WK 10 Discussion SOCW 8205: Psychosocial Aspects of Cancer
WK 10 Discussion SOCW 8205: Psychosocial Aspects of Cancer
Cancer is often synonymous with fear, uncertainty, and death. A diagnosis of cancer begins a long journey that affects physical health, mental well-being, and relationships with loved ones. Although cancer care today often provides advanced medical treatment, psychosocial issues may not be adequately addressed (Artherholt & Fann, 2012). This failure may compromise the effectiveness of overall cancer management.
Oncology social workers play an integral role in cancer care in multiple settings. It is common for oncology social workers to engage in individual, family, and group intervention. In addition to providing direct patient care, oncology social workers provide valuable public health interventions, such as health education programs and policymaking.
To prepare for this Discussion:
Review this weeks resources. Select one of the many different types of cancer and think about the overall impact of the disease. Consider the psychosocial effects of cancer. How might the cancer affect the health and well-being of an individual and caregivers?
Questions in bold then answers 300 to 500 words
Post an explanation of how this type of cancer might affect the health and well-being of the patient and caregivers.
Explain the psychosocial effects of the cancer on the patient and caregivers.
Explain how psychosocial factors might impact a treatment care plan and the management of the disease.
Finally, explain how you might address the psychosocial needs of a cancer patient and caregiver.
Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.
Resources
Beder, J. (2006). Hospital social work: The interface of medicine and caring. New York, NY: Routledge.
Chapter 8, Oncology Social Work with Adults (pp. 8194)
Gehlert, S., & Browne, T. (Eds.). (2019). Handbook of health social work (3rd ed.). Hoboken, NJ: Wiley.
Chapter 19, Oncology Social Work (pp. 440-458)
An Uninvited Guest: Addressing Students Death
Anxiety in Oncology Social Work Field
Placements
Meuche, Glenn . Field Educator ; Boston Vol.7,Iss.1, (Spring 2017).
ProQuest document link
ABSTRACT (ENGLISH)
Field placements present a wide breadth of challenges that afford students fertile ground to refine their clinical
skills of active listening, engagement, and relationship. The inclusion of a curriculum that encourages self-
reflection and centers on students attitudes and beliefs surrounding end-of-life care has a positive influence and
direct correlation to their comfort level and openness to speaking with their clients about death and dying. The
supervisory relationship has been heralded as the cornerstone in the development of effective clinicians and as
the quintessential learning experience for the clinician, the foundation of students educational growth and
development, and the therapeutic alliance in which supervisees develop their own style. (Sormanti, 1994, p. 75)
Death anxiety and unfamiliarity with regard to skills that are solicited in oncology social work and end-of-life care
may account for students difficulty in recognizing the clinical dimension of these field placements. The clinical
skills employed in oncology social work placements are unique and often different from interventions used for
instance, in mental health venues. Students discover themselves struggling with the clinical skills of the capacity
to sit with the silence and offer the gift of presence in end-of-life care. Curricula that include discussions about
the psychology of illness, including defenses and their usefulness in helping people adapt to the many anxieties
raised by severe and life-threatening illnesses, would prepare students better for oncology placements (Sormanti,
1994, p. 84). Bridging the academic component with the affective dimension of social work practice is integral to
the development of clinical acuity…
FULL TEXT
Social work student internships are an indispensable ingredient in the formation of students professional identity.
Field placements present a wide breadth of challenges that afford students fertile ground to refine their clinical
skills of active listening, engagement, and relationship. The issues that are addressed by students specializing in
psychosocial oncology and end-of-life care are unique. Students in these field placements are not only confronted
by their clients dying and death, but forced simultaneously to reconcile themselves to their own mortality as well.
Why, you may ask, take on this unpleasant, frightening subject? Why stare into the sun? Why grapple with the most
terrible, the darkest and most unchangeable aspect of life? [] Death [] is always with us, scratching at some
inner door, whirring softly, barely audibly, just under the membrane of consciousness. (Yalom, 2008, p. 9)
Death is an inescapable mortal wound that everyone experiences. Engaging with those who are dying is not an
isolated event, but instead, a collective experience. Dying is a relational event, and the clinician cannot be neutral,
absent, or objective (Berzoff, 2008, p. 182). The realization of death can become a wellspring, therefore, for
opportunity and growth. Its inevitability provides the impetus for us to engage with others in personal and intimate
ways.
