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Best Practices in Psychosocial Oncology


Best Practices in Psychosocial Oncology Katherine Walsh, PhD, MSW, LICSW Professor, Springfield College School of Social Work Past President: Association of Oncology ... – PowerPoint PPT presentation

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Title: Best Practices in Psychosocial Oncology

Best Practicesin Psychosocial Oncology
  • Katherine Walsh, PhD, MSW, LICSW
  • Professor, Springfield College School of Social
  • Past President Association of Oncology Social
  • Psychotherapist Private Practice

Summit Hungary 2008
Cancer Incidence and Mortality USA

Racial or Ethnic Variations All cancers
combined, men Incidence rates are highest among
black (607.3), followed by white (527.2),
Hispanic (415.5), Asian/Pacific Islander (325.8),
and American Indian/Alaska Native (288.6) men.
Death rates are highest among black (303.5),
followed by white (224.8), Hispanic (152.8),
American Indian/Alaska Native (151.2), and
Asian/Pacific Islander (137.0) men. All cancers
combined, women Incidence rates are highest
among white (405.9), followed by black (379.7),
Hispanic (318.6), Asian/Pacific Islander (267.4),
and American Indian/Alaska Native (242.2) women.
Death rates are highest among black (182.8),
followed by white (156.4), American Indian/Alaska
Native (110.7), Hispanic (101.9), and
Asian/Pacific Islander (92.3) women. Among four
races and Hispanic origin American Indian/Alaska
Native men have the lowest incidence rates of
cancer however, Asian/Pacific Islander men have
the lowest death rates from cancer. White women
have the highest incidence rates of cancer
however, black women have the highest death rates
from cancer. American Indian/Alaska Native women
have the lowest incidence rates of cancer and the
third-highest cancer death rates.

A Historical Perspective on Psychosocial Cancer
Care United States of
First psychosocial research in oncology published
by psychiatrists and social worker team
Psychosocial Oncology
IPOS Is formed
The Psychosocial Oncology Group is formed
First Pediatric Oncology social Worker hired in
APOSW Is formed
AOSW Is formed
APOS Is formed
Introduction of chemotherapy in Rx of Cancer
War on Cancer, P.L. 92-218, Nixon admin
National Cancer Plan includes rehabilitation,
cancer control, and psychosocial research
Combined Therapeutic Modalities Increase
Survival in Childhood leukemia
First decrease in cancer mortalities in US
Twenty to Twenty-first Century
National Coalition For Cancer Survivorship (NCCS)
sponsors first March on Washington
Mental Health Parity Act passed\ By US Congress
Patient Navigation Act passed by US Congress
Institute of Medicine Report
Institute of Medicine Report
Factors contributing to Greater Emphasis on
Psychological and Social Issues in Cancer
  • Societal Attitudes shifting away from fatalism
    about cancer
  • Trend toward revealing diagnosis in many
  • Patient participation in treatment decisions
    (autonomy, informed consent)
  • Increased doctor-patient dialogue
  • Development of valid instruments for measuring
    subjective symptoms and quality of life
  • Recognition that effective cancer prevention and
    screening is dependent on changing behaviors
  • Increased awareness of psychosocial sequelae of
    cancer and cancer treatment accompanying
    increased survival
  • Holland, Jimmie (Ed.). (1998). Societal view of
    cancer and the emergence of psycho-oncology.
    Chapter 1 in Holland and Jacobson,
    Psycho-oncology. New York Oxford University
    Press p.9

Factors influencing Funding and Psychosocial
  • Federal Government Legislation Funding
  • Government Insurance for Elders and Disabled
    (Medicare) and the poor (Medicaid)
  • For profit insurance companies (insurance
    provided through employers)
  • For profit Pharmaceutical and other Suppliers
  • Non-profit Organizations (American Cancer
    Society, LAF, Cancer Care, Wellness Community,
    Hospitals who employ Physicians, Psychiatrists,
    Psychologists, Social Workers)
  • Private Practitioners (Physicians, Psychiatrists,
    Psychologists, Social Workers, Complementary care
    providers-eg massage

Location of Service
Physician Practionter Offices
Non-Profit Organizations International National
Regional State Community
For Profit Organizations International National
Regional State Community
Institutions Acute Hospitals (NCI CCC) (For
Profit) (Community) Chronic/Rehab (Skilled
Four Broad Areas of Psycho-Oncology
  • Psychosocial oncology services for patients (and
  • Education and training programs
  • Research addressing psychosocial issues
  • Publications of research and scholarly papers
    Holland,J. (1998) p. 11

