Clinical Programs in the Department of Supportive Care - Psychosocial Oncology
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Transcript of Clinical Programs in the Department of Supportive Care - Psychosocial Oncology
Psychosocial Oncology
Madeline Li, MD PhD
Psychiatrist, Department of Supportive Care
Department of Supportive Care
Department of Medical Oncology
Department of Radiation Oncology
Department of Surgical Oncology
Supportive CareSupportive Care
grief &bereavement
anti-cancertreatments
Longitudinal & Integrated Cancer Care
Cancer Risk
Diagnosis
Supportive Care
CAPO Definition of PSO“Psychosocial Oncology is a professional sub-specialty in oncology. The domain of psychosocial oncology includes the formal study, understanding and treatment of the social, psychological, emotional, spiritual, quality of life and functional aspects of cancer as applied across the cancer trajectory from prevention through bereavement. It seeks to develop and integrate new knowledge and techniques of the psychosocial and biomedical sciences as it relates to cancer care”
CCO Multidisciplinary PSO Team
PsychosocialOncology
PsychosocialOncology
Social Social WorkWork
PsychiatryPsychiatry
RegisteredRegisteredDieticiansDieticians
PsychologyPsychology Advanced Advanced Practice Practice
NurseNurse
Speech and Speech and Language Language
PathologistsPathologists
Rehabilitation Rehabilitation SpecialistsSpecialists
OncologistsOncologists
Volunteer Volunteer ServicesServices
Spiritual Spiritual CareCare
Fitch MI. Providing supportive care. In: Supportive Care Framework: A Foundation for Person-Centred Care. Pembroke (ON): Pappin Communications; 2008. p. 23–24.
Princess Margaret Princess Margaret Psychosocial Psychosocial
OncologyOncologyResearch
Ambulatory Services
Children & Family Support Services
HBB Volunteer Support Program
In-patient Services
Education
• ~1200 referrals/year• Routine distress screening• Individual, marital, family and group-based support
Importance of Psychosocial Care
Severe psychosocial distress is associated with:
– Poor quality of life
– Distress in family caregivers and children
– Desire for hastened death/request for medical assistance in dying
– Worse patient satisfaction with care
– Less treatment compliance
– Greater health care utilization
– Increased mortality independent of medical variables
Distress Assessment and Response Tool: DART
• Screens for– physical symptoms (ESAS)– depression (PHQ-9)– anxiety (GAD-7)– social difficulties (SDI)
• Computerized survey completed by patients in oncology clinics at diagnosis and every 2-3 months
• Intelligently programmed to minimize patient burden• Clinical decision support tool on clinician output to facilitate
PSO referral• Customized with additional patient reported outcome
measures in select tumour sites
Ambulatory/Inpatient Services• Individual and couple outpatient care (psychiatry,
psychology, social work)• Inpatient consult service• Group Interventions (MBCT, iREST)• Tailored treatment (AYA, cancer geriatrics,
neurocognition)• Targeted treatment (CALM, EASI, ASURE)• Music Therapy• UHN MAID
• Screening and selection of volunteers• Specialized training program• Supervision and collaboration with professional staff• Multiple functions
– Clinic-based support– Navigators– Group interventions
• 150 new volunteers trained • Research program evaluating selection and training process and outcomes
Healing Beyond the Body Volunteer Support Program
Family Centered Care
Magic Castle• Therapeutic play
program for children with cancer undergoing radiotherapy and for children whose parents are receiving cancer treatment at PM
Research Program
Research Research TeamsTeams
Quality of LifeQuality of Life
Pain & SymptomPain & SymptomControlControl
Adjustment to Adjustment to Advanced Disease Advanced Disease
and End of Lifeand End of Life
Genetic RiskGenetic Risk
Neurocognitive Neurocognitive Effects/SurvivorshipEffects/Survivorship
Health ServicesHealth Services
Educational Program• Psychiatry residents, social work
students and psychology practicum rotations
• Seminar Program– Grand Rounds– Pain & Symptom Management– Manuscript Review – Research Development– Research in Progress– Palliative Psychiatry
• Elective undergraduate trainees• Fellowship program• Inter-professional education to
oncologists and nurses– Communication skills training– Distress management– PSO education for medical staff
“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
Psychosocial Oncology:
Tumour-centred care Person-centred care