No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
On Being a Psycho-Oncologist A Counseling Psychology Perspective
Abstract
This special issue of TCP focuses on the psychological and psychosocial components of coping with cancer and its aftermath. Psycho-oncology, a subspecialty within professional psychology, is a multidisciplinary field emphasizing the psychological and social aspects of cancer. In this introductory article, I show the congruence between counseling psychology and psycho-oncology, indicate how counseling psychologists can expand their parameters of practice to include cancer patients and families, and explain what evidence-based resources are needed to acquire relevant background knowledge. Health care reform changes—in general and oncology-specific—are explained as they currently open new opportunities for counseling psychologists in psycho-oncology. Finally, the five articles that make up this special issue are previewed. Psycho-oncology is a challenging yet rewarding subspecialty within counseling psychology, congruent with its values and parameters of practice, and now is an opportune time to expand one’s practice to include psycho-oncology and help those coping with cancer and its aftermath.
Psychosocial implications of breast cancer diagnosis in families typically focused on marital and mother-daughter relationships. The lack of sibling-oriented perspectives on this phenomenon led this present study to investigate the experiences of Filipino women living with a sister diagnosed with breast cancer. Using the phenomenological approach of inquiry, semi-structured interviews were conducted to twelve purposively sampled women recruited from the Breast Care Center-Philippine General Hospital between January to February 2017. Qualitative data were analysed using thematic analysis. Findings revealed that the participants have encountered many facets of the impact of the cancer journey, and these oftentimes led to unwanted personal and familial adjustments. Hence, improving the provision of services that address the psychosocial effects of cancer is warranted.
The author offers a critique on current counseling psychology research from her perspective as a US counseling psychology researcher and editor. She notes that unless something happens to change the trajectory, future US counseling psychology research will be open to the same criticisms. She summarizes counseling psychology values and argues that counseling psychology research reflects those values. She then identifies five ways that counseling psychology could be different in the future by: building theory-based research, embracing diversity of populations, research questions and methodologies, informing (and being informed) by other psychological disciplines, and informing policy and practice.
Black women are traditionally underserved in all aspects of cancer care. This disparity is particularly evident in the area of psychosocial interventions where there are few programs designed to specifically meet the needs of Black breast cancer survivors. Cognitive-behavioral stress management intervention (CBSM) has been shown to facilitate adjustment to cancer. Recently, this intervention model has been adapted for Black women who have recently completed treatment for breast cancer. We outline the components of the CBSM intervention, the steps we took to adapt the intervention to meet the needs of Black women (Project CARE) and discuss the preliminary findings regarding acceptability and retention of participants in this novel study.
Sexual quality of life after cancer is an integral component of well-being for many survivors. However, the experience of cancer presents significant challenges to sexual health and well-being, often requiring survivors to negotiate the many physical, psychological, social/relational, and cultural factors that impact psychosexual functioning. By embracing a sex-positive approach to conceptualization, assessment, and treatment, psychologists can better serve the unique psychosexual needs of survivors and assist in enhancing sexual and intimate expression that promotes adaptation and flexibility. This article will (a) present a positive conceptualization of sexual health and well-being for cancer survivors and (b) discuss culturally competent treatment strategies to promote the sexual health and well-being of cancer survivors.
The search for meaning in bereavement is a topic of increasing scholarly interest. Nonetheless, literature has not yet appeared that examines the intersections of diverse theories of meaning, corresponding empirical findings, and clinical implications for counseling psychologists engaged in cancer-related bereavement psychotherapy. Meaning theories drawn from several domains of scholarship including existential, spirituality, stress, and bereavement are surveyed followed by a review of related empirical trends in the scholarship. A hypothetical case vignette is then presented to highlight potential strategies for counseling psychologists to integrate a broadened meaning-based approach to bereavement psychotherapy related to the loss of a loved one from cancer. The article concludes by identifying limitations of a meaning-based approach, as well as directions for further research.