  • To influence Policies and Funding
  • To reduce health care disparities
  • To improve quality of care
  • To increase access to psychosocial care for all
  • To fund psychosocial research
  • To support education and training of psychosocial
    oncology experts
  • NASW, AOSW, APOS, NCCS, NPAF, C-change

AOSW Association of Oncology Social Work
  • Mission To advance excellence in the
    psychosocial care of persons with cancer, their
    families, and caregivers through Networking,
    Education, Advocacy, Research, Resource
  • Vision StatementAOSW envisions a global society
    in which oncology care meets the physical,
    emotional, social and spiritual needs of all
    people affected by cancer.
  • AOSW Goals
  • Increase awareness of the psychosocial effects of
  • Advance the practice of psychosocial
    interventions that enhance quality of life and
    recovery of persons with cancer and their
  • Foster communication and support among
    psychosocial oncology caregivers. 
  • Further the study of psychological and social
    effects of cancer through research and continuing
  • Advocate for programs and policies to meet the
    psychosocial needs of oncology patients and their
  • Promote liaison activities with other
    psychosocial oncology groups and professional
    oncology organizations. 
  • Promote the highest professional standards and
    ethics in the practice of oncology social work.

  • International Psycho-Oncology Society (IPOS)
    was created to foster international
    multidisciplinary communication about
  • clinical,
  • educational and
  • research issues
  • that relate to the subspecialty of
    psycho-oncology and two primary psychosocial
    dimensions of cancer 
  • Response of patients, families and staff to
    cancer and its treatment at all stages
  • 2) Psychological, social and behavioral factors
    that influence tumor progression and survival.

American Psychosocial Oncology Society
  • The mission of American Psychosocial Oncology
    Society is to advance the science and practice of
    psychosocial care for people with cancer.This
  • Providing a forum for professionals and
    individuals interested in the areas of
    psychological, social, behavioral, and spiritual
    aspects of cancer
  • Raising the level of awareness of health
    professionals and the public about psychological,
    social, behavioral, and spiritual domains of care
    for patients with cancer
  • Developing and implementing educational programs
    for health professionals, patients, and the
    public on the psychological, social, behavioral,
    and spiritual aspects of cancer
  • Developing a research agenda to be used as a
    guide for scientific study in the field
  • Developing standards of care for the management
    of the psychological, social, behavioral, and
    spiritual domains of cancer
  • Assuring attention to the psychological, social,
    behavioral, and spiritual domains in the
    evaluation of the quality of care for patients
    with cancer by regulatory agencies
  • Exploring innovative methods to enhance the
    recognition and treatment of psychological,
    social, behavioral, and spiritual aspects of
  • Promoting education and training of health
    professionals in the psychological, social,
    behavioral, and spiritual domains of cancer
  • Addressing the special needs of children, the
    elderly, and the underserved.

Model of Psychosocial
Oncology Research

Personal Medical Social Economic Life
Quality of Life Survival Bereavement
Cancer Disease and Treatment effects
( Adapted from Holland, p. 13)
Complexity of Cancer
  • The complexity and variability of psychosocial
    issues associated with cancer has created the
    demand for highly skilled practitioners who are
    trained to provide multilevel assessment and
    intervention throughout the illness continuum.
    (Smith, Walsh-Burke and Cruzan, 1998)

Psychosocial services through the continuum of
cancer care
Counseling Individuals Families Groups
Education Pt/Caregiver Public SW Students
High Risk Screening for Psychosocial Distress
Comprehensive Psychosocial Assessment
Community Organization/ Coalition Building
Genetic Counseling
Treatment plan
Remission/ Recurrence
EOL/Palliative CARE
Adv Directives
Cancer Screening Events
Case Management
Patient Navigation
Prof Ed Research and Publication
Discharge Planning
Program Development
Referral, Linking, Advocacy
Supervision Administration
Legislation/ Policy
Interdisciplinary Team Collaboration
Screening Assessment Case Management Medication
management Counseling and other Psychosocial
Interventions Financial Assistance Education
Advocacy Research
(No Transcript)
Interdisciplinary Collaboration
  • Patients who are significantly depressed or
    experiencing severe anxiety and who are not
    responding to counseling or other psychosocial
    interventions should be discussed with
    interdisciplinary colleagues. There is a risk of
    suicide for those experiencing depression in the
    context of a life-limiting illness and suffering
    can be alleviated through appropriate
    intervention. Pain and fatigue can be
    contributing factors to anxiety and depression
    and addressing these is essential
  • Psychiatric referral may be advisable to address
    the pharmacological agents for treatment of
    depression or anxiety. There are a variety of
    anxiolytic (or anti-anxiety) and anti-depressant
    medications that can be helpful in alleviating
  • AOSW Social Work and End of Life course