Although the universality of death has the potential to connect human beings to one another on a deeper level, it
can lend itself to an existential crisis and heightened experience of death anxiety. Anxiety surrounding death
references the perceived amount of emotional distress provoked by the anticipated total nonexistence of the self
(Hui, Bond, &Ng, 2007, p. 200). Fear of death repeatedly is the pink elephant in the room. Its presence is palpable
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and yet it often remains unspoken. Death anxiety can range from a fear of ego-dissolution and annihilation to fear
of the dead. It may reveal itself in anxiety over the process of dying and fear of the unknown. Field instructors can
help students embrace these fears, reframe them, and understand how death anxiety can enhance the therapeutic
relationship and their capacity to share in the suffering of the other.
Clinically, the experience of death anxiety may contribute to students difficulty in establishing alliances and
facilitating rapport with their clients. The fear of death for instance, can manifest itself in students reticence in
initiating dialogue with their clients and sharing in meaningful conversation pertinent to death and dying. Students
may attempt to change the subject because of concern over upsetting their clients or engage in positive thinking
or reframing of their clients experience. In its worse scenario, death anxiety may translate to an avoidance of the
person who is at the end-of-life.
Professionals in end-of-life care have directed their attention to social work education and criticized the absence of
adequate training at times within the arena of death, dying, and loss. Social work educators and clinicians have
repeatedly pointed out the need for social work curricula to place more emphasis on social workers attitudes
toward death, dying and bereavement (McClatchey &King, 2015, p. 347). The inclusion of a curriculum that
encourages self-reflection and centers on students attitudes and beliefs surrounding end-of-life care has a
positive influence and direct correlation to their comfort level and openness to speaking with their clients about
death and dying.
The importance of death education to impart content knowledge about the death process and gaining insight into
the death attitudes of helping professionals has been emphasized by students, practitioners, educators, and
ethicists. It is clear there is a near universal agreement on the need for the inclusion of death education in the
training of helping professionals. (McClatchey &King, 2015, p. 346)
Therefore, it is critical that field placements situate emphasis on the experiential as well as the academic and
clinical component. Supervisors can encourage introspection and help student interns begin the process of
examining their insecurities and vulnerabilities pertaining to death, dying, and loss. This, however, would also
require field instructors to exhibit a willingness to recognize and connect with their own death anxiety and the
manner in which this impacts and directs their clinical work. Students not only model the clinical skills we impart
to them, but also with their clients they mirror the supervisory experience.
The supervisory relationship has been heralded as the cornerstone in the development of effective clinicians and
as the quintessential learning experience for the clinician, the foundation of students educational growth and
development, and the therapeutic alliance in which supervisees develop their own style. (Sormanti, 1994, p. 75)
Death anxiety and unfamiliarity with regard to skills that are solicited in oncology social work and end-of-life care
may account for students difficulty in recognizing the clinical dimension of these field placements. Students
sometimes expressed concern that an oncology setting is not clinical enough and that they feel they cannot apply
what they are learning in social work classes to their fieldwork (Sormanti, 1994, p. 80). The clinical skills employed
in oncology social work placements are unique and often different from interventions used for instance, in mental
health venues. Students describe clinical work as treatments with patients who can be labeled with a []
diagnosis and as work that can be done in an office setting in 50-minute hours under a mutually agreed-on client-
worker contract (Sormanti, 1994, p. 80). Students discover themselves struggling with the clinical skills of the
capacity to sit with the silence and offer the gift of presence in end-of-life care. Many students are uncomfortable
with emotionality, in part related to their own histories, but also because they may not know how to sit with it or
what to do with it professionally (Urdang, 2010, p. 531). Students discomfort with these skills may preclude their
ability to establish and foster therapeutic relationships with those who are dying. Beginning where the person is
entails the recognition of the innateness of suffering in the human condition and readiness, therefore, to begin
where death and dying are. Being present means tolerating ones own anxiety about death in order to be able to
help clients and families to tolerate their own (Berzoff, 2008, p.179).
