You are a nurse at a hospital and Hanna a 38-year-old woman with hepatitis C is one of your patients. She is severely depressed as she has just finished treatment and she is still testing positive for hep C. One of the nurses you are working with says to her ‘what do you type of people expect; I mean you’ve been drinking alcohol too, of course you failed’. Hanna tells you she wants to go home to her partner and if you don’t let her go she will just walk out. The doctor states she has to stay until the following day in order to have further assessment due to her depression. What do you do?
Issues for discussion
- While treatment is not always successful many people blame themselves rather than treatment failure and feel like ‘bad patients’. Response rates are often associated with particular genotypes. People with genotype 2 and 3 have a 80% sustained virological response (SVR) while people with genotype 1 and 4 have a 50% SVR.
- Depression can occur during treatment as a side effect from medication and it can sometimes take months for people to adjust. Signs of depression should be managed by treating physician and GP and linked to support through hospital or HCCQ support groups.
- Abstinence from alcohol is often very difficult for people to manage in social settings, strategies for controlled drinking can sometimes be more successful, depending upon the person. While a high level of alcohol is associated with progression of liver disease, it is not an indicator of treatment response. People may drink small amounts of alcohol while on treatment.
- How well informed are consumers before they undergo treatment?
- There may be benefits to treatment (e.g. reduced fibrosis) despite not having cleared the virus.
Client issues
- Hanna is depressed and emotional support is a priority concern
- What referral to support services can you provide?
- How can you best support her health needs?
- How can you encourage self-management to increase a sense of control and confidence for Hanna?
- If Hanna is unable to be assessed she may not receive further support or treatment that she may require.
Organisational issues
- What strategies can you use to counter other staff attitudes? “You type of people” denotes a stereotyped perception of people with hepatitis C and a reinforcement of negative self perceptions.
- In-house training addressing discrimination and stereotypes may address some of these issues
- Providing support programs / services / groups for people undergoing treatment in order to provide emotional support, cope with depression and help with strategies for reducing alcohol intake and promoting a healthy diet.
- Clearly display resources relating to the effects of hepatitis C treatment and support services.