Scope of Practice
  • Services to cancer survivors, families, and
    caregivers through clinical practice providing
    comprehensive psychosocial services and programs
    through all phases of the cancer experience
  • 2. Services to institutions and agencies to
    increase their knowledge of the psychosocial,
    social, cultural and spiritual factors that
    impact coping with cancer and its effects, and to
    insure provision of quality psychosocial programs
    and care. 
  • 3.Services to the community through education,
    consultation, research and
  • volunteering to utilize, promote or strengthen
    the community services, programs, and resources
    available to meet the needs of cancer
  • 4.Services to the profession to support the
    appropriate orientation, supervision and
  • evaluation of providers in oncology
    participate in and promote student training
  • and professional education and advance
    knowledge through clinical and other research.

(AOSW) Scope and Standards of Practice (1998)
AOSW Standards of Practice
  • Use of high risk screening criteria to identify
    survivors and families in need of Social Work
  • Completion of a psychosocial assessment to
    determine survivor and familys strengths and
    needs relative to coping effectively with cancer
    diagnosis, treatment and follow-up cares. 
  • Development of a multidisciplinary care plan with
    survivor and family input and based on mutual
  • Use of a range of therapeutic and other
    interventions, including supportive counseling,
    group work, and education to address issues in
    each phase of the illness. 
  • Provision of pre-admission, transfer, and
    discharge planning. 
  • Provision of case management services. 
  • Provision of direct assistance to meet financial,
    transportation, lodging and other needs. 
  • Advocacy to remove barriers to quality care, to
    address gaps in service, to help survivors and
    families secure the protection of existing laws,
    and to work for any changes needed to policies,
    programs and legislation. 
  • Involvement conducting and publishing research to
    advance knowledge about the impact of cancer,
    refine interventions, and evaluate practice

  • 1. Services to cancer survivors, families, and
  • through clinical practice providing
    comprehensive psychosocial services and programs
    through all phases of the cancer experience

Example Services to cancer survivors, families,
and caregivers
The Cancer Survival Toolbox is a free audio
program designed to help cancer survivors and
caregivers develop practical skills to deal with
the diagnosis, treatment and challenges of
The Toolbox is made possible by unrestricted
educational grants from the Amgen Foundation and
the EliLilly and Company Foundatio
  • 2. Services to Institutions and Agencies
  • The goals of practice in providing to
    institutions and agencies are
  • To insure that the agencies and institutions are
    responsive to the needs of both individual cancer
    survivors, families and caregivers, as well as
  • To contribute the multidisciplinary effort to
    provide quality medical psychosocial care to
    oncology survivors. 
  • To assist social work colleagues and members of
    other disciplines to manage the stress of
    clinical practice.
  • The functions necessary to such services are
  • Education and consultation to professionals and
    staff regarding the biopsychosocial,
    environmental, spiritual, and cultural factors
    affecting cancer care. 
  • Collaboration with other professionals in the
    delivery of quality psychosocial care, education
    and research. 
  • Recording, statistical reporting, and evaluation
    to improve services, assist in identifying gaps
    in services and programs, and assure quality
  • Development of programs and resources to address
    the needs of cancer survivors. 
  • Provision of support services to aid in stress