This article advocates the need for a much stronger emphasis on and commitment to the science and practice of prevention in counseling psychology. Historical and recent developments in the profession are highlighted, as are the changing U.S. demographics and societal needs that mandate an enhanced prevention focus for the field. A prevention-based agenda of four fundamental goals for counseling psychology is articulated. The goals include eight training domains and objectives as well as skills needed to support a prevention agenda for counseling psychology. Barriers and adjustments needed to give renewed vitality toward prevention are discussed. Prevention resources and funding opportunities are presented.
Preventive interventions have been shown to successfully aid the development of children, youths, and adults and avert maladjustment in individuals at risk for negative outcomes. Continued scientific advancement of preventive interventions is crucial to further the health of U.S. children, youths, and families. This article presents 15 best practice guidelines on prevention practice, research, training, and social advocacy for psychology. These guidelines articulate clear standards and a framework for moving the profession toward improving the well-being of a greater number of individuals and communities. The guidelines are intended to assist psychologists in evaluating their preparation for engaging in prevention work and in furthering their understanding through increased knowledge, skills, and experience in prevention.
This article presents an overview of the Houston 2001 National Counseling Psychology Conference. The authors discuss the context for the 4th National Counseling Psychology Conference, documentthe process of decision makingaboutthe conference, andexamine the content of the conference. The authors also examine a unique feature of the conference, the social action groups, discussing their philosophical underpinnings as well as how they were organized, what took place, and recommendations drawn from the groups. The authors evaluatethe outcomes of the Houston Conference andalso assess the conference within the context of the legacy of the three other counseling psychology conferences held at Northwestern University in 1951, in the Greyston Conference Center at Teachers College in 1964, and in Atlanta in 1987. Finally, the authors make recommendations for the field to move the conference’s initiatives forward and plan for future conferences.
Considerable discussion has occurred through the years regarding models of training. With the recent accreditation of counseling psychology programs espousing the practitioner-scholar model, the importance of reexamining the merits of this as well as the traditional scientist-practitioner is now very important for the future of the field. This article consists of two positions: One pro practitioner-scholar and the other pro scientist-practitioner and con practitioner-scholar. The first position (first part of the article) by Biever, Patterson, and Welch argues for inclusion of the practitioner-scholar model as an alternative for training in counseling psychology. The second position (in the second part of the article) by Stoltenberg, Pace, and Kashubeck reviews concerns with two competing models. These authors conclude that the scientist-practitioner model is a better fit for training in counseling psychology. Recommendations for training within models are presented.
This article, written by the coeditors of The Counseling Psychologist's (TCP) International Forum section, reviews the status of counseling psychology from an international perspective and presents a rational and modest proposal for promoting counseling psychology's commitment to global perspectives. The brief history of TCP's International Forum section is reviewed and specific recommendations for internationalizing counseling psychology are put forth. These recommendations are organized along (a) methods of psychological science, (b) profession-based initiatives, (c) Division 17 (counseling psychology) initiatives, and (d) program-specific activities. The marked challenges to internationalizing counseling psychology are also addressed.
