Hello, it's nice to see you all again. This is Doctor Ramachandran. And we'll be doing a brief review of our transitions and care material from survivorship to hospice. Just a quick reminder, illness looks different depending on the type of illness and that illness trajectory can inform how peoples function and well being are. For example, in cancer you can often feel good for a long period of time and then closer to end of life, you can have a precipitous decline in both function and quality of life. Dementia often is a slow progressive decline punctuated by very small, almost imperceptible changes. And then something like liver disease or organ failure can often see changes which are initially not very severe. But then you can have precipitous declines based on changes in organ function and then recover from that. Even when folks have illness that has a good prognosis, we can still see changes in how people do, both in terms of their function and well-being. People can have periods where right before it transplant, where they hit an all time low where their liver is not working, where they don't feel well, and then they can get a transplant, and then they could have a new lease on life. Similarly, with cancer, you could be getting treatment and then have a set-back and then be able to also come back to good performance data, some good function. As you go through all of this, it's very clear that patients and families are struggling with many different emotions. The concept of survivorship for many starts when they actually get diagnosed with illness. We define survivorship as, after you finish or complete treatment and as you start to think a little bit about returning to your normal activities and your normal life. However, even as you encounter those changes, there is changes that you experience emotionally as well as physically. As a physician, you might be excited to present this good news to your patients. Here you see this doctor saying congratulations, it looks like your transplant was successful. But as a patient, you may have some doubt. You may wonder what's going to happen next. How do you return back to your normal life? For some folks, a survivorship care plan can be very helpful, and this is often done through a survivorship team or a survivorship nurse. Where it's documented, all of the important components of what you need to do in terms of having the best health outcomes possible. This could be something simple, as when you get your surveillance tests, as well as even thinking a little bit about what are the key components to promote physical and emotional health, such as getting good exercise on a regular basis. And a survivorship care plan, as well as a good survivorship team could really help to normalize and to think about all of the things that are normal, even as you encounter this next phase. For example, you might have changes in your physical health, such as neuropathy or hair loss, or even something as significant as physical disfigurement. There's often cognitive changes that could be both due to the underlying disease as well as the treatment for the disease. And under all of this, underpinning all of this is a little bit of fear that, how long will this new normal stay? Is there a chance that I may have problems from my illness again? And that fear is normal. That sense of distress is normal. And during those transitions, whether it's to survivorship or to end of life. Patients and families often go through many different types of change. For example, there could be social changes, how people perceive you, what your identity is all about. Something as difficult as a job loss or a divorce. For many folks, there's physical changes that really accompany treatment or accompany the illness, that redefine how people see them. The emotional changes are profound, fear, uncertainty, sadness. And then of course, a lot of folks have the sense of distress around why this is all happened. This could be a why me feeling or why did God do this to me? Has God abandoned me? So spiritual and existential distress is also quite common. And then as we know, all of us at some point will transition to end of life. And hospice comes with it its own sense of thinking through, what has life brought for all of us? Thinking about meaning, legacy, letting go. How are family members going to do without us? How are we going to ensure that what is important to us is conveyed to the people that we care about? And with that comes change for everyone, not just for the patient, but for the caregiver, for children, for all those that are touched by that patient. We know hospice is something that is a service in the United States that we use when patients have a prognosis of six months or less. But all around the globe, people deal with end of life, and it's done often with family really being the core caregiver for patients as they enter their final days. We know that all of these transitions, whether it's through treatment, through survivorship, through chronic illness, and through hospice are associated with transitions. Those transitions bring with it emotions, anxiety, sadness, fear, peace and relief. We hope that there is this level of patience as you handle your patients or your family that encounter these transitions. That you bring normalcy, peace, and you start to think about both the difficult parts of transitions as well as the good that can come with the learning that comes with these different phases of illness and of peoples lives.