The following excerpt illustrates the discomfort that students experience. S was a student intern working with a
woman whose husband was diagnosed with stage IV metastatic pancreatic cancer. Her husbands prognosis was
poor and although death was present, it nonetheless remained the pink elephant as the student was reticent in
opening the door. In addition to feeling confused and frightened by the prospect of her husbands dying and death,
Ss client also articulated struggling with anger over which she subsequently experienced guilt.
Student: I see. Its good that youre reaching out to us. Were here to listen. So I understand that hes receiving
treatment for his pneumonia? How did that go?
Client: Hes doing well. Hes already back at home. Next month Im going to meet with the oncologist. They said he
still has a 4mm tumor left. They shrank it down from 6mm. Theyre talking about putting him on additional
chemotherapy to shrink the rest. He may even undergo a clinical trial. But my husband, he doesnt want to. He said
his body is not able to handle it right now. And I dont blame him. I wont force him to go back. But Im sure he will
change his mind once he talks to the doctor.
Student: Chemo must have been rough for him.
Client: Yeah it was. You know, he lost all of his hair. When it first started, he would just put his hand through his
hair and a bunch of hair could come out. He decided to shave it all off. Now he wants to wear hats. I always joke
with him and use humor to keep me positive.
Student: Thats admirable. Using humor is a very creative and effective way to cope. Im glad youre able to stay
positive through all this.
Client: But, you know, I also get angry over all this as well. It just isnt fair what is happening to him. And then I feel
guilty for feeling this way. Its hard sometimes.
Student: I understand that you and your husband moved recently?
Client: Yeah, I mean our families are here so there are always people checking in on us.
Student: Im glad to hear that you have supportive people around you to help you cope with your husbands
diagnosis.
Client: I wont give up. I always know that God is out there looking out for me and my mother in heaven is looking
down on me.
In reflecting upon what transpired in the session, S was uncertain as to whether or not attention should center on
anticipatory loss or, instead, the clients anger and guilt. The student writes, It seems like the client wanted a place
to vent her worries that she cannot share with her husband. She mentioned feeling angry and that this might
perhaps be a goal for her to work on. I did not dwell on it further as our time was up and I was not sure if the anger
has anything to do with the cancer. However, this is a topic that can be clarified and possibly pursued if it
surrounds her husbands cancer. Maybe I should go over goal setting with her instead of letting her vent? Even
though her initial request for counseling was simply to have someone to talk to how do I shape this into a more
structured and organized discussion?
The establishment of the therapeutic relationship is an integral aspect of oncology social work and end-of-life care.
Students discover themselves struggling at times with use of self and what they should disclose and reveal to
clients within the session. Many students, for instance, who herald from mental health settings, are dissuaded
from engaging in self-disclosure.
Several supervisors shared stories about students who were afraid to acknowledge that they used interventions
such as physical contact and sharing of personal information, which the supervisors believed was appropriate to
use, but students were discouraged from doing so in class. (Sormanti, 1994, p. 80)
Field instructors can respond to students concerns by helping them feel more comfortable with the clinical skills
that are encompassed in their work with the dying. Helping students develop the art of presence and encouraging
deep listening will enable them to interact with their clients in rich and profoundly empathic ways. In attempting to
transcend narratives that have been solely reduced to clinical technique, Frank (1998) suggests that:
The deeply ill person is the immediately needy one, and this persons story deserves primary attention. Clinicians
may share parts of their own stories, but they do so in response to the ill persons story. Reciprocity is sustained in
the appreciation with which the clinician receives the patients stories. To give the gift of listening is to appreciate
receiving the gift of a story. Not just understanding this reciprocity but embracing it seems to me to be the
beginning of clinical work. (p. 200)
Oncology social work and end-of-life care are emotionally laden field placements and students may feel
overwhelmed and stressed by continually witnessing their clients suffering. The intensity and range of emotions
that are articulated by clients can instill feelings of impotency in students. Field instructors have indicated an array
of challenges oncology social work presents to students and have underscored several factors that can contribute
to the complexity of supervising interns in these settings. The most notable influences on students are:
[] constant confrontation with loss, dying, and death; exposure to physical mutilation and pain; negotiation
between social worker and clients of intense affective responses over a long period; immediate and strong
countertransference reactions; helplessness and frustration at ultimately being unable to save patients; and use of
a less restricted, unconventional set of boundaries. (Sormanti, 1994, p. 78)
Students may discover they are unprepared for this work and field placements sometimes lack the support that is
necessary to assuage the risk of vicarious trauma and compassion fatigue. Supervision, therefore, becomes more
complicated and field instructors may assume greater responsibility with regards to addressing their students
needs.