Using the metaphor of viewing a movie premiere, characteristics of doctoral programs in clinical health psychology are outlined. Common elements of training include: uniform training competencies, graduated sequence of training, emphasis upon broad and general training, reliance on the biopsychosocial model, and integration of scientific and practical competencies. Exclusive programs, in which all students are being trained in one area of concentration, are differentiated from programs embedded within general training in clinical or counseling psychology. Elucidation of these program characteristics assists prospective students, faculty members who develop these programs, and those developing educational and training guidelines within clinical health psychology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
What is professional competence and how should it be assessed? Professionalism in psychology requires the habitual and judicious use of knowledge and skills as well as ongoing assessment. The authors synthesize discussions of the Assessment of Competence Workgroup that met during the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The workgroup discussed how to establish a culture of competence and elaborated principles and considerations necessary for the development of methods to assess competence. Principles identified include maintaining a developmental perspective, practicing multicultural sensitivity, and conducting formative and summative, career-long assessment. Recommendations are offered that support a "culture shift" from the current levels of competence assessment to an embracing of continual assessment of professional knowledge and skills over the life span. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although there is a profound connection between personality and developmental psychology on the one hand and counseling psychology on the other, this relationship has been marked by ambivalence. Reasons for this are discussed, and it is suggested that the relationship is moving in the direction of actualization. Four substantive areas are explored in which personality and developmental psychology both inform and are influenced by counseling psychology: career behavior, cultural identity, psychoanalysis, and adult development. Finally, the "healthy personality" is examined as an area of personality and developmental psychology in which counseling psychology has not fulfilled its promise, and the importance and possible directions of such work are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article provides a conceptual framework for training in professional psychology focused on the construct of competency. The authors present a 3-dimensional competency model delineating the domains of knowledge, skills, attitudes, and values that serve as the foundation required of all psychologists, the domains of functional competencies that broadly define what psychologists do, and the stages of professional development from doctoral education to lifelong learning through continuing education. The goal in presenting this model is to provide a conceptual frame of reference for those responsible for psychology education, credentialing, and regulation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Changes in the health care system and a renewed focus on patient-centered medical homes, which integrate behavioral health services into primary care, present professional psychologists with unprecedented workforce and growth opportunities. However, the profession must act immediately to take full advantage of these emerging opportunities. Although many conceptualize integrated primary care as including mental health services in primary care, in practice, the role of the primary care behavioral professional extends far beyond mental health concerns. The authors suggest two key domains of action: First, in order to serve optimally as behavioral health professionals and leaders in primary care, psychologists must receive training in clinical health psychology. Second, psychologists need to increase knowledge and skills in the conduct of translational research in “real-world” clinical settings. The discussion centers on delineating the imperatives the profession must address and offers general suggestions for possible approaches, which ideally will form the basis for specific models of professional preparation. What is abundantly clear is that, as the face of health care changes, professional psychology must respond swiftly and appropriately not only to remain viable, but to thrive. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
If a cancer patient were referred for services, would most psychologists know how to do a psychosocial assessment? The possibility of doing so is high, as nearly 8.2 million people are now living with cancer. This article explains how to do a psychosocial assessment interview of the adult cancer patient. The most relevant variables are identified and defined, and an assessment interview is presented. Common reasons for referrals, treatment planning recommendations, self-report questionnaires, and an outline for the written report are also explained. As more people live with cancer, professional psychologists need to know how to evaluate psychosocial adaptation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Our goal was to develop evidence-based recommendations for the organization and structure of cancer survivorship services, and best-care practices to optimize the health and well-being of post-primary treatment survivors. This review sought to determine the optimal organization and care delivery structure for cancer survivorship services, and the specific clinical practices and interventions that would improve or maximize the psychosocial health and overall well-being of adult cancer survivors.
We conducted a systematic search of the Inventory of Cancer Guidelines at the Canadian Partnership Against Cancer, the U.S. National Guideline Clearinghouse, the Canadian Medical Association InfoBase, medline (ovid: 1999 through November 2009), embase (ovid: 1999 through November 2009), Psychinfo (ovid: 1999 through November 2009), the Cochrane Library (ovid; Issue 1, 2009), and cinahl (ebsco: 1999 through December 2009). Reference lists of related papers and recent review articles were scanned for additional citations.
Articles were selected for inclusion as evidence in the systematic review if they reported on organizational system components for survivors of cancer, or on psychosocial or supportive care interventions HOWELL et al. designed for survivors of cancer. Articles were excluded from the systematic review if they focused only on pediatric cancer survivor populations or on populations that transitioned from pediatric cancer to adult services; if they addressed only pharmacologic interventions or diagnostic testing and follow-up of cancer survivors; if they were systematic reviews with inadequately described methods; if they were qualitative or descriptive studies; and if they were opinion papers, letters, or editorials.
Evidence was selected and reviewed by three members of the Cancer Journey Survivorship Expert Panel (SM, TC, TKO). The resulting summary of the evidence was guided further and reviewed by the members of Cancer Journey Survivorship Expert Panel. Fourteen practice guidelines, eight systematic reviews, and sixty-thee randomized controlled trials form the evidence base for this guidance document. These publications demonstrate that survivors benefit from coordinated post-treatment care, including interventions to address specific psychosocial, supportive care, and rehabilitative concerns.
