Transcript Ethics and Social Work in Health Care

ONCOLOGY SOCIAL
WORK
Chapter 19
Handbook of
Health Social
Work, 2nd Edition
CHAPTER OBJECTIVES
Provide an introduction of cancer
epidemiology, treatment, and the
psychosocial, behavioral, and spiritual impact
of the disease on individuals and families.
Describe the history, conceptual foundations,
and functions of oncology social work in
general, and the field of psychosocial
oncology.
Describe the contributions of social work to
oncology research.
CHAPTER OBJECTIVES CONT.
 Define the scope of practice knowledge, skills,
and interventions that oncology social workers
use to assess and ameliorate psychosocial and
quality of life concerns.
 Address emerging issues in psychosocial
oncology including cancer survivorship, family
decision-making, genetic testing, and end-of-life
care.
 Present selected resources available for patient
education and support, and professional
development.
EPIDEMIOLOGY
Average American life span, 44% of men and
38% of women will develop some form of
cancer.
Cancer is an umbrella term for hundreds of
diseases characterized by uncontrollable
growth of abnormal cells in the body.
CANCER BY MEN AND WOMEN
Breast, Uterine, Colon and Rectum, and
Melanoma are the top leading cancers for
women.
Prostate, Colon and Rectum, Urinary bladder,
Melanoma and Non-Hodgkin Lymphoma are
the top leading cancers for men.
T YPES OF CANCER
Carcinoma is used to describe all cancers
especially the malignancies that originate in
the epithelial linings of organs.
Sarcomas affect bones, cartilage, muscle or
connective tissue.
Adenomas begins in the adrenal, pituitary,
and hormonal glands.
T YPES OF CANCER CONT.
Lymphomas are cancers of the lymphatic
system and affect the organs affiliated with
the immune system.
Leukemias are blood cancers that arise in the
bone marrow where stem cells mature and
travel through the bloodstream.
HEALTH DISPARITIES
 Health disparities are not full understand but they
likely reflect complex interactions.
 Such as: Biological, Social, and Behavioral factors.
 Includes: Genetic differences, exposure to environmental
toxins, and lack of access to good nutrition, preventive
screening, and health insurance (Link & Phelan, 1995;
Williams, 1997).
CANCER TREATMENT
Oncologists base treatments on type and
invasiveness of the disease, or its stage
in development.
Treatment may include some
combination of surgery, chemotherapy,
and radiation.
SPIRITUAL PRACTICES
An estimated 53-68% of all adults in the
U.S. have reported using prayer or
spiritual practices, naturopathic
supplements, breathing and relaxation
exercises, yoga, and chiropractic to
enhance their health (Richardson, et. al.,
2000; Tilden, Drach, & Tolle, 2004).
FUNDING
Public and Private funding for cancer research
and training began to increase once
treatments became more common.
Federal government established National
Cancer Institute in 1937.
American Society of Clinical Oncology to
increase public education about cancer
prevention.
SOCIAL WORK CONTRIBUTION
 Today social workers provide comprehensive
psychosocial assessment, case management, and
supportive individual, family, and group interventions
that help patients and their families navigate
medical systems, make use of community resources,
and attain optimal adjustment to the disease and
treatment (Hermann & Carter, 1994).
PSYCHOSOCIAL IMPACT
 Newly diagnosed patients experience a range of
emotions including fear, shock, uncertainty, and
grief.
 Many struggle to mobilize coping skills needed to
manage these emotions.
 Psychosocial stressors can undermine an individual’s
sense of self and self-worth, provoke fears and
anxieties, and test coping mechanisms, values, and
social support systems.
MENTAL ILLNESS
Individuals with cancer have higher rates of
mental illness than their peers.
Adjustment disorders, anxiety, depression,
and fatigue are the top disorders.
Depression is often under-diagnosed or viewed
by healthcare professionals as a “natural”
response to life-threatening disease (Spiegel,
1996).
CANCER AND THE FAMILY
• Disrupts family and social roles
• Causes emotional upheaval
• Hard to maintain normal family functioning
• Family caregivers provide the bulk of care for
patients particularly if young, elderly, or has
advanced cancer
FAMILY ADAPTATION AND DYNAMICS
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Communication
Flexibility
Mutuality
Cohesion
Family life state
Illness variables
Patients level of functioning
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Requires families to talk about things that they have little
or no experience in talking about.
CHILDREN AND ADOLESCENCE
 Interpret and experience illness and treatment dif ferently.
 Children with cancer often experience increase anxiety,
depression, social isolation and regression.
 Can impede normal developmental tasks, identity
development and building intimate friendships.
 Can interfere with exploration of sexual identities; an
estimated half of adolescent survivors of cancer feel
uncomfortable with the opposite sex and avoid dating
(Zebrack & Chesler, 2001).
LATER LIFE
•Older adults account for 77% of new cases.
•Older patients are more likely to die than those
younger than 65 years.
• Frailty is a condition defined by muscle weakness,
limited mobility, and fatigue.