Example Service to Institutions
and Agencies
3. Services to the Community Goals

Assure that community programs and
resources address and are responsive to the needs
of cancer survivors, families, and caregivers. 
Provide expertise to communities as they work to
assist cancer survivors. Functions Education
of communities to increase awareness of the
psychosocial needs of cancer survivors, families,
and caregivers.  Collaboration with community
agencies to remove barriers to cancer prevention,
screening and early detection, and access to
care.  Collaboration in the development of
special programs and resources to address
community-based needs.  Consultation with
voluntary cancer agencies, such as the American
Cancer Society and the Leukemia and Lymphoma
Society to provide community education and
develop programs to benefit cancer survivors.
Examples Service to the Community
Online Courses Understanding Cancer Course To
understand cancer and cancer care for
individuals with cancer and their loved ones
Online courses Achieving Cultural Competence to
Reduce Health Disparities in End of Life Care
  • Multidisciplinary Training in Psycho-Oncology
  • The "Multidisciplinary Training in
    Psycho-Oncology" is offered by the APOS Institute
    for Research and Education (AIRE) at no cost and
    is intended to train cancer care professionals in
    key areas of psychosocial oncology. The program
    includes fifteen Webcast lectures in the five
    following tracks.
  • Introduction to Oncology
  • Program Administration
  • Symptom Detection and Management (eight webcasts)
  • Interventions (four webcasts)
  • Population-Specific Issues

Example Cancer Care
  • ICAN
  • Teleconferences
  • Financial Assistance
  • Online Support Groups
  • Individual, Group, Family Counseling
  • Special programs serving Diverse populations
  • Doula programs for End of Life Care

Services to the Profession The goals of providing
services to the profession are To assure that
oncology social workers have the necessary
knowledge, skills, resources, time, funding, and
support to deliver quality psychosocial services
to all cancer survivors, families and caregivers.

EXAMPLE Oncology Social Work Brochure Produced
NASW Public Education Campaign
Oncology Social Work Advertisement
Example IPOS Multilingual Multidisciplinary
Online Lectures
Új!"A Daganatos Betegség Mint Családi Probléma" by Lea Baider PhD Translator  Tamás HalmaiIPOS Reviewer  Katalin Muszbek MD Narrator  Zsuzsa Adorjáni (Adorjáni Zsuzsa színészno, a Magyar Hospice Alapítvány támogatója)
Új!"Veszteség és Gyász" by David Kissane MD Translator  Tamás HalmaiIPOS Reviewer  Katalin Muszbek MD Narrator  György Csapó (Csapó György színész, a Magyar Hospice Alapítvány támogatója)
"Communication and Interpersonal Skills in Cancer Care" by Walter F. Baile, MD Translator  Dr. Mária MolnárNarrator  György Csapó
"Anxiety and Adjustment Disorders in Cancer Patients" by Katalin Muszbek, MD Translator  Tamás HalmaiNarrator  Zsuzsa Adorjáni
"Distress Management in Cancer" by Jimmie C. Holland, MD Translator  Tamás HalmaiNarrator  Zsuzsa Adorjáni
-ed/core- curriculum/core-curriculum-pres.htmHung
Case Example What this means for the Patient and
  • 32 yr old caucasian nurse discovers lump during
    pregnancy mamogram
  • dx w triple negative breast ca in 8th month of
    pregnancy 4/07
  • (risk factorsage, pregnancy)
  • Husband is psych nurse. Insurance through his
    employer Both have hx of alcohol abuse in 12 step
    recovery (risk factor) Pt unemployed
    (socioeconomic risk factor)
  • Delivers healthy baby 5/07
  • Mastectomy and reconstruction 6/07
  • Begins AC and Herceptin after birth 7/07
  • Sees osw in clinic-distress screen anxiety
  • Case management by OSW begins given Cancer
    Survival Toolbox
  • Referred to support group, attends 2x
  • Referred to family retreat program, d/n attend
  • Referred to Licensed Independent Clinical Social
    Worker for psychotherapy and begins 9/08
  • Completes chemotherapy 10/07, Completes
    reconstruction 11/07
  • Husband self-refers for counseling 4/08
  • Recurs w metastasis to liver, lung, bones 6/08
  • Marital counseling session w husband 6/08
  • Radiation to bones begins 7/08
  • Herceptin,Zometa, Taxol begin 8/08
  • Acupunture, massage, self-hypnosis begin,
    psychotherapy continues

  • Cognitive-behavioral therapy for anxiety
  • (Cognitive restructuring, progressive
    muscle relaxation and guided imagery)
  • Solution-focused marriage therapy sessions
  • Motivational interviewing for cessation of
    alcohol and tobacco use
  • Self-advocacy training for adequate medication
    for side effects of chemo
  • Advocacy for financial support in day care
  • Disability income, Palliative Care

Cancer Patient Bill of Rights
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