Ongoing high-quality research is essential to optimize services for cancer survivors. Interventions that promote healthy lifestyle behaviours or that address psychosocial concerns and distress appear to improve physical functioning, psychosocial well-being, and quality of life for survivors.
To report acceptability, feasibility, and outcome data from a randomized clinical trial (RCT) of a brief intervention for caregivers of children newly diagnosed with cancer.
Eighty-one families were randomly assigned following collection of baseline data to Intervention or Treatment as Usual (TAU). Recruitment and retention rates and progression through the protocol were tracked. Measures of state anxiety and posttraumatic stress symptoms served as outcomes.
Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria (40%) and an unexpectedly low participation rate (23%). However, movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback. Outcome data showed no significant differences between the arms of the RCT.
There are many challenges inherent in conducting a RCT shortly after cancer diagnosis. Consideration of alternative research designs and optimal timing for interventions are essential next steps.
This article explores the possible future of psychosocial oncology. Advancements in treatment and the concomitant increase in survivorship, combined with a highly educated patient population, will result in huge demands on an already strained healthcare system. Role changes and paradigm shifts will be required in order to cope with these challenges. Issues with current treatment silos and fragmented care systems are presented, and the role of a biopsychosocial approach is discussed.
Society expects autonomous professions to ensure the competency of it practitioners, and professions should facilitate the continuing education and training of its members. Given the shift from psychology as a mental health profession to that of a health profession, the authors propose a self-assessment model for the individual practitioner to gauge his or her readiness to provide professional service in expanded areas of practice. This model could also be useful to the American Psychological Association, state psychological associations, and other purveyors of continuing education programs in systematically developing postgraduate experiences. A template for self-assessment that reflects well-accepted core domains of knowledge and skills is presented.
Posttraumatic stress symptoms (PTSS), particularly intrusive thoughts, avoidance, and arousal, are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers. We conducted a randomized wait-list control trial of a newly developed 4-session, 1-day intervention aimed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches—the Surviving Cancer Competently Intervention Program (SCCIP). Participants were 150 adolescent survivors and their mothers, fathers, and adolescent siblings. Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group. A multiple imputations approach was used to address nonrandom missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained. The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family.
Society expects autonomous professions to ensure the competency of its practitioners, and professions should facilitate the continuing education and training of its members. Given the shift from psychology as a mental health profession to that of a health profession. the authors propose a self-assessment model for the individual practitioner to gauge his or her readiness to provide professional services in expanded areas of practice. This model could also be useful to the American Psychological Association, state psychological associations, and other purveyors of continuing education programs in systematically developing postgraduate experiences. A template for self-assessment that reflects well-accepted core domains of knowledge and skills is presented.
This article, written by the coeditors of The Counseling Psychologist's (TCP) International Forum section, reviews the status of counseling psychology from an international perspective and presents a rational and modest proposal for promoting counseling psychology's commitment to global perspectives. The brief history of TCP's International Forum section is reviewed and specific recommendations for internationalizing counseling psychology are put forth. These recommendations are organized along (a) methods of psychological science, (b) profession-based initiatives, (c) Division 17 (counseling psychology) initiatives, and (d) program-specific activities. The marked challenges to internationalizing counseling psychology are also addressed.
Although there is a profound connection between personality and developmental psychology on the one hand, and counseling psychology, on the other, this relationship has been marked by ambivalence. Reasons for this are discussed and it is suggested that the relationship is moving in the direction of actualization. Four substantive areas are explored in which personality and developmental psychology both inform and are influenced by counseling psychology: career behavior, cultural identity, psychoanalysis, and adult development. Finally, the "healthy personality" is examined as an area of personality and developmental psychology in which counseling psychology has not fulfilled its promise, and the importance and possible directions of such work are discussed.
