Write an essay which analyses the case study in terms of the sociological and psychological facts that might impact on the person and their family, and their experience of health and social care provision and the benefits system.

Alan's distress with the initial diagnosis of cancer may well continue with some 20% and 30% of patients being depressed and anxious for at least 6 months and more as according to Kiss and Meryn (2001), who go on to say that a man's sex and gender play a large psychosocial role in how men deal with such illnesses. Also, along with the depression, Alan is also likely to experience certain aspects of gender related depression such as stress intolerance, low impulse control, alcohol misuse and aggressive behaviour.

Having being a family man with a responsibility for bringing up his children and in turn who has 'kept' his wife, Alan has clearly been the breadwinner and the care-giver of the family. As such Alan is likely to want to appear that he is still self sufficient and that his social and familial status is not under threat, and additionally he will want to appear calm and emotionally distanced thus presenting a tough resilience to a life threatening condition, moreover increasing his own belief that his family are still very much dependent on him to cope during the illness.

Alan may embrace some form of hegemonic masculinity and is unlikely to want to ask for help because it would be seen as a sign of weakness thus indicating that Alison will have to find a way of giving support and care without Alan realising it. Additionally, it has been found that men tend to want to keep this type of diagnosis private, whereas Alison is likely to become frustrated at not being able to relate to other people about Alan's illness. Gray et al (2000) also points out that in their attempts to support their husbands, women were often constrained from employing their usual strategies of coping, and couples look to health professionals for supporting and managing the impact of such illnesses. In the few studies comparing psychological distress of patients with prostate cancer and their wives, the wives were more distressed than their husbands (Kornblithe et al 1994). The children will feel a huge of sense loss with their father facing the prospect of early death, with the daughter in particular probably preferring to stay at home with her father in his last few years instead of going to University.

Given that Alan, Alison and the children will need some form of psychosocial support as the illness progresses, they're unlikely to get it from the medical professionals best served to help them. In a private e-mail, Consultant Urologist Tim Terry (2002) says, "The patient will have to deal with psychological aspects of cancer on him as well as family," and adds, "he will need support from urology cancer nurse specialist (doctors are too busy) and may seek help from the net! Like most devastating issues, the more good quality info the patient can get the better!"

Perhaps this is a mere indication that such professionals are only interested in treating the disease within the framework of the biomedical model, however, there are other services available to them. Moreover, considering the statistics by the Department of Health (2000) claiming that in 1997, 18,300 men were diagnosed with prostate cancer in England and Wales, this would indicate that the few urologists there are in the UK, are far too busy dealing with the increasing incidences of prostate cancer, especially considering that it is likely to overtake incidences of lung and breast cancer over the next decade.

The NHS Cancer plan indicates the Government's pledge to fund cancer services with an extra £570 million a year which means a 20 fold increase in funds to prostate cancer research to fulfil its aims (Nursing Times 2001) and furthermore, the increase in funding this area of cancer research is essential considering the statistics suggesting that prostate cancer will soon become the biggest killer cancer, especially given that many men are still unaware of the dangers of this cancer with very little information encouraging men to regularly check their testicles for lumps and bumps. This is clearly what the changes in the Government's social policy aims to do.

Deciding what treatment to undertake is a standard option which may involve deep x-ray therapy plus hormones (Terry 2002). As a result of being diagnosed, Alan and his family may want to find out more about the condition, with the immediate fear being not only of shock, but also the issue of facing up to death and the fact that Alan is reminded he is growing old, especially given that the majority of men with prostate cancer are over 60 (Dowd 2001). Localised prostate cancer doesn't spread very quickly and so Alan could have been looking a 10 year survival had his cancer not been localised, therefore significantly decreasing the time he has left to live. Whilst the case study states a potential for urinary dysfunction and bowel problems, the particular treatment as would be given by Terry (2002) is unlikely to affect the waterworks, though impotency is an issue, which can be later managed with injections or vacuum devices. However, as with any treatment, there is a potential for these short term side effects, and the possible complications that may arise from any given treatment - especially if the non-localised cancer continues to spread.

Holistic care considers the psychological and sociological needs of patients in line with their physical needs, which means that in any decision making process about the treatments if clients, the clinical view is considered along with the patient's views and feelings about treatment, and that the range of services and treatments offered by all the different multi-disciplinary teams, such as social services, counselling and so on are taken also in consideration to complete a whole 'package' of care (Porter 1997). Furthermore, as according to Patterson (1998), holistic health care can only be interpreted in relation to an individual's perception which looks at balancing our physical, spiritual, psychological and social needs.

Hammersmith Hospital and the Bristol Cancer Help Centre are two centres who have already integrated their philosophy to give patients truly holistic care, and who use a whole range of treatment options thus bringing together two different cultures of treatment dealing with both the biomedical and psychosocial models (Burke and Sikora 1992). The models of practice used by both Hammersmith and Bristol include providing a supportive care team of professionals which cater for short term care and self help strategies. Additionally, there is planned individual counselling thus acknowledging the emotional problems and other difficulties for not only Alan, but also to his wife and family so that they can benefit from a supportive environment. Added to this is the service of crisis intervention giving immediate support. The clinics also provide resource files giving information on all the different types of therapies available, with an opportunity to consider the level of care that they will need.

Over time as the illness takes its course, it is likely that Alan will need to take time off from work thus resulting in a change of his social and financial status. These sociological changes will likely affect his sense of well being and how he sees himself fitting within the community, thus as a teacher he will sense a huge loss of 'prestige' to what is considered an important role for in society - associated with this will be his sense of loss of no longer playing a valuable part in his community thus depreciating his own sense of self esteem and self worth.

