Sustaining factors, rewards, and challenges for psychologists providing clinical care in psycho-oncology.

OBJECTIVE: Many who choose to work in oncology manage an ongoing tension-the work is rewarding, yet simultaneously challenging. Given the need for psychosocial professionals to provide treatment for the increasing number of cancer survivors in our aging society, it is important to consider what helps and hinders professionals in their work. Therefore, this study sought to understand the work experiences of psychologists working in psycho-oncology, specifically clarifying the rewards and challenges they experience as a result of their occupation. METHODS: Twenty psychologists with oncology work experience in the United States completed semi-structured interviews; data were analyzed using the Consensual Qualitative Research method. RESULTS: In this paper, findings are presented for two of the domains that emerged from the data. In the domain of Sustaining Factors and Rewards, six themes were identified: (a) making a difference, (b) personal impact of the work on psychologists' lives and personal enrichment, (c) sense of purpose and fit with the work, (d) important relationships, (e) unique aspects of psycho-oncology, and (f) benefits derived from the workplace. In the domain of Challenges, five themes were identified: (a) job-related challenges, (b) emotional intensity, (c) financial challenges, (d) ambiguity in professional roles and psycho-oncology, and (e) ethical dilemmas. CONCLUSION: Psychologists employed in psycho-oncology found great meaning and purpose in their jobs, but also struggled with challenges related to the work and their workplaces. These findings can lead to better training, supervision, retention initiatives, and administrative policies to support productive employees.

You Can Only Go Full Speed for So Long: The Career Development of Psychologists Working in Psychosocial Oncology Settings.

Cancer centers have adopted a holistic approach to cancer treatment to better meet the psychosocial needs of cancer survivors. However, the current number of psychosocial providers in oncology is inadequate to meet the growing demand and psychosocial providers may face barriers in accessing oncology-specific training. The current study aims to explore the career development of psychologists working in oncology to inform training and workplace supports, as well as to inform training for health psychologists interested in other sub-specialties. Interviews were conducted with 20 psychologists with oncology work experience. Data were analyzed using the consensual qualitative research method. Results indicated three primary domains: (a) factors influencing entry into the field, (b) factors influencing ongoing career decision-making, and (c) factors influencing success in psychosocial oncology. The complexities of these domains are discussed; suggestions for supporting psychologists interested in psychosocial oncology at individual as well as systemic levels are provided.

Cancer-related hair loss: a selective review of the alopecia research literature.

OBJECTIVE: Alopecia is a common side effect of cancer treatment, affecting approximately 65% of patients. Healthcare providers and allied staff recognize that alopecia is distressing for people with cancer; however, they are often unaware of the extent of distress or the great efforts expended by patients to cope with hair loss. This study reviews the existing literature regarding the psychosocial impact of alopecia on cancer survivors and the coping strategies they use to manage hair loss. METHODS: We searched for studies examining the psychosocial effects of alopecia on cancer survivors using PubMed and PsycInfo databases and Google Scholar. RESULTS: A total of 36 peer-reviewed articles were deemed relevant to be included in this review. In this review, alopecia was consistently ranked as one of the most distressing side effects of cancer treatment. Survivors report that hair loss disrupts how they experience their bodies, interact with others, and conceptualize their body image beyond treatment. Although upsetting for both genders, the scarce literature that exists suggests that there may be some gender-specific aspects of experiencing cancer-related hair loss. Cancer survivors cope with alopecia in numerous ways and often rely on strategies such as concealment, social support, social avoidance, information seeking, and behavioral rehearsal. CONCLUSIONS: Treatment-induced alopecia negatively affects millions of survivors each year in unique and nuanced ways. We hope that survivors' healthcare providers and loved ones may better appreciate the psychosocial challenges they experience related to hair loss, as well as the strategies they use to cope. Further research is much needed to better understand cancer-related alopecia. Copyright © 2015 John Wiley & Sons, Ltd.

Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers.

OBJECTIVE: The National Comprehensive Cancer Network (NCCN) is comprised of 25 National Cancer Institute-designated cancer centers and arguably could thus set the standard for optimal psychosocial staffing for cancer centers; therefore, information was sought from NCCN Member Institutions about their current staffing for psychosocial services. These findings are put into perspective given the limited existing literature and consensus reports. METHODS: The NCCN Best Practices Committee surveyed member institutions about their staffing for psychosocial services. The survey was administered electronically in the winter of 2012. RESULTS: The survey was completed by 20 cancer centers. Across institutions, case managers and mental health therapists, typically social workers, were utilized most frequently to provide psychosocial services (67% of full-time-equivalents (FTEs)), with other psychosocial professionals also represented but less consistently. Most psychosocial services are institutionally funded (ranging from 64 to 100%), although additional sources of support include fee for service and grant funding. Training of psychosocial providers is unevenly distributed across responding sites, ranging from 92% of institutions having training programs for psychiatrists to 36% having training programs for mental health therapists. CONCLUSIONS: There was variability among the institutions in terms of patient volume, psychosocial services provided, and psychosocial staff employed. As accreditation standards are implemented that provide impetus for psychosocial services in oncology, it is hoped that greater clarity will develop concerning staffing for psychosocial services and uptake of these services by patients with cancer.

