactions with friends and accounting for the role work has played in the person’s life.