Because of his career path, Alan is likely to have a good salary package enabling him to receive full pay on sick leave for a period of time, and dependent on how long he has worked for his organisation, this will then be reduced to half pay for a similar period. As his cancer is not localised, this may well mean he will need more care from Alison, and more time off work. Depending on the successes or failures of the treatment given, there is the potential for Alan to have to leave his job, and thus being unable to personally support his wife, or his daughter who wants to go to university. Given this, Alan can continue to claim S.S.P. and then Incapacity Benefit, if his employer can no longer pay his wage. This means that his job may always be open to Alan should he become well enough to work. Alison may well become a victim of circumstance and could affected by the gradual onset of the disease. She may have to give up her own part-time work in order to give full time care to Alan.

The benefits system is not a perfect financial safety net, however, the UK law does state that everyone is entitled to a minimum income guarantee according to individual circumstances. Given that both may have to give up work after the short term, the likely benefits that they will receive will not only include a right to claim incapacity benefit, but also allowances for all three children if living at home. Assessment would be made to see if Alan and his wife can apply for the care components of Disability Living Allowance which bring with it the opportunity to claim enhanced disability premiums and other benefits. Furthermore, Alison's opportunity to claim for carer's allowance would soften the financial impact of losing a job and losing an income. Given that all these benefits would be made available to Alan and his family as directed under the law, it would mean that Alan's daughter would get more financial support from the local education authority and the student loans system, thus implying that she could still go to university and complete her studies.

Conclusion

What I have attempted to show is a brief synopsis of the sociological and psychological factors that will impact on Alan and his family as his illness takes it course, and go some brief way to explaining his likely experiences of the health and social care provision.

As shown by Kiss and Meryn (2001) Prostate cancer is a devastating disease that brings with it a need for individuals, couples and families to strongly consider the treatment options and lifestyle options amidst the confusion of jumbled emotions, fears and concerns which can be supported within the framework of holistic treatment, thus working towards a more positive future beyond diagnosis.

Research by Gray et all (2000) has clearly shown the experiences of previous patients that Alan and his wife can draw on, and with the huge, growing amount of information that is universally available, decision making, the impact on emotions, and the psychosocial changes caused by such a diagnosis are thus greatly reduced.

Furthermore, as according to Dowd (2001), the governmental changes in social policy and the increase in funds for the kind of treatment will not only make treatment better for Alan up to and beyond 2004, but will ensure that more men are diagnosed at an earlier stage, thus improving their survival rate with the disease.

Not only does prostate cancer present real difficulties for men and their families, but also presents real challenges for social policy changes to be made which can strengthen research, education and support in this field of cancer, and thus minimising the short term negative experiences of men, thus improving the long term outcomes of this disease.

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References

DEPARTMENT of HEALTH (2000) Delivering the NHS Cancer Plan : Prostate Cancer. [online] Last accessed on 23 April 2002 at URL http://www.doh.gov.uk/cancer/pdfs/prostatea9.pdf

DEPARTMENT OF HEALTH (2001) Cancer: NHS Cancer Plan. [online] Last accessed on 23 April 2002 at URL http//www.doh.gov.uk/cancer/educup_april2001.htm

EVERYMAN (2002) Prostate Cancer. [online] Last accessed on 11 May 2002 at URL http://www.icr.ac.uk/everyman/about/prostate.html

KISS, Alexander, MERYN, Siegfried. (2001) Effect of sex and gender of psychosocial aspects of prostate and breast cancer. British Medical Journal. Volume 323. 3 November 2001

KORNBLITHE AB, HERR HW, OFMA US, SCHER HI, HOLLAN JC. Quality of life of patients with prostate cancer and their spouses: The value of a database in clinical care. Cancer. 1994(73) pp2791-2802

O'DOWD, Adrian (2001) The Phantom Menace. Nursing Times. 97 (23)

TERRY, Tim (2002) Urology Assignment. [online] Message to Krystyna Haywood. Sent 11 May 2002 (cited 12th May 2002). Personal correspondence to [email protected]

Bibliography

BANYARD, Philip. (1996) Applying psychology to health. Hodder and Stoughton.

BURKE, Claudette and SIKORA Karol (1992) Cancer - The dual approach. Nursing Times. 88 (38) pp62-66

DEPARTMENT of HEALTH (2000) Delivering the NHS Cancer Plan : Prostate Cancer. [online] Last accessed on 23rd April 2002 at URL http://www.doh.gov.uk/cancer/pdfs/prostatea9.pdf

DEPARTMENT OF HEALTH (2001) Cancer: NHS Cancer Plan. [online] Last accessed on 23 April 2002 at URL http//www.doh.gov.uk/cancer/educup_april2001.htm

EVERYMAN (2002) Prostate Cancer. [online] Last accessed on 11 May 2002 at URL http://www.icr.ac.uk/everyman/about/prostate.html

GRAY, Ross E, FITCH Margaret, PHILLIPS Catherine, LABRECQUE Manon, FERGUS Karen. (2000) Managing the impact of illness: The experiences of

men with prostate cancer and their spouses. Journal of Health Psychology 5 (4)

O'DOWD, Adrian (2001) The Phantom Menace. Nursing Times. 97 (23)

PATTERSON, Elissa. (1998) The philosophy and physics of holistic health care: spiritual healing as a workable interpretation. Journal of Advanced Nursing. 27, pp287-293.

PORTER, Sam (1997) The patient and power: sociological perspectives on the consequences of holistic care. Health and Social Care in the Community. 5(1) pp17-20

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