Discharge Planning for a Patient with Multiple Myeloma
Discharge planning, in relation to cancer and chronic pain, is especially important in providing pain relief, education, and support programs that foster meaningful connections; however, the biggest challenge for patients and families as they approach discharge is the establishment of attainable goals due to the uncertainty and ambiguity awaiting them upon returning home (Molassiotis, Wilson, Blair, Howe, & Cavet, 2011; Mor & Besdine, 2011). Consequently, the establishment of community support and achievable goals is essential, especially in the context of cancer care as partners are at greater risk of psychological distress due to competing demands (Molassiotis et al., 2011). Nurses play a central role in coordinating proposed discharge plans and evaluating ongoing responses. They also significantly impact patient discharge goals by identifying barriers, needs, and opportunities for discharge planning, improving communication and congruence in discharge needs, and providing direct patient education; however, they do not work alone, but as part of an interdisciplinary team (Nosbusch et al., 2011; Saint Paul’s Hospital (SPH), 2001). Through proper education and support systems, key factors in adequate discharge planning, stress can be minimized and expectations managed thereby preventing complications and reducing rates of readmission (Jack et al., 2009; Rini et al., 2007). This is clearly exemplified in the following case analysis.
Alonso, Barbarro, A., Bruera, E., Varela-Cerdeira, M., Boya-Cristia, M.G., Madero, R., Torres-Vigil, I., De Castro, Javier, & Gonzalez-Baron, M. (2011). Can this patient be discharged home? Factors associated with at-home death among patients with cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 29(9), 1159-1167.
Balogh, E., Ganz, P., Murphy, S., Nass, S.J., Ferrell, B.R., & Stovall, E. (2011). Patient-centered cancer treatment planning: improving the quality of oncology care: Summary of an Institute of Medicine Workshop. The Oncologist, 16, 1800-1805.
British Columbia Cancer Agency. (2013). Regional Services: Vancouver Center. Retrieved on May 15, 2014 from:
Canadian Red Cross Society. (2014). Community Health Services in Canada. Retrieved on May 15, 2014 from: http://www.redcross.ca/what-we-do/community-health-services-in-canada.
Hoey, L.M., Ieropoli, S.C., White, V.M., & Jefford, M. (2008). Systematic review of peer-support programs for people with cancer. Patient Education and Counselling, 70(3), 351-137.
Jack, B.W., Chetty, V.K., Anthony, D., Greenwald, J.L., Sanchez, G.M., Johnson, A.E., Forsythe, S.R., O’Donnell, J.K., Passche-Orlow, M.K., Manasseh, C., Martin, S., & Culpepper, L. (2009). A reengineered hospital discharge program to decrease rehospitalisation. Annals of Internal Medicine, 150(3), 178-186.
Laird, B., Colvin, L., & Fallon, M. (2008). Management of cancer pain: Basic principles and neuropathic cancer pain. European Journal of Cancer, 4(44), 2-6.
Lewis S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G., & Bucher, L. (2014). Medical-surgical nursing in canada: Assessment and management of clinical problems (3rd ed.). Toronto, ON: Elsevier.
Mikkelsen, T., Sondergaard, J., Jensen, A., & Olesen, F. (2008). Cancer rehabilitation: psychosocial rehabilitation needs after discharge from hospital. Scandinavian Journal of Primary Health care, 26(4), 216-221.
Molassiotis, A., Wilson, B., Blair, S., Howe, T., & Cavet, J. (2011). Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psycho-Oncology, 20(1), 88-97.
Mor, V. & Besdine, R.W. (2011). Policy options to improve discharge planning and reduce rehospitalisation. Journal of the American Medical Association, 305(5), 302-303.
Nosbusch, J.M., Weiss, M.E., & Bobay, K.L. (2011). An integrated review of the literature on challenges confronting the acute care staff nurse in discharge planning. Journal of Clinical Nursing, 20(5-6), 754-774.
Polomano, R.C., Dunwoody, C.J., Krenzischek, D.A., & Rathmell, J.P. (2008). Perspective on pain management in the 21st century. Pain Management Nursing, 9(1), S3-S10.
Rini, C., Lawsin, C., Austin, J., DuHamel, K., Mararian, Y., Burkhalter, J., Labay, L., & Redd, W.H. (2007). Peer mentoring and survivors’ stories for cancer patients: Positive effects and some cautionary notes. Journal of Clinical Oncology, 25 (1), 163-166.
Saint Paul’s Hospital. (2001). Discharge planning: Standards and processes. Vancouver, BC: Providence Health Care.
Steultjens, E.M.J., Dekker, J., Bouter, L.M., Jellema, S., Bakker, E.B., & Van den Ende, C.H.M. (2004). Occupational therapy for community dwelling elderly people: a systematic review. Age and Aging, 33, 453-460.
University of British Columbia School of Nursing (2009). Assessment framework for nursing practice. Author. Retrieved May 15, 2014 from:
Urch, C.E. & Dickenson, A.H. (2008). Neuropathic pain in cancer. European Journal of Cancer, 4(8), 1091-1096.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).