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September 2017 VOL 8, NO 9
The Benefits of a Combined Psychosocial Oncology and Palliative Medicine Fellowship Program
A combined Psychosocial Oncology and Palliative Medicine Fellowship Program at The Ohio State University (OSU) James Cancer Hospital provides fellows with a core curriculum to promote quality cancer care from diagnosis to end of life.
As the population of the United States ages, the need for provider knowledge of psychosocial oncology and palliative medicine becomes more apparent, according to Alissa Banyasz, PhD. The fellowship program at OSU was designed to address this need by creating a new generation of psychologists with specific expertise in working with patients with cancer at the end of life.
The fellowship, currently in its tenth year, trains future clinical psychologists for research, teaching, and clinical practice and gives them the tools to provide transdisciplinary care to oncology patients from diagnosis until the end of life. The program also aims to expand the empirical basis of psychosocial care of patients with advanced disease.
At the APOS Annual Conference, Dr Banyasz, a current fellow in the program, discussed the core aspects of this successful program at OSU.
The Program Design
To address the overarching goals of the fellowship, 20 specific objectives were developed. One such objective addresses the application of empirically supported psychological treatment techniques. “Most individuals come into this fellowship with a background in evidence-based treatments, but what’s been extremely valuable to me is how to adapt these to patients with cancer in all different stages of treatment, and how to integrate various treatments in a patient-centered way,” she said.
According to Dr Banyasz, another objective of note addresses the provision of empirically supported nonpharmacologic symptom management (eg, cognitive therapy for pain, cognitive behavioral therapy for insomnia, activity pacing for fatigue). The curriculum also focuses heavily on self-care. “Working in this field is emotionally challenging, so training us how to take care of ourselves in the midst of taking care of others is an important pursuit of this program,” she added.
The 2-year fellowship is divided into 4 phases. The first year of the fellowship concentrates on ambulatory psychosocial oncology and palliative medicine, and the second year includes hands-on rotations, allowing the fellow to gradually build expertise in symptom management, end-of-life care, and grief counseling.
When a fellow begins the program, a specific learning plan is designed, tailored to that fellow’s interests, strengths, and areas for growth and is reevaluated in conjunction with the program objectives every 6 months. The fellowship implements a variety of teaching methods to achieve the program objectives: didactics (psychosocial oncology grand rounds, seminars, readings), outpatient clinics (every fellow spends 3 days per week providing clinical work and patient therapy in the general psychosocial oncology outpatient clinic and 1 day per week in a disease-specific clinic), and 3 complementary 1-month clinical rotations in consultation-liaison psychiatry, hospice, and inpatient palliative medicine.
Two additional focuses of the fellowship are training in teaching (ie, disease-specific groups, provision of grand rounds) and research. In the first year, a fellow has the opportunity to collaborate on ongoing projects and is then given the opportunity to develop his or her own research project in the second year of the program.
Significant Increases in Competency
The teaching and learning strategies in the program correspond to evaluations. Fellows complete a self-evaluation at the start of the fellowship, followed by knowledge- and skill-based evaluations every 6 months for the duration of the 2-year program. Primary supervisor evaluations are conducted initially, after every rotation, and every 6 months thereafter.
Data from preanalysis and postanalysis of past fellows have showed significant improvements across all objectives in self and supervisor evaluation scores. Fellows’ ratings indicate increased knowledge of oncology, skill in diagnosing psychologic disorders in advanced illness, broadened psychotherapeutic skills, and the ability to assist families with end-of-life preparation. According to Dr Banyasz, about half of the fellows coming out of the program have gone into clinical positions, while the other half have gone into research.
Interdisciplinary collaboration, GME accreditation, and a combination of clinical, teaching, and research opportunities contribute to the strength of the fellowship program at OSU, she said. Opportunities for continued growth include the addition of more faculty, inpatient growth, additional rotations (addiction, pain, neuropsychology), and external funding.
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