With my job in the oncology Palliative care clinic, it is not uncommon to see patients transition through the different stages of change. Some start from the pre-contemplation and end up on the maintenance. Some of my patients may relapse as they go through the disease process. I remember this particular patient, he is a young man with metastatic cancer with bone involvement. He had every reason to hurt and was in a significant amount of pain due to his cancer. We provided him with opioids for pain management. With the provision of opioids came the necessary urine drug screen(UDS). The first UDS came back positive for illicit drugs. He denied the use of illegal drugs even though the results of subsequent UDS remained the same.
This patient is in the pre-contemplation stage. The Pre-contemplation stage is the first stage in the Transtheoretical Model (Stages of Change), where individuals are not yet considering or are unaware of the need for change(Raihan & Cogburn, 2023 ). They may not see their behavior as a problem or may be resistant to the idea of change. This stage is often characterized by denial, lack of awareness, or a sense of being overwhelmed by the idea of change(Raihan & Cogburn, 2023 ). For me, the main problem here is the denial and lack of desire to change.
I tried not to be judgmental but also tried to educate the patient on how his choices could hurt or derail his treatment and could lead to death. I recognized that a times I was frustrated and impatient, especially after offering him all available resources to help combat his addiction. I understood that recognizing these feelings is essential so they don’t influence how I approach this patient. In the end as a professional, I had to choose the safest opioid or pain medication that would cause him the least harm which was buprenorphine/naloxone.
Reference
Raihan, N., & Cogburn, M. (2023).Stages of change theory. PubMed; StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556005/