The primary purpose of Module 3 of the MAC program is the understanding and exploration of values as a central orienting concept. In the context of understanding the important role of values in enhanced performance and quality of life, the functional and dysfunctional role of emotions is also considered. This chapter suggests to clients that their personal values will be the anchor point for all behavioral decisions that need to be made in the course of enhancing performance and achieving goals. The concepts of mindful awareness, mindful attention, and cognitive fusion and cognitive defusion become integrated with the concept of values-directed versus emotion-directed behavior. The Relevant Mindful Activity Exercise is intended to connect the mindfulness concept to a relevant performance situation in the client’s life. The question of personal values is particularly salient when confronted by the variety of emotions and internal rules that client confronts on a daily basis.

This chapter provides a brief overview of the empirical support underscoring the efficacy of problem-solving therapy (PST). It also demonstrates how PST can be flexible in terms of its multiple applications across clinical problems and populations as well as with regard to the methods or venues by which it can be implemented. An example of PST applied in a group format is an outcome study that evaluated the efficacy of PST for adults reliably diagnosed with unipolar depression. Both traditional statistical analyses and an analysis of the clinical significance of the results indicated substantial reductions in depression in the PST group as compared to both the problem-focused therapy (PFT) and waiting-list control (WLC) conditions. Conceptualizing the stress associated with adjusting to cancer and its treatment as a series of problems, PST has been applied as a means of improving the quality of life of adult cancer patients.

Incontinence is a personal challenge that imposes heavy consequences on individual quality of life and a high financial burden on national healthcare costs. Both women and men suffer with incontinence, but more women than men experience it, with a female-to-male ratio of 2.6. Smaller numbers of both sexes suffer from fecal incontinence. This chapter deals with urinary incontinence (UI) in women, but similar factors influence policy affecting UI in men and fecal incontinence. Estimates of the cost of UI include the direct costs of diagnosis, treatment such as medication or surgery, and routine care such as absorbent pads. Stress, urge, and mixed incontinence are the most common types of UI in women. Strong research support has accumulated in favor of choosing conservative approaches as the first-line treatment for all three types of incontinence common in women. These practices include pelvic floor muscle training, bladder training, and the Knack Maneuver.

The peripheral nervous system plexuses include the cervical, brachial, lumbar, sacral, and coccygeal plexuses; of these, the lumbar and sacral plexuses typically are discussed as a single entity, the lumbosacral (LS) plexus. Through the brachial and LS plexuses, nerve fibers pass to all four extremities and the shoulder and pelvic girdles. Consequently, patients with neoplastic plexopathies have significantly impaired quality of life. This chapter begins with a review of plexus anatomy and lesion classification, followed by the various types of tumor classification utilized. The World Health Organization categorizes peripheral nerve tumors into four groups: neurofibromas, schwannomas, perineuriomas, and malignant neural sheath tumors. The remainder of the chapter focuses on clinically relevant information, including the differential diagnosis of neoplastic plexopathies, their evaluation and management, and prognostication. Throughout these sections, specific neoplastic disorders and treatment complication (e.g., radiation plexopathy) will be discussed. The chapter ends with prognostication and future perspectives.

Cancer pain can be classified into two broad categories: nociceptive pain or pain caused by damage or injury to body tissues and neuropathic pain or pain caused by damage or injury to nerves. Nociceptive pain can be further subdivided into somatic, which is usually well localized to the area of tissue damage, and visceral, which arises from the stretching or irritation of the hollow organs and is poorly localized. This chapter elucidates the pathophysiology and clinical presentation of visceral pain as it relates to the cancer patient. For those patients suffering from cancer related visceral pain, treatment options include pharmacologic, manual, interventional, and complementary/alternative medicine techniques. Psychosocial support should also be an integral part of any treatment program. The ultimate outcome of pain management in individuals with cancer is to relieve suffering and enable such individuals the best possible quality of life.