Resilience in adults with cancer: development of a conceptual model.

OBJECTIVE: Resilience is a construct addressed in the psycho-oncology literature and is especially relevant to cancer survivorship. The purpose of this paper is to propose a model for resilience that is specific to adults diagnosed with cancer. METHODS: To establish the proposed model, a brief review of the various definitions of resilience and of the resilience literature in oncology is provided. RESULTS: The proposed model includes baseline attributes (personal and environmental) which impact how an individual responds to an adverse event, which in this paper is cancer-related. The survivor has an initial response that fits somewhere on the distress-resilience continuum; however, post-cancer experiences (and interventions) can modify the initial response through a process of recalibration. CONCLUSIONS: The literature reviewed indicates that resilience is a common response to cancer diagnosis or treatment. The proposed model supports the view of resilience as both an outcome and a dynamic process. Given the process of recalibration, a discussion is provided of interventions that might facilitate resilience in adults with cancer.

Group therapy among OEF/OIF veterans: treatment barriers and preferences.

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) combat Veterans are at risk for developing post-traumatic stress disorder (PTSD). Many are seeking treatment from the Veterans Health Administration; yet, it is an ongoing challenge to engage some Veterans in sustained mental health services, especially group therapy for PTSD. This pilot study assessed OEF/OIF Veterans' prior use of mental health treatment and perceived barriers to and interest in group therapy for PTSD using a survey distributed in one outpatient OEF/OIF PTSD specialty clinic in the Midwest. The 110 OEF/OIF Veterans reported experience with a range of mental health treatment services and most frequently identified perceptions of the group process to be barriers to engaging in group therapy. Specifically, OEF/OIF Veterans endorsed concerns about taking part in a group, expressing emotions, being misunderstood, and disliking the group composition. A clear preference for individual over group therapy for PTSD treatment was reported with 57% reporting disinterest in group therapy. Data suggest that Veterans are apprehensive about taking part in group therapy for PTSD. Awareness of barriers and treatment preferences can inform clinical practice and aid in developing patient-centered Veterans Health Administration services.

Perspectives of postdoctoral fellows: A qualitative study of clinical supervision in psycho-oncology.

Given the prevalence and distress associated with a cancer diagnosis, the training of psycho-oncology providers to meet the mental health needs of cancer survivors warrants investigation. Clinical supervision is a key teaching strategy for psychology trainees, particularly during a postdoctoral fellowship when trainees are gaining specialized training and making important career decisions. This qualitative study examined how postdoctoral fellows in psycho-oncology used clinical supervision and the supervisory relationship for their personal and professional development. Interviews were conducted with 10 postdoctoral trainees in the United States; data were analyzed using consensual qualitative research methodology. Five themes emerged from the data: supervisees' learning experiences in supervision, foundations and features of support derived from supervision, ethical and social issues, unmet needs in current supervision, and strategies to enhance future supervision. Supervision was a space to learn about leadership and supervisory skills, professional identity, career preferences, multidisciplinary teamwork, knowledge about cancer, emotional responses, self-care practices, ethical dilemmas, social and cultural issues, and power dynamics. Participants also shared needs that were not met in supervision, which included both missed content (e.g., professional development issues and clinical concerns) and constraints of the supervisory relationship. Drawing on the study findings, recommendations are made to enhance the supervisory relationship for both trainees and supervisors in psycho-oncology and to ensure clinicians can thrive while competently and compassionately working with cancer survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Fruit and vegetable dietary behavior in response to a low-intensity dietary intervention: the rural physician cancer prevention project.

CONTEXT: Increased fruit and vegetable intake can reduce cancer risk. Information from this study contributes to research exploring health disparities in high-risk dietary behavior. PURPOSE: Changes in fruit and vegetable behavior were evaluated to assess the effects of a low-intensity, physician-endorsed dietary intervention in a rural population. METHODS: The study was a randomized trial of 754 patients from 3 physician practices in rural Virginia. Low-literacy nutrition education materials and personalized dietary feedback were administered by mail and telephone. Mixed model analysis of variance was used to determine the effect of the intervention on fruit and vegetable intake behavior, knowledge, intentions, and self-efficacy at 1, 6, and 12 months. FINDINGS: The intervention effect was moderated by age, race, sex, and education. Intake at 1 and 6 months was increased for older and younger participants and those with some college, and further maintained at 12 months by those who did not complete high school. African Americans in the intervention group displayed significantly greater intentions to increase fruit/vegetable intake than whites/others. Knowledge of fruit/vegetable recommendations significantly increased in the intervention group at 12 months, particularly for men. CONCLUSIONS: For the rural population, a low-intensity physician-endorsed self-help dietary intervention was successful in initiating fruit and vegetable dietary changes at 1 and 6 months post-intervention, and increasing intentions to change in African Americans. The relationship of the moderating effects of age, race, sex and education need to be further explored in relation to dietary intervention and dietary behavior change for the rural population.