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005
Prognosis is poor and quantity of life is compromised for individuals with advanced cancer. Quality of life is impacted, for some, by psychological distress. According to Acceptance and Commitment Therapy (ACT), psychological distress is associated with emotional avoidance and lack of valued living. ACT aims to increase psychological health via acceptance of one’s “minding,” a focus on present-moment living, and a commitment to value-driven life. In this article, we introduce the advanced cancer patient, the theory behind ACT, and how ACT may be delivered. We present the hypothetical case of J.B., a 56-year-old woman with recurrent Stage III ovarian cancer who reports thoughts of hopelessness and worthlessness, and how ACT might be applied to help J.B. experience a rich and meaningful life irrespective of her time remaining.
With increases in the number of cancer survivors, many persons now experience cancer as a chronic disease followed by adaptation to a new reality of what is normal in their lives. In response, cancer survivorship researchers have begun attending to the multidimensional needs of survivors, including the need to promote optimal psychological adaptation and health. Theoretical models of well-being that account for the complexity of survivorship issues are needed. We present a social cognitive model of restorative well-being as a framework for reviewing recent research on coping with early stage adult cancer (i.e., stages I and II) and optimizing post-treatment adjustment. We focus on research on cancer-related coping strategies, efficacy beliefs, personality traits, and environmental supports, which have been linked to adjustment outcomes and which may inform psychosocial interventions. By grounding this research in a theoretical base, we highlight the potential for counseling psychologists’ contributions to cancer survivorship research.
Counseling psychologists generally agree that science-practice integration is a good thing. However, most discussions of this topic are less clear about how to actually apply scientific findings to an individual client case. In this article, the author attempts to describe a philosophy for applying research to practice in counseling psychology that requires using theory as the bridge between science and practice.
The empirical literature and the author's professional experience over four decades have convinced him that concerning practice patterns and work settings there is little to distinguish counseling psychology from other psychological practice specialties. What is distinctive are certain core values that undergird and distinguish this specialty. First, a definition of “values” is presented, followed by a brief review of a limited number of studies that address the topic of values and counseling psychology. Next, the author describes a qualitative study of the perceptions and beliefs of 18 experienced counseling psychology educators and trainers about core values that distinguish the specialty and set it apart from other psychology specialty practice areas. The final section presents nine proposed core values, most of which are distinctive to counseling psychology, derived logically from the themes of the literature and the interviews with the counseling psychology educators as filtered through the author's biases and assumptions.
Concerns about the cross-cultural validity of constructs are discussed, including equivalence, bias, and translation procedures. Methods to enhance equivalence are described, as are strategies to evaluate and minimize types of bias. Recommendations for translating instruments are also presented. To illustrate some challenges of cross-cultural counseling research, translation procedures employed in studies published in five counseling journals are evaluated. In 15 of 615 empirical articles, a translation of instruments was performed. In 9 studies, there was some effort to enhance and evaluate equivalence between language versions of the measures employed. In contrast, 2 studies did not report using thorough translation and verification procedures, and 4 studies employed a moderate degree of rigorousness. Suggestions for strengthening translation methodologies and enhancing the rigor of cross-cultural counseling research are provided. To conduct cross-culturally valid research and deliver culturally appropriate services, counseling psychologists must generate and rely on methodologically sound cross-cultural studies. This article provides a schema for performing such studies.
We propose a prototype for a scientist-practitioner model of psychological assessment that is a reformulation of the Pepinskys's model of the counselor-as-scientist. We integrate with the Pepinskys's model theory and research on human inference, judgment, and decision making, research on threats to accurate clinical prediction (e.g., confirmatory hypothesis testing), and findings about counselor characteristics associated with effective judgment processes (e.g., cognitive complexity). Issues related to counseling psychologists' application of research findings and use of scientific reasoning in counseling practice are explored, including implications for training, research, and practice.
A consensus has long existed that the scientist-practitioner model has failed to reflect what was envisioned by the Boulder Conference participants and endorsed by counseling psychology at the Greyston and Georgia Conferences. Counseling psychology's commitment, however, to the scientist-practitioner model has not faltered. Furthermore, developments within the health care system (e.g., managed care, empirically validated treatments, treatment guidelines) demand from psychologists increasing levels of scientific knowledge and a wider range of research skills. Psychology's current commitment to positivist explanation, scientific knowledge characterized by law-governed causal processes, is at the core of the scientist-practitioner split. To integrate scientist-practitioner ideals into a comprehensive approach to counseling psychology training, research, and practice, counseling psychologists should embrace an identity as evidence- based practitioners. Inherent in this framework is a philosophical, scientific, political, and social shift toward an expanded view of what constitutes scientific evidence.