Neuromuscular complications in patients with cancer are common and they meaningfully affect function and quality of life. Recognition of specific processes is necessary for appropriate diagnosis and intervention. Complications can occur as a direct result of the underlying malignancy, complications of therapy, paraneoplastic effects, indirect effects of chronic illness, infection, or unrelated underlying medical conditions. Careful clinical examination and electrodiagnostic studies are central to accurate diagnosis and characterization of neuropathy. Mononeuropathy affects a single named nerve, most commonly by nerve compression or entrapment. Polyneuropathy, typically refers to a more generalized or systemic process. Mononeuropathy (mononeuritis) multiplex is a distinct pattern of multiple evolving mononeuropathies and is produced by several processes. The chapter discusses chemotherapy-induced peripheral neuropathy, neuropathy associated with monoclonal gammopathies and lymphoproliferative disorders, neuropathies associated with monoclonal gammopathies or lymphoproliferative syndromes, neuropathies associated with myeloma and nonmalignant immunoglobulin G or immunoglobulin A monoclonal gammopathies, and amyloid neuropathy.

This chapter purpose is twofold. The first is to review various strategies that may help in bladder management in those with cancer or cancer treatment who may have a resulting voiding disorder. The second is to give a brief overview of bladder cancer and review surgical treatments and postoperative care for individuals with bladder cancer who have a urinary diversion. Voiding dysfunctions lead to medical problems, such as skin irritation or breakdowns, embarrassment, or general decrease in quality of life. Therefore it is important to accurately diagnose and treat a person’s voiding dysfunction. In those with cancer, the disease itself or side effects of the treatment may cause severe bladder damage that significantly worsens the quality of life of the patient. In these cases, removal of the damaged bladder (simple cystectomy supravesical urinary diversion) may be necessary. Pre and postoperative education and follow-up are essential in urinary diversion.

Endocrine disorders stem from dysfunction of one or more of the organs in the endocrine system. These organs are the pituitary, thyroid, parathyroid, pancreas, and adrenal glands. The two most commonly encountered endocrine disorders in seriously ill patients are diabetes and thyroid disease. Dysfunction of the pituitary gland or of the thyroid itself can result in hypothyroidism or hyperthyroidism. This chapter helps the nurse to identify risk factors and interventions for diabetes, articulate the symptoms that are associated with thyroid disorders, and explain end-of-life considerations for endocrine disorders. Endocrine disorders are commonly encountered in hospice and palliative care settings and must be managed in a way that promotes the patient's quality of life. When interventions are discontinued, extensive teaching and family support are needed. The nurse should frequently review the goals of care with the patient and family and ensure that interventions to promote comfort are undertaken.

This chapter focuses on the rehabilitation implications for occupational therapy and physical therapy practitioners when working with patients with cancer who have undergone a surgical procedure. There are a variety of surgical procedures that have different effects on function and quality of life. It discusses breast surgery, head and neck surgeries, orthopedic surgeries, and pediatric surgeries. Physical therapy and occupational therapy interventions with these complex patients require a high level of clinical reasoning. The collaborative goal for both physical and occupational therapy is to return patients to a maximum level of independence in daily activity and mobility to improve quality of life. The chapter’s main objective is to describe the complexity of postsurgical rehabilitation with the oncology population. It provides references and resources to guide therapy practitioners and healthcare professionals on the various surgeries and activity restrictions that limit patient engagement in activities of daily living (ADL).

This chapter describes the basic features of person-centered care. A variety of factors contributes to person-centered care, including consistent assignment of staff, effective communication, empowerment of residents, and promotion of a meaningful life for residents. Being cared for by the same staff on a regular basis fosters residents’ ability to receive person-centered care. The ability to choose when and how care will occur and the type of activities that they wish to engage in fosters an active role for residents in their care, respects them as adults, and enhances quality of life. Helping residents achieve the highest possible level of physical, mental, and psychosocial function and well-being are crucial elements of person-centered care. Promoting physical activity not only carries many benefits for physical health, but also enhances residents’ confidence and independence, which influences quality of life.