Presentation on theme: "Best Practices in Psychosocial Oncology Katherine Walsh, PhD, MSW, LICSW Professor, Springfield College School of Social Work Past President: Association."— Presentation transcript:
Best Practices in Psychosocial Oncology Katherine Walsh, PhD, MSW, LICSW Professor, Springfield College School of Social Work Past President: Association of Oncology Social Work 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.
Introduction of chemotherapy in Rx of Cancer War on Cancer, War on Cancer, P.L , Nixon admin P.L , Nixon admin 1971 First psychosocial research in oncology published by psychiatrists and social worker team 1950s Psychosocial Oncology National Cancer Plan includes rehabilitation, cancer control, and psychosocial research The Psychosocial Oncology Group is formed AOSW Is formed A Historical Perspective on Psychosocial Cancer Care: United States of America IPOS Is formed APOS Is formed Oncology APOSW Is formed 1990s First decrease in cancer mortalities in US First decrease in cancer mortalities in US 1960s Combined Therapeutic Modalities Increase Survival in Childhood leukemia First Pediatric Oncology social Worker hired in Boston
Twenty to Twenty-first Century Institute of Medicine Report National Coalition For Cancer Survivorship (NCCS) sponsors first March on Washington Patient Navigation Act passed by US Congress Mental Health Parity Act passed\ By US Congress 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 countries 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 Oncology 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
Non-Profit Organizations International National Regional State Community Clinics For Profit Organizations International National Regional State Community Physician Practionter Offices Institutions Acute Hospitals (NCI CCC) (For Profit) (Community) Chronic/Rehab (Skilled Nursing) Location of Service Provision
Four Broad Areas of Psycho- Oncology Psychosocial oncology services for patients (and families) Education and training programs Research addressing psychosocial issues Publications of research and scholarly papers Holland,J. (1998) p. 11
ADVOCACY 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 Development Vision Statement AOSW 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 cancer. Advance the practice of psychosocial interventions that enhance quality of life and recovery of persons with cancer and their families. Foster communication and support among psychosocial oncology caregivers. Further the study of psychological and social effects of cancer through research and continuing education. Advocate for programs and policies to meet the psychosocial needs of oncology patients and their families. 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.
IPOS 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: 1)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 includes: 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 cancer 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.
IndependentMediatingOutcome Cancer Disease and Treatment effects Personal Medical Social Economic Life Stresses Interventions Quality of Life Survival Bereavement Model of Psychosocial Oncology Research ( Adapted from Holland, p. 13) Variables
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 Cancer Screening Events High Risk Screening for Psychosocial Distress Counseling Individuals Families Groups Case Management Referral, Linking, Advocacy DXDX RXRX SURVIVORSHIP EOL/Palliative CARE BEREAVEMNT Comprehensive Psychosocial Assessment Prof Ed Research and Publication Education Pt/Caregiver Public SW Students Community Organization/ Coalition Building Discharge Planning Program Development Supervision Administration Legislation/ Policy Patient Navigation Adv Directives Pre- D X Genetic Counsel ing Evaluation Treatment plan Remission/ Recurrence Prevent tion
Interdisciplinary Team Collaboration Patient/Family MDPsychologist Spiritual Counselor Nursing Social Work Screening Assessment Case Management Medication management Counseling and other Psychosocial Interventions Financial Assistance Education Advocacy Research
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 anxiety. AOSW Social Work and End of Life course
Scope of Practice 1.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 survivors. 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 services. 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 goals. 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 outcomes.
1. Services to cancer survivors, families, and caregivers 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 cancer. 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 groups. 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 care. Development of programs and resources to address the needs of cancer survivors. Provision of support services to aid in stress management.
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 cer/resources/understanding_cancer_course.html Online Courses: Understanding Cancer Course : To understand cancer and cancer care for individuals with cancer and their loved ones 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 ed/webcasts.aspx Online courses: Achieving Cultural Competence to Reduce Health Disparities in End of Life Care
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 by NASW AOSW
NASW Public Education Campaign: Oncology Social Work Advertisement
Example: IPOS Multilingual Multidisciplinary Online Lectures Új! "A Daganatos Betegség Mint Családi Probléma" by Lea Baider Ph D "A Daganatos Betegség Mint Családi Probléma" Translator : Tamás Halmai IPOS Reviewer : Katalin Muszbek MD Narrator: Zsuzsa Adorjáni (Adorjáni Zsuzsa színészno, a Magyar Hospice Alapítvány támogatója) Új! "Veszteség és Gyász" by David Kissane MD "Veszteség és Gyász" Translator : Tamás Halmai IPOS Reviewer : Katalin Muszbek MD Narrator: György Csapó (Csapó György színész, a Magyar Hospice Alapítvány támogatója) "Communication and Interpersonal Skills in Cancer Care""Communication and Interpersonal Skills in Cancer Care" by Walter F. Baile, MD Translator: Dr. Mária Molnár Narrator: György Csapó "Anxiety and Adjustment Disorders in Cancer Patients""Anxiety and Adjustment Disorders in Cancer Patients" by Katalin Muszbek, MD Translator: Tamás Halmai Narrator: Zsuzsa Adorjáni "Distress Management in Cancer""Distress Management in Cancer" by Jimmie C. Holland, MD Translator: Tamás Halmai Narrator: Zsuzsa Adorjáni curriculum/core-curriculum-pres.htm#Hungarian
Case Example: What this means for the Patient and Family 32 yr old caucasian nurse discovers lump during pregnancy mamogram + dx w triple negative breast ca in 8 th month of pregnancy 4/07 (risk factors=age, 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
Psychotherapy 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