The origin and development of the field of counseling psychology are described. The discussion considers the philosophy, scope, method, and work setting of this occupation, and the structure of its professional organization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Primary care psychology is a growing field that requires specific training opportunities for successful practice. The knowledge and skills that practitioners need for work in this setting are outlined here in detail. This curriculum integrates literature and experience in family psychology, health psychology, and pediatric psychology; considers multiple levels of education and training; and provides illustrative examples. It is a first attempt in an evolving process of integrating historical and cutting edge literature from many areas of psychology and other disciplines to contribute to comprehensive primary care psychology training. It can be used by programs and individual practitioners alike in designing education and training experiences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper contains an overview of psycho-oncology. A definition of this discipline and its aims is given. Advances in knowledge are described in the following areas: the psychological toll of cancer and its treatments, psychological factors affecting quality of life, psychological precursors of cancer, psychological prognostic factors and psychobiological research. Advances in clinical practice comprise the development and controlled evaluation of psychological therapy for cancer patients. Finally, some major challenges facing psycho-oncology in the immediate future are listed.
Supportive therapy for cancer patients includes the skills normally used for supportive therapy, but require additional understanding of the medical issues and the medical milieu and comfort in dealing with many concrete issues about the patient's physical traumas. The unpredictability of cancer is reflected in the nature of the therapy, which must be highly flexible. It may be dynamic psychotherapy one week, crisis intervention the next, existential life review after that. Trust and fidelity between patient and therapist are the mainstays of an enduring and meaningful treatment. The tragic and unjust nature of many cases requires psycho-oncologists who understand themselves well with respect to their losses and can count on their endurance in difficult situations.
Background:
Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.
Methods:
For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months.
Results:
At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months.
Conclusions:
Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.
With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and anticipate the submission of manuscripts across the full spectrum of topics related to health psychology and health disparities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Despite substantial evidence that patients with cancer commonly have significant psychosocial problems, for which we have evidence-based treatments, many patients still do not receive adequate psychosocial care. This means that we risk prolonging life without adequately addressing the quality of that life. There are many challenges to improving the current situation, the major one of which is organizational. Many cancer centers lack a system of psychosocial care that is integrated with the cancer care of the patient. Psychosocial care encompasses a range of problems (emotional, social, palliative, and logistical). The integration must occur with the cancer care of the patient at all stages (from screening to palliative care) and across all clinical sites of care (inpatient and outpatient cancer services as well as primary care). In this article, we consider the challenges we face if we are to provide such integrated psychosocial services. We focus on the collaborative care service model. This model comprises systematic identification of need, integrated delivery of care by care managers, appropriate specialist supervision, and the stepping of care based on systematic measurement of outcomes. Several trials of this approach to the management of depression in patients with cancer have found it to be both feasible to deliver and effective. It provides a model for services to meet other psychosocial needs. We conclude by proposing the key components of an integrated psychosocial service that could be implemented now and by considering what we need to do next if we are to succeed in providing better and more comprehensive care to our patients.
There is a growing consensus that psychosocial care should be integrated into the routine care of patients with cancer. This consensus is consistent with the considerable body of evidence about the deleterious effects of allowing psychosocial needs to remain unmet and the growing body of evidence about the beneficial effects of providing psychosocial services to address unmet needs. Despite this evidence, available data suggest that a considerable portion of the population of patients with cancer does not receive needed psychosocial care. Three lines of professional activity initiated in recent years have the potential to address this issue in fundamental ways: the formulation of standards of cancer care that address the psychosocial component of care, the issuance of clinical practice guidelines for psychosocial care of patients with cancer, and the development and implementation of measurable indicators of the quality of psychosocial care in oncology settings. This article provides an overview of accomplishments in each of these areas; it is designed to ensure that oncologists and other cancer treatment providers are knowledgeable about current standards for psychosocial care, existing consensus- and evidenced-based recommendations for clinical practice in this area, and resources and tools for evaluating and, if indicated, improving the quality of the psychosocial care their patients are receiving. The article concludes with a critical appraisal of these activities and a consideration of how current efforts might be enhanced.
