Presented by Lynn Barwick, LCSWPresented by Xochitl Gaxiola, MSW in Spanish

Stress in patients and families well documentedRecognized psychosocial dimensions of cancerDesire to improve psychosocial care

National Comprehensive Cancer Network:Develop standards of care in 2008Reduce stigma of psychological problemsRecommended use of term “distress”

(National Comprehensive Cancer Network. Distress Management Guidelines, 2008)

“You have Cancer”Disbelief, shock and panicAnger and hostilityFears based on risk of mortalityFeeling out of control and vulnerableLossesLearning language of cancerTreatment decisions

(Social Work in Oncology, 2001)

Physical side effects Body image changes Changes in roles Disruption of work, home, family Increased dependence Loss of dreams Emotional Insurance and Finances

Type of cancer, stage, prognosisDegree of disability Intensity of treatmentAge and stage in life cyclePast experience with cancerCurrent life circumstancesDegree of social supportCoping skills (Social Work in Oncology, 2001)

Struggle to comprehend – Why me? Continuum from denial to acceptanceVacillation between hope and despairSense of personal failureBad things do happen to good people

Making sense of life and deathCreating a new normalChanging prioritiesGreater sensitivity towards othersIncreased closeness in relationshipsAwareness of life’s giftsSpiritual questA negative, life-altering experience

(McMillen, 1999)

Children need to know: Name of disease Part of body being treated They did not cause the cancer They will be loved and cared for It is unlikely that other parent will get cancer It is unlikely that they will get cancer Routines will be maintained as much as possible

Adolescents

Interruption or delay of individuation from parents May need to take on more responsibilities Need relief from responsibilities Need to be thanked Need time to be with peers and maintain activities Reassurance that it is okay to have fun

As a Family we can Cope

(When a Parent has Cancer, Wendy Harpham, MD, 1997)

--Caregiver Needs--

Physical assistance Support GroupsCancer educationRespite careFinancial assistanceCounseling

Identify patients with psychosocial needs Facilitate communication Collaboration with health care team Maintain cultural sensitivity

Help patients and families feel more in control

(Social Work in Oncology, 2001)

Psychosocial Needs & Services Information about illness, treatments, services available

Assistance coping with emotions regarding illness

Help in managing illness related symptoms

Counseling for changing behavior or mood issues

Educational material and resources

Help in managing disruptions in work, school, family

Financial assistance with community resources (Cancer Care for the Whole

Patient , 2008)

INTERVENTIONS FOR DEPRESSION AND ANXIETY

Referral to social worker for assessment Mood Disorders or Suicidality Decision-making capacity Safety concerns

Counseling by social worker COPE D Study – PHQ-9 Short term counseling to help with issues

Referral to psychiatrist or therapistPsychotropic medicationsSupport groups

Compassion FatigueWe work in a high-loss, high-stress

environmentRecognizing signs

fatigue, headaches, sleep difficulties, GI disturbances, irritability

Grieving lossesRenewing oneself

Finding balance Cancer Caregiving Rounds Learning to maintain personal boundaries

ReferencesHarpham, Wendy (1997). When a parent has cancer:

A guide to caring for your children. New York: Harper Collins.

Institute of Medicine (IOM). 2008. Cancer care for the whole patient: Meeting psychosocial health needs. Nancy Adler and Ann E.K. Page, eds. Washington, DC: The National Academies Press.

Lauria, Marie, et al. (2001). Social work in oncology: Supporting survivors, families, and caregivers. Georgia: American Cancer Society.

McMillen, J.C. (1999). Better for it: How people benefit from adversity. Social Work, 44(5), 455-468).

National Comprehensive Cancer Network (1999). Practice guidelines for the management of psychosocial distress. Oncology, 13(5A), 113-147.

Look for Peaceful environments

Any questions, comments or discussion?