Encouraging self-reflection among students can prove beneficial in promoting professional growth and
competency. The creation of a secure environment where students are able to engage in introspection is
paramount to developing insight into their beliefs and values surrounding death, dying, and end-of-life care.
Students need educational support and direction to deepen their capacity to develop a professional self, including
an ability to recognize, understand, and utilize their feelings and insights on behalf of their clients (Urdang, 2010,
p. 532). Working in oncology social work can become a potential battleground. A venue where students can
process the clinical work and address countertransference may help to mitigate the risk for burnout.
CancerCares student internship program acknowledges the significance of individual supervision and student
peer support groups as crucial in strengthening students resilience and enabling them to address the needs and
concerns of their clients who are living with cancer or may be at the end-of-life. Social work professionals have
emphasized the role of intersubjectivity in the therapeutic relationship, especially as it pertains to transference and
countertransference. Urdang (2010) has issued a call for process oriented clinical work and states that:
Students need to understand the interactional nature of work with clients, how to process this internally, and, when
appropriate, directly with clients; they first must learn how to process basic interview crunches before they can
move on to more intense crunches [] from clients. (p. 532)
Utilizing process recordings, for instance, not only serves as a vital tool in promoting self-reflection but elucidates
conscious as well as unconscious interpersonal dynamics between the student and client.
Recognizing the importance of death education in abating the impact of death anxiety, CancerCare has
established Lets Talk about Death round-table discussions.
Helping those coping with death, dying, and bereavement can provoke confusing and frightening existential
questions and painful feelings of personal loss. Coming to terms with death involves both internal and
interpersonal processes that are influenced by individual and societal death attitudes. These attitudes profoundly
influence how one copes with death on an up close and personal level as well as an abstract and complex
concept. (McClatchey &King, 2015, p. 345)
In these discussions, students are afforded an opportunity to share and process feelings and fears they may
harbor surrounding death and dying. In addition, CancerCare offers a variety of in-service programs that are
designed to expand students comprehension of cancer, treatment, and loss. Curricula that include discussions
about the psychology of illness, including defenses and their usefulness in helping people adapt to the many
anxieties raised by severe and life-threatening illnesses, would prepare students better for oncology placements
(Sormanti, 1994, p. 84). Bridging the academic component with the affective dimension of social work practice is
integral to the development of clinical acuity in oncology social work and end-of-life care. It is imperative that
[students] are not only knowledgeable about the dying process but also feel a certain comfort level working with
this population and have increased insight into their personal attitudes and feelings about death, dying, and
bereavement (McClatchey &King, 2015, p. 358).
Although death is an uninvited guest and is often depicted metaphorically as the Grim Reaper, it also has the
potential of opening doors to greater interiority and increasing the depth of human relationships. R, a second-year
student in CancerCares internship program, reflects:
The internship definitely guided me to raising self-awareness and comfort when having the conversation of death
and dying with others. There seemed to have been emphasis on meeting the clients where they are in their journey
– which I think is unique as CancerCare encourages this. I felt that the topic of death is very abstract and looking
back at my experience, CancerCare seems to be open-minded and supportive in this area.
Students working in oncology social work field placements may find their clinical skills challenged by death
anxiety. Supportive field instructors who are sensitive to the impact of death anxiety on students can help
ameliorate their fear of dying. Students will then become empowered and can begin the process of embracing the
challenge in order to enhance their connection to clients who may be at the end-of-life.