Patients in the terminal phase of a disease may have complex needs. It is often family and friends who play a central role in providing support, despite health professional input and regardless of whether the patient is at home or elsewhere. Such informal caring may involve considerable physical, psychological, and economic stresses. A range of supportive programmes for caregivers is being developed including psychological support and practical assistance.
To assess the effects of supportive interventions that aim to improve the psychological and physical health of informal caregivers of patients in the terminal phase of their illness.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2010); MEDLINE (1950 to May 2010); EMBASE (1980 to May 2010); PsycINFO (1872 to May 2010); CINAHL (1937 to May 2010); National Health Service Research Register (2000 to November 2008) and Dissertation Abstracts (1716 to May 2010). We searched the reference lists of relevant studies; contacted experts; and handsearched journals.
Randomised controlled trials (RCTs) of interventions to support adults who were caring for a friend or relative with a disease in the terminal phase. Interventions could include practical and emotional support and/or the facilitation of coping skills. Interventions could support caregivers indirectly via patient care.
Two authors independently screened citations against the selection criteria. Data were extracted by one author and checked by another. This included extraction of any adverse effects. Risk of bias assessment was undertaken by two authors. We contacted trial authors to obtain missing information. Trial data were combined, where appropriate, on the review's primary outcomes.
We included eleven RCTs involving 1836 caregiver participants. Nine interventions were delivered directly to the caregiver. Seven of these provided support in the caring role, another involved a family life review, and one grief therapy. None provided practical support. The other two interventions aimed to support caregivers indirectly via patient care. Overall the risk of bias is unclear, as all trials under-reported methods.There is low quality evidence that interventions directly supporting the caregiver significantly reduce psychological distress in the short term (8 trials: standardised mean difference (SMD) -0.15; 95% confidence interval (CI) -0.28 to -0.02). There is also low quality evidence that these interventions in the short term may marginally improve coping skills and quality of life, but neither results were statistically significant (7 trials: SMD -0.05; 95% CI -0.24 to 0.14; 6 trials: SMD 0.08; 95% CI -0.11 to 0.26, respectively). One study assessed physical outcomes, specifically sleep improvement, and found no difference (median effect 0.00). No study measured health service use or adverse outcomes. In one study, however, a subgroup of intervention participants had higher levels of family conflict.Evidence was less clear on the indirect interventions. While both trials in this category found that supporting the patient may reduce psychological distress, none of the four assessments were statistically significant. There were no evaluations of coping with the caring role, quality of life, service use or adverse outcomes. In one trial there was no difference between trial arms in the proportion of caregivers reporting good physical health.
There is evidence that supportive interventions may help reduce caregivers' psychological distress. These findings suggest that practitioners should enquire about the concerns of caregivers and should consider that they may benefit from additional support. There is, however, a need for further research to explore the benefits identified, and to assess the interventions' effects on physical health, and potential harms. Trials need to report their methods fully.
This article reviews the 2009 APA President's initiatives and recommendations for the future of psychology practice and science. The future of psychology practice requires that we expand the focus of traditional practice; become health care providers, not just mental health providers; use evidence-based practice, assessment, and outcome measures; incorporate technology into our practices, including electronic health records; and change training and focus to meet the needs of our diverse society. The future of psychological science requires that we train and work in multidisciplinary teams, employ different methods and approaches, and shift our focus to translational science. The future of our profession requires substantial changes in graduate education to prepare our students for science and practice in the 21st century. In light of advances in science and practice that reveal the critical importance of psychosocial and behavioral factors in health and disease, I call for the creation of a department of behavioral health within the federal government.
