Meeting Psychosocial Needs of Women with Breast Cancer (2004) / Chapter Skim
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4 Psychosocial Services and Providers
4 Psychosocial Services and Providers
Pages 70-94
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From page 70... ...
This section of the report describes the range of psychosocial interventions that are used to alleviate distress and the providers who may deliver them, as well as professional education and training opportunities that are available in the area of psycho-oncology. PSYCHOSOCIAL SERVICES A number of interventions are used to enhance adjustment to cancer by addressing psychosocial concerns and reducing distress.
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From page 71... ...
~ e.g., analgesics, Continued monitoring ancI re-evaluation are neeclecI to determine if clistress symptoms have exceeclecI "normal" expected levels ancI if a referral to more specializecI psychosocial services is inclicatecI. Signs ancI symptoms that shouicI signal that a patient neecis more help in coping inclucle: excessive worries, excessive fears or laciness, anger or feeling out of control, preoccupation with illness, poor sleep or appetite, unclear thinking, clespair, severe family problems, or spiritual crisis (NCCN Distress Management Guiclelines, 20031.
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From page 72... ...
Nurses, psychologists, anti social workers are among the providers who augment information from other sources, clirectly aciciress psychosocial concerns, anti aicI in the shared clecision-making process. Psycho-eclucation is also often a component in cognitive-behavioral interventions (see below)
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From page 73... ...
Specific techniques for breast cancer patients are hypnosis, progressive muscle relaxation, ancT autogenic training to incluce relaxation. These methods are commonly employecT, primarily by psychologists, as acTjuncts to pain management ancT to recluce anxiety, particularly in anticipation of a frightening experience or procedure.
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From page 74... ...
on the effectiveness of these interventions, ancI later chapters, in particular Chapter 6, cliscuss how women can fincI out about some of these treatment options ancI gain access to them. Crisis counseling The most common form of clinical intervention is brief counseling, which is typically clone in relation to coping with a crisis.
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From page 75... ...
Women may choose counseling from a pastoral counselor who can provide spiritual support anti help aciciress guilt, loss of faith, fear of punishment, anti the neecI for prayer. Clinical practice guiclelines were clevelopecI for pastoral counseling by the multiclisciplinary pane!
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From page 76... ...
Psychopharmacologic Interventions Subsumed uncler psychosocial services are those mocialities that combine psychosocial support ancI psychopharmacological intervention. Meclication to recluce distress is prescribed to control symptoms in patients with severe symptoms that are not amenable to psychological or behavioral interventions alone.
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From page 77... ...
~ .1NoC~ DIS -12 FIGURE 4-2 Clinical management of mood disorder. SOURCE: NCCN Distress Management Guideline tDIS-124.
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From page 78... ...
Services might be conceptualizecI as basic, that is, proviclecI as part of routine care by sympathetic anti supportive physicians, nurses anti clinic anti hospital staff who come in contact with the breast cancer patient, supplementecI at the next level by others like social workers, support groups, anti clergy as neeclecI, anti moving in the presence of more serious problems to the highest level of specifically trained mental health professionals such as psychiatrists, psychologists, anti clinical social workers (clescribecI in HollancI, 19901. Figure 4-3 illustrates the complexity of contemporary breast cancer care, showing the typical progression from screening to therapy anti the many providers a woman might encounter as she completes her care.
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From page 79... ...
and the forthcoming 2004 IOM Adult Cancer Survivorship report stress the importance of surveillance ancI interventions to manage late effects ancI other survivorship concerns by various health professionals. This section of the report describes the education, training, availability, ancI practice of the professionals involvecI in providing psychosocial services to women with breast cancer.
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From page 80... ...
acivocacy. Currently, there are 29,802 members of the Oncology Nursing Society (Cynthia Miller Murphy, Oncology Nursing Certification Corporation, Executive Director, personal communication to Roger Herciman, September 4, 2003)
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From page 81... ...
The American College of Surgeons' Commission on Cancer has a program to approve cancer care facilities that meet certain stanciarcis, inclucling stanciarcis regarding the provision of psychosocial services (see Chapter 61.
