December 2015 Vol 6, NO 6

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Psychosocial Support

Guiding Patients Through End-of-Life Care: The Magnitude of Psychosocial Support

Christine Erickson 

Patients’ experiences, self-awareness, self-confidence, dignity, and personal integrity represent the fundamental obligations of psychosocial care, according to John Wynn, MD, DFAPA, Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Medical Director, PsychoOncology & Supportive Care, Swedish Cancer Institute, Seattle, WA. Dr Wynn went on to describe the significant role of oncology psychosocial care during his keynote address at the 2015 Association of Oncology Social Work 31st Annual Conference in Seattle, WA.

Helping Patients Cope with Their Diagnosis

Patients with cancer often worry about their outcomes. “They’re frightened of death; physical death by disease progression, social death by stigmatizing scars and disability, emotional death by losses, autonomy, self-sufficiency, and the ability to fully participate in their precancer life,” Dr Wynn said.

According to Dr Wynn, oncology psychosocial care providers must defend the relationships that their patients want to preserve, including relationships with spouses, partners, children, friends, employers, landlords, and bill collectors, as well as themselves, during invasive treatments and procedures.

“Even the most solitary of our patients is embedded in a society of relationships and social history of acceptance and rejection, value and shame, support and neglect,” Dr Wynn said. “The diagnosis and treatment arrive to see, in the patient’s context, their histories, their families, their belongings, and their disconnections….We put the ‘personal’ in personalized medicine, and the ‘personal’ is always more than just the person before you.”

Posttreatment Care

Patients need psychosocial care posttreatment. Patients can become frustrated with caregivers who assume that life returns to normal after treatment when, in reality, patients can experience posttreatment challenges, such as “chemo brain,” scars, and lymphedema. Dr Wynn suggests that psychosocial support can meet this challenge by addressing the issues that medicine and surgery cannot address.

It is also important to consider that patients have different ideas about the meaning of life and death. “I have to routinely remind myself that my ideas of how it all works can help me or hinder me, make me more sensitive to my patient’s needs, or render me blind and obtuse,” he stated. “This is the mandate of psychosocial oncology—to accompany, support, encourage, protect, and ultimately deliver [the patient] safely to whichever shore is next.”

Strategies for Psychosocial Care

Dr Wynn described his experience at the Swedish Cancer Institute, where he and his colleagues observed that there was a great demand to address oncology patients’ concrete psychosocial needs. As soon as the staff found out that an oncology social worker was available, the oncology social worker was consulted for anything not chemotherapy, radiation, or surgery related—housing, transportation, financial advice, paperwork, phone calls, marital advice, emotional issues, and selecting psychotropic medication.

Dr Wynn and colleagues realized that they needed to change their model of psychosocial care to better meet their patients’ needs. “Our emphasis has shifted over the years from a focus mostly on navigation and advocacy, to one that increasingly includes direct care,” he said.

Improving the Future

Clinical leadership requires being a good listener. “If you’re not alleviating suffering, lightening someone’s load, making the intolerable tolerable, or challenging a growth experience, get out of the way", he said. “In all of these roles, listening is the core skill….Hearing requires ears alone, but listening requires the stuff in between your ears.”

Dr Wynn emphasized that being able to listen well requires knowing what to listen for. The better providers understand their patients, the more effectively they are able to listen. Taking the time required to listen well is ultimately more efficient; problems are better anticipated, and the right solutions are chosen.

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