With numerous studies demonstrating that psychosocial care reduces distress and improves quality of life, practitioners have an obligation to treat cancer patients in a manner consistent with this evidence. Although the rationale is straightforward, major challenges exist in achieving the goal of translating research into clinical practice. One challenge has been the nature of the evidence, with many studies of psychosocial interventions characterized by poor methodological quality, absence of eligibility criteria specifying heightened distress, and minimal consideration of dissemination potential. A second challenge has been to make practitioners aware of relevant evidence. Targeted efforts at dissemination, such as the issuance of clinical practice guidelines and evidence-based recommendations and the distribution of intervention materials via the Internet, appear to be more effective than passive efforts in providing practitioners with useful information. Perhaps the most challenging aspect has been to persuade practitioners to change how they practice. One approach currently under development would allow practitioners and health-care organizations to perform self-evaluations of the quality of their psychosocial care based on review of medical records. Feedback showing quality of care to be less than optimal is likely to motivate change, especially if the quality indicators assessed are considered to be important and reliable and point to specific actions that can be taken. The use of evidence to promote changes in clinical practice represents one of the major ways in which the field of psycho-oncology can fully realize its potential to positively affect the lives of people with cancer.
Around the world, traditionally the diagnosis of cancer and its prognosis was withheld from patients for centuries, due to the stigma and fears attached to it. This custom of 'never telling' precluded talking with patients about their feelings and how they were coping with illness and the threat of death. In the last quarter of the twentieth century, patient's right of access to information, coupled with the diminished stigma attached to cancer, encouraged physicians into a more open dialogue. In the majority of countries today, patients learn their diagnosis and know their treatment options. This change permitted the first formal psychosocial studies of patients in the 1950s, and the beginning of research into coping and development of interventions to improve quality of life. However, a second independent stigma, also present for centuries, has persisted: the stigma associated with mental disorders (even in the context of severe physical illness). This prejudice about mental problems has been a barrier to the integration of the psychosocial domain into total cancer care; the identification of patients who are distressed; and, patient's acceptance of psychological help. Despite these barriers, psychosocial oncology has developed worldwide, with a small, but active cadre of investigators and clinicians engaging in clinical, educational and research aspects of psycho-oncology. The International Psycho-Oncology Society (IPOS), since 1984, has brought them together. The Sutherland Memorial Lecture has honored nine individuals from five countries who have made major contributions to the field: 1982, Avery Weisman; 1984, Bernard Fox; 1987, Morton Bard; 1991, Margit von Kerekjarto; 1993, Ned Cassem; 1996, Steven Greer; 1998, Hiroomi Kawano; 2000, Robert Zittoun; and 2003, Jimmie Holland. The scientific base for psychosocial oncology is now secure with a body of knowledge, textbooks and journals which have led to the development of evidence-based clinical practice guidelines for psychosocial services in several countries. A benchmark now exists against which care can be monitored and accountability established. The next 25 years will see an improvement in the psychosocial care of patients, based on research that gives a scientific basis for interventions, and a reduction in the barriers to psychosocial care in cancer.
Clinical practice guidelines are increasingly being developed in medical settings to provide evidence-based recommendations to guide the clinical care of patients. The development of Clinical practice guidelines for the psychosocial care of patients with medical illness is a newer initiative, and more complex as the target audience includes health care professionals from diverse backgrounds. In Australia, the National Breast Cancer Centre and National Cancer Control Initiative have collaborated to develop Clinical practice guidelines for the psychosocial care of adults with cancer, funded by the Australian Government Department of Health and Ageing. This paper outlines the development of these guidelines in the international context, gives an overview of their content, and describes strategies for their implementation and evaluation.
The stresses and uncertainties of cancer can be overwhelming for families. The Family System Illness model offers a psychosocial map to address these challenges and to make the inevitable strains more manageable. It provides a set of terms and a common language within a framework that attends to the longitudinal, psychosocial pattern of a health condition within a multigenerational, life cycle, and belief system context. Such a psychosocial framework can facilitate collaborative, effective coping and adaptation, thereby enhancing the quality of life for families affected by cancer. The model's utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings.