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From page 82... ...
The training of radiotherapists has generally not incluclecI communication skills. The ciaily visits to a radiation oncology unit ancI ciaily contact with technicians provide an important setting for positive, sensitive interaction ancI psychosocial support.
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From page 83... ...
Social Workers Social workers are the primary providers of psychosocial services in hospitals ancI many cancer centers ancI are trained to facilitate patient ancI family adjustment to a cancer diagnosis, its treatment, ancI rehabilitation (Smith et al., 19981. Social workers may also refer cancer patients ancI family members who show signs of distress or who have significant family or social problems to psychologists or psychiatrists.
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From page 84... ...
offers the following career clevelopment grants for social workers (www.cancer.org) : · Master's Training Grants in Clinical Oncology Social Work: AwarclecT to institutions to support training of seconcT-year master's clegree students to provide psychosocial services to persons with cancer ancT their families.
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From page 85... ...
as well as the American Psychosocial Oncology Society (www.apos-society.org, accessed April 3, 20031. Psychology Psychologists are the mental health professionals who, after social workers, are most likely to be available for clinical consultation anti management of psychosocial concerns in patients with cancer ancI their families.
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From page 86... ...
Post-resiclency clinical fellowships of 1 or 2 years can be taken in psychiatric ancI psychosocial oncology at a few major academic cancer centers. These few centers have contributed many of the young clinicians ancI investigators in the fielcI.
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From page 87... ...
The NCCN Clinical Practice G? viclelines for Management of Distress, written by a multiclisciplinary panel, incluclecI pastoral counseling ancI pastoral counselors as an integral part of psychosocial services ancI psychosocial professionals involvecI in supportive services (NCCN, 20031.
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From page 88... ...
FounclecI in 1986, the American Psychosocial Oncology Society (APOS) has undertaken a new initiative to network all the clisciplines mentioned in this chapter that provide psychosocial services to patients with cancer.
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From page 89... ...
Work effectively In a liaison role, provide support to oncology staff so as to better facilitate understanding of patient and family centered issues. Communicate psycho-oncology Information to others, oral and written dissemination of civically based or research-oriented practices/findings, teach medical students, psychiatric interns, residents Be able to critically evaluate arid understand and/or conduct research In psycho-o~cology.
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From page 90... ...
Psychological factors · Coping with a life-threatening illness Social support FamliY adaptation to cancer Childhood cancer The older patient with cancer Sexual dysfunctions in cancer patients · The oncology staff 111 COMMON PSYCHIATRIC DISORDERS AND TH EI R MANAGEMENT · Normal reactions and psychiatric disorders in cancer patients ~~.~ · Depression · Suicide Anxiety, panic attacks and phobias · Personality disorders · Somatoform disorders S ~ h I z 0 p h re n i a PharmaCoiogical management of psychiatric disorders in cancer patients ~ Psychiatric emergencies IVY ETHICAL ISSUES IN CANCER CARE · Informed consent · Do Not Resuscitate (DNR] i Orders V
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From page 91... ...
Given the effectiveness of psychosocial interventions in alleviating psychosocial distress, the BoarcI recommencis that: Sponsors of professional education and training programs (e.g., NCI, ACS, ASCO, ONS, AOSW, ACS-CoC, APOSJ should. support continuing ed.~cation programs by designing, recommending, or funding them at a level that recognizes their importance in psycho-oncology for oncologists, those in training programs, and nurses and for further development of programs similar to the ASCO program to improve clinicians' communication skills; and Graduate education programs for oncology clinicians, primary care practitioners, nurses, social workers, and psychologists should evaluate their capacity to incorporate a core curriculum in psycho-oncology in their overall curriculum.
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From page 92... ...
2002. The Role of Oncology Nursing to Ensure Quality Care for Cancer Survivors.13ackground paper prepared for the National Cancer Policy Board.
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From page 93... ...
1998. Principles of training social workers.
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From page 94... ...
2002. Cancer Survivorship: Professional Education and Training.
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