References
Berzoff, J. (2008). Working at the end of life: Providing clinically based psychosocial care. Clinical Social Work
Journal, 36(2), 177-184. doi:10.1007/s10615-007-0119-z
Frank, A. W. (1998). Just listening: Narrative and deep illness. Families, Systems &Health, 16(3), 197-212.
doi:10.1037/h0089849
Hui, V. K., Bond, M. H., &Ng, T. S. W. (2007). General beliefs about the world as defense mechanisms against death
anxiety. OMEGA: Journal of Death and Dying, 54(3), 199-214. doi:10.2190/8NQ6-1420-4347-H1G1
McClatchey, I. S., &King, S. (2015). The impact of death education on fear of death and death anxiety among
human services students. OMEGA: Journal of Death and Dying, 71(4), 343-361. doi:10.1177/0030222815572606
Sormanti, M. (1994). Fieldwork instruction in oncology social work: Supervisory issues. Journal of Psychosocial
Oncology, 12(3), 73-87. doi:10.1300/J077V12N03_05
Urdang, E. (2010). Awareness of self-A critical tool. Social Work Education, 29(5), 523-538. doi:
10.1080/02615470903164950
Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA: Jossey-Bass.
DETAILS
Subject: Internships; Students; Fear &phobias; Curricula; Palliative care; Anxieties; Oncology;
Social work; Professionals; Attitudes; Education; Learning; Field study; Death &dying
Publication title: Field Educator; Boston
Volume: 7
Issue: 1
Publication year: 2017
Publication date: Spring 2017
Publisher: Simmons College
Place of publication: Boston
Country of publication: United States, Boston
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An Uninvited Guest: Addressing Students Death Anxiety in Oncology Social Work Field Placements d
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Oncology Social Work in
Palliative Care
W
ith regard to cancer, two facts are clear: cancer is the second
leading cause of death in the USA,1 and the consequences of
unmet psychosocial needs for those with terminal cancer have
evastating consequences for quality of life experienced.2 The medical
iterature on this topic recognizes the importance of addressing these
eeds and recommends that the education and training for oncologists
nclude skills necessary for assessing and handling psychosocial issues.3-5
This body of literature, however, does not address the importance of
oncologists understanding the role of the oncology social worker, whose
training and experience is focused exclusively on insuring that the psycho-
social needs of individuals diagnosed with cancer are addressed. The
oncology social worker is an important resource for oncologists, whose time
allotted to patients is often focused out of necessity on medical issues and
less on psychosocial needs. As the number of palliative care teams
continues to grow, oncologists and oncology social workers will increas-
ingly find themselves working together. If the team is to address
holistically the needs of individuals with cancer, capitalizing on the social
workers expertise and skills will be crucial.
This article seeks to heighten the awareness and understanding of
oncology social work, as well as the contribution this profession can make
to oncologists and other members of the palliative care team. First, the
reported psychosocial needs of cancer patients and their families are
discussed. Next, the skills, knowledge, and theoretical approaches a social
worker uses to meet those needs are detailed. Finally, the relationship
between oncology social workers and the oncologists with whom they
work daily is addressed. It is hoped that the information provided in this
article will result in an increased recognition of what oncology social
work has to offer individuals grappling with the devastating effects of
cancer, and to the oncologists who work to provide these individuals with
quality care.
Curr Probl Cancer 2011;35:357-364.
0147-0272/$34.00 0
doi:10.1016/j.currproblcancer.2011.10.010
Curr Probl Cancer, November/December 2011 357
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sychosocial Needs of Patients Diagnosed with
erminal Cancer
Much has been written about the psychosocial needs of individuals
iagnosed with terminal diseases, many of whom had a cancer diagnosis.
ne line of research that has contributed a great deal of insight into the
sychosocial needs of individuals at the end of life is the study of the
actors that motivate individuals diagnosed with cancer and other terminal
llnesses to consider a hastened death.
