A Multidimensional Approach to Cancer Care for the Whole Person
Each year, a growing number of cancer patients seek an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. In this article, Jeremy Geffen—author of the highly acclaimed The Journey Through Cancer: Healing and Transforming the Whole Person and creator of the leading-edge integrative medicine and oncology program, The Seven Levels of Healing®—offers an insightful look toward the future of multidimensional approaches to cancer care.
Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer.
Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly.
As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience…
Integrative oncology has come a long way, and we have taken many significant steps in the right direction. But the compelling questions before us are the following: (a) Where does integrative oncology need to go next? (b) Where is it ultimately heading? and (c) What are the most efficient and effective ways to get there?
I believe that what’s coming next may someday be called the era of “multidimensional medicine.” This will move beyond the current integrative approach to a broader and deeper view and practice, which fully honors every dimension of who we are as human beings—whether patients, family members, doctors, nurses, CAM practitioners, technicians, or society as a whole.
A Multidimensional Approach to Care: What Does This Mean?
A multidimensional approach to care will embody a more coherently conceptualized purpose, vision, and consensus about what we’re really here to do, and be, for people with cancer and their loved ones, as well as for ourselves, our colleagues, and our own family members and communities.
It will provide a richer, more comprehensive, and more satisfying experience for everyone involved by addressing the multidimensional needs and concerns of human beings in a proactive way.
A multidimensional approach for the future will encompass a number of elements that are not yet fully, or consistently, incorporated into the practice of mainstream medicine or even integrative medicine. Although this is not intended to be a complete list, the key elements discussed below illuminate and inform the path ahead.
Humans Are Multidimensional Beings
The first key element is that we will, finally and unabashedly, acknowledge that we are all multidimensional beings. At the most basic level, this means that we all have a mind, a heart, and a spiritual dimension as well as a physical body—not to mention deep and important interpersonal connections—and that our job is to honor and care for all these dimensions with equal skill and integrity. This is, of course, no easy task, particularly in a “bottom-line” oriented and highly specialized health care system that focuses almost all its attention and resources on diseases, procedures, interventions, and other physically measurable parameters.
Historically, as we all know, the biomechanical, reductionist model of medicine has focused primarily on what can be seen and measured. Although this approach has led to enormous technological and medical advances that provide great benefits to many people, what can be seen and measured is still only the proverbial tip of the iceberg of what comprises a human being or what needs to be addressed for healing to occur at deep levels. The most substantial part of an iceberg lies well below the surface, and the same is true for humans. Here, beneath the physical domain, lies fertile territory for exploration that can pay great dividends.
With the advent of newer and more sophisticated technologies we’ve thankfully become increasingly able to look more deeply below the surface, including into the molecular and genetic components of illness and disease. However, this still ignores the rich matrix of mental, emotional, social, and even spiritual dimensions of people, all of which not only affect their thoughts, feelings, beliefs, and deeper emotional reality but their physiology as well. This is also largely true for most CAM modalities, which—although generally more holistic in their orientation—are nonetheless primarily focused on relieving symptoms, particularly as CAM is currently practiced within integrative models of care.
Multidimensional medicine in the future will take a much broader, bolder view. It will fully recognize and acknowledge the deeper mental, emotional, social, and spiritual dimensions of being that profoundly affect all aspects of one’s life and health. Furthermore, while continuing to provide impeccable care for the physical body, it will elevate these other dimensions from their historic “second-class” status and validate their essential, intrinsic role in health and healing.
The Context as Well as the Content of Care Will Be Acknowledged & Enhanced
A multidimensional approach will clarify important distinctions between the content versus context of care. The content of care encompasses everything we do in medicine, including patient consultations, follow-up visits, billing, coding and administering chemotherapy and radiation. In the future, this will also, increasingly, include administering and monitoring CAM services.
The context of care, on the other hand, is the container in which all this activity occurs, and it profoundly affects the actual experience of everyone involved. The word context is derived from the Latin con, meaning together, combined with the Latin textere, meaning to weave. Thus, the context of care is what weaves together the people and the activities in which they are engaged.
Context of care encompasses many things. It begins with the consciousness and intentionality of the physical and energetic environment. This goes beyond having plants and paintings in the lobby, which, as attractive as they may be, are not a substitute for an environment that is consciously and genuinely warm and welcoming. In this respect, the consciousness and intentions of physicians and staff—to create an environment where people feel that they are truly wanted and are greeted by human beings who demonstrably care about them—can be as important as, if not more important than, the physical aspects of the facility itself.
Next, the context of care is profoundly affected by the quality of communications that is occurring in an organization—including intrapersonal and interpersonal as well as verbal and nonverbal. This includes communications among physicians and staff as well as with patients and family members.
A multidimensional approach will acknowledge the critical importance of the communication style of physicians and staff and also provide training and support for more effective, empathic communication skills.