•Older patients share many physical, psychological,
social, and spiritual concerns that shape their aging
and illness experiences, quality of life, and palliative
care needs .
LATER LIFE CONT.
 Fixed incomes and inadequate insurance benefits can limit an
older cancer patient’s access to the resources needed for coping
with treatment.
Common challenges include paying for treatment not covered
by Medicare, transportation to appointments, and needing
assistance in performing daily self care.
Older patients are frequently excluded from clinical trials
based solely on age.
Physicians may refrain from aggressive treatments under the
assumption that older patients cannot handle adverse ef fects.
SURVIVORSHIP
Outliving a life threatening condition requires managing long
term ef fects that can cause emotional distress, functional
limitations, and further chronic health problems.
Chronic conditions and side ef fects act as ongoing reminders
of the negative emotional experiences associated with cancer.
Childhood survivors frequently worry about recurrence and may
need support from parents and peer groups.
Learning disabilities can develop and may impede academic
progress, cause loss of self esteem, depression, anxiety, and
family problems.
As survivors become adults they become vulnerable to long
term treatment side ef fects and early mortality.
SOCIAL WORK ROLE
Oncology social work provide psychosocial support
that maximizes the health & functioning of individuals,
families, groups, & communities affected by cancer.
Social workers draw on the profession’s person -inenvironment perspective to treat “the whole person” in
the context of social & environmental factors that can
enhance or exacerbate the illness experience.
SCOPE AND FUNCTIONS
 Social workers intervene at multiple levels and across systems
to enhance patient care & quality of life.
Oncology social workers use a variety of interventions, &
provide a range of services from clinical case management to
intensive psychotherapy to meet the unique needs of cancer
patients & their families at dif ferent points on the cancer
continuum.
Traditionally, they primarily practice in inpatient & ambulatory
hospital settings, but the sub -specialty has grown to a range of
inpatient, outpatient settings, home health &hospice services,
community based cancer support programs, private practice and
community based mental health settings.
SUPPORT GROUPS
 Ef fective resource for cancer patients, caregivers, and other
family members to find answers to illness -related questions &
ameliorate psychosocial concerns.
 Helped to reduce social isolation and build social supports,
facilitate the sharing of emotional concerns, provide safe
places to exchange strategies for managing symptoms,
interacting with family members and healthcare providers.
 Groups can help to keep children and adolescents on track
developmentally, support overburdened and exhausted
parents, and provide continuity during chaotic or uncertain
transitions.
FAMILY
 Oncology social workers emphasize the family as a unit of
care
 Family -centered care engages family members as allies in
providing quality treatment, treats families with dignity &
respect, and helps patients and families make more informed
and consensual care decisions.
 Social workers help families to adapt to illness -related
changes in family roles & responsibilities, provide emotional
support & resources to reduce the burdens of family
caregiving, assist with financial & other logistical concerts, &
empower families to stay informed about a patient’s status.
INTERDISCIPLINARY TEAM
 Oncology social workers act as a bridge between patients &
the healthcare system, advocate for patients & families, &
help keep the oncology team informed about the unique
concerns, strengths, cultural beliefs, & care preferences that
af fect the patient’s experience with cancer.
 They also contribute to the advancement of cancer prevention
& quality care by developing social services and programs
that responsive to the needs of cancer patients and survivors.
 Promote public education about early cancer screening and
treatment options.
CONCEPTUAL FOUNDATIONS
 Practice is grounded in a variety of theoretical frameworks &
empirical literatures, including psychosocial oncology,
attachment & loss, stress & coping models, family systems, &
relational coping, child & adult development, narrative &
meaning-making.
 For the oncology social worker, “the ecosystems perspective is
a way of seeing care phenomena (the personal & the
environment) that are interconnected & multilayered to order
& comprehend complexity & avoid oversimplification” (Meyer,
1995, p.18).
MEDICAL AND PSYCHOSOCIAL
KNOWLEDGE
 Social workers in oncology must be well informed about
common types of cancer, symptoms, treatment protocols,
medical procedures, short & long -term side ef fects, illness
trajectories, and survivorship.
 New research suggest that social workers can help with
cancer prevention by tailoring individual, behaviorally oriented
interventions to target harmful behaviors among groups.
HEALTHCARE AND SOCIAL SERVICES
 Linking patients with essential programs and
resources requires up-to-date knowledge of ever
changing policies and services, including eligibility
requirements, application procedures, and strategies
for communication information to cancer patients
and their caregivers.
 Oncology social workers must be familiar with health
insurance, managed care, Medicare, and Medicaid.
ONGOING ASSESSMENT
 Early assessments help identify and resolve
problematic coping and health behaviors.
 Comprehensive assessments can predict morbidity
and mortality in older patients with cancer.
 Assessments should be ongoing as cancer
progresses, remits, or recurs.
CULTURAL COMPETENCE AND ADVOCACY
 Ability to practice with people from a variety of cultural, ethic,
racial, socioeconomic, and religious backgrounds is a