Research has been conducted both retrospectively with health care
rofessionals and family members and prospectively with terminally ill
ndividuals. In regard to the retrospective reporting, individuals who
ought a hastened death were motivated by psychosocial factors, such as
ack of enjoyment in life,6 loss of control,6,7 fear of future pain,6,8 loss of
eaning in life,9 feelings of being a burden,6,9 and loss of dignity6,9 and
utonomy.6 Prospectively, terminally ill individuals, many of whom were
iagnosed with cancer, reported the same psychosocial factors as those
eported retrospectively, as well as others. In regard to social support,
ndividuals reported having few social supports,10,11 a lower quality of
ocial support,10,12,13 conflictual social support,11 low satisfaction with
ocial support,14 and a lack of social support.15 In addition to social
upport needs, individuals also reported anxiety,12 depression,12,13 a lack
f enjoyment in life, feelings of being a burden and useless,16 and a lack
f control.16
Studies focused solely on cancer patients have also found psychosocial
eeds to be prevalent. In a large study of oncologists, 72% reported that
heir patients experienced psychosocial distress over issues that included
ogistics, coping with their illness and treatment, and addressing the
oncerns of their partner and children.17 In a qualitative study, researchers
nterviewed young adults diagnosed with cancer, who reported experi-
nces with emotional distress and a lack of social support.18 Researchers
onducted a review of studies on depression and cancer and discovered
vidence that depression can make coping with cancer more difficult, and
t can negatively affect immune functions.19 A major study of 4500
atients diagnosed with cancer found that 35% reported experiencing
sychological distress, and this distress was greatest for respondents
hose cancer had a poor prognosis.20 In another study, fatigue, a key
ymptom of cancer, was found to be correlated with depression.21 Finally,
n a systematic review of 94 studies conducted on the prevalence of unmet
sychosocial needs, such needs were determined to be present both during
nd after cancer treatment.22
58 Curr Probl Cancer, November/December 2011
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ypes and Times
In studies of individuals diagnosed with cancer, evidence has been
ound concerning the psychosocial distress associated with a particular
uncture in the cancer journey or with a particular type of cancer. In a
ualitative study of 96 terminally ill elders, 15 reported 4 critical events
n their dying process that resulted in psychosocial suffering: two-thirds
f these individuals were diagnosed with cancer.23 These 4 events
ncluded being given a terminal diagnosis in what was perceived of as an
nsensitive and uncaring manner; suffering unbearable and untreated
hysical pain; not addressing the feelings individuals had about having to
eceive chemotherapy or radiation treatment; and receiving care in a
tressful environment. Concerning types of cancer, researchers have
ound that persons with lung cancer had a significantly high risk of
xperiencing psychosocial problems, such as depression and anxiety,
fter both diagnosis and treatment.24 Forty-seven percent of 236 newly
iagnosed breast cancer patients were determined to have experienced
igh levels of distress resulting from worry, nervousness, and depres-
ion.25
Knowledge of the types of psychosocial issues experienced by individ-
als diagnosed with cancer, as well as particular times of vulnerability
nd cancers that may put people at higher risk of psychological distress,
s key to determining how best to intervene and address such issues.
onsistently, authors of these studies point out the need for psychological
creening and early intervention,16,20,25 particularly at the time of
iagnosis.24 Researchers also agree on the need for more research to
efine current assessment procedures and develop interventions that
ddress more effectively emotional distress in individuals diagnosed with
ancer. Both assessment of psychosocial issues and intervention are the
ey areas of expertise possessed by trained oncology social workers.
ncology Social Work
The main providers of psychosocial services in cancer centers and
ealth care settings in the community are oncology social workers.26
hese professionals possess significant knowledge of cancer, the resulting
sychosocial issues, and the intervention strategies for addressing such
ssues.
The training and skills provided to social workers through their graduate
ducation makes them uniquely suited to work with cancer patients. First,
he social work profession is distinctive in its use of a person-in-
nvironment approach, which takes note of the reciprocal relationship
urr Probl Cancer, November/December 2011 359
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etween the person and his or her environment, and how he or she is
nfluenced by interactions with the environment. Social workers view
ndividuals as being dynamically involved with systems in the environ-
ent that include family, friends, work, social service organizations,
eligions, health care, educational, government, and culture, to name a
ew. The person in his or her environment is a whole in which the person
nd the situation are both cause