Finally, context of care encompasses team alignment and synergy. This becomes even more critical when practitioners with a variety of different backgrounds, training, and worldviews are working together. A multidimensional approach will thus require a more expanded view of how institutions are organized and managed. This will include having a shared vision, mission, purpose, and values along with clearly defined roles and responsibilities. It will also include having clear agreements as well as communication tools and skills that facilitate open, honest, and supportive communication among team members and help effectively and efficiently resolve disputes and upsets.
Clarity of intention, mission, purpose, more skillful and effective communications, and team agreements will go light years toward moving the fields of integrative medicine and oncology forward. Although time consuming on the front end, these will yield great dividends—immediately and over the long term—for everyone involved. They will create greater trust and efficiency and foster authentic congruence between an organization’s stated mission and its actual culture. This congruence is often sorely lacking, to everyone’s detriment.
Families & Loved Ones Are Essential, Interconnected Partners in the Healing Journey
A third key element is that we will more actively engage families and loved ones in the healing process, particularly caregivers of people with cancer. This will include providing education for them, as well as for patients, and inviting them into their own healing and transformation process.
Family members and loved ones affect—positively or negatively—a patient’s well-being and quality of life and possibly their survival as well. As multidimensional beings, we are fundamentally not separate, and in fact, we are all dynamically interconnected. No patient—or anyone, for that matter—exists independently of his or her immediate social network or the web of human existence. It is thus difficult, if not impossible, to heal at the deepest levels without addressing the social dimensions of a person’s life. Part of our work will be to consciously and more effectively address this larger web in our efforts to help patients heal.
The intrinsic interconnectedness of everyone, and everything, is not simply a social or philosophical concept. Modern physics has demonstrated both the wave–particle duality of matter (including the atoms in all of our bodies) and the impact of the observer on quantum events. At the quantum level, it is very hard, if not impossible, to discern where one person ends and another begins. Emerging evidence also suggests that consciousness itself is nonlocal. The clinical implications of these findings in particular remain unclear. However, they clearly challenge our traditional, Newtonian notions of space, time, and separation and are Integrative Cancer Therapies consistent with ancient wisdom that has long affirmed the essential interconnectedness of all life.
We Will Move From a Reactive to a Proactive Approach to Care
The fourth key element is that we will help patients and loved ones navigate all dimensions of the healing journey—including the physical, mental, emotional, social, and spiritual dimensions—in a clear, coherent, and proactive manner. We will not just wait for illness and symptoms to show up and try to respond; we will be more proactive partners with patients trying to help themselves.
In support of a larger trend toward preventive health care, this will be a further evolutionary step in the movement away from a reactive “disease-management” model—which has led to a strained, often dysfunctional, and blatantly inequitable health care system—toward a proactive model of “health-promotion.”
Especially for people with cancer, we will help them plan effectively for the myriad challenges they are likely to encounter and provide concrete, practical tools that they can use to address them skillfully and effectively. In this new model, patients and loved ones will be actively supported in expanding their self-awareness and participating in all aspects of their healing journeys.
There Will Be an Enhanced Focus on Survivorship & End-of-Life Care
As increasing numbers of people are living longer with cancer than ever before, there is growing awareness of, and interest in, survivorship. It is becoming increasingly clear that completing one’s treatment is often just the first step on a longer journey that involves an entirely new set of issues, questions, and challenges than those encountered in the initial weeks and months following a cancer diagnosis. In response to this, we will help patients not only receive and complete their treatment as gracefully and effectively as possible but also establish a clear vision for their lives and a plan of action for maintaining a healthy lifestyle.
A multidimensional approach will also recognize death and dying as a sacred and integral part of life and will enhance end-of-life care. This will involve showing more respect and giving more help to those who are dying and supporting them to complete their lives in the most satisfying and fulfilling way possible. Helping terminally ill patients and their family members come to terms with and more readily accept mortality will also save untold millions of dollars in questionable or futile medical interventions that only minimally extend life (if at all) while often prolonging suffering.
In summary, a multidimensional approach will move beyond the classical, reductionist approach to treating disease and associated symptoms and even beyond the current integrative approach, which is still often fragmented and reactive, rather than genuinely holistic and proactive. We will move toward a much broader vision of honoring and caring for patients and their loved ones as truly multidimensional, interdependent beings; skillfully and coherently addressing their needs and concerns on all levels; and helping them consciously create lives of wholeness, meaning, and purpose—regardless of how long they have to live…
I believe that we in oncology—and especially those who are committed to an integrative, multidimensional approach to cancer care—have…not only an opportunity but a rare privilege to guide those who come to us toward wholeness, meaning, and joy…with wisdom, love, skill, and understanding. But to do so most effectively, we must commit to finding wholeness in ourselves and make it a priority in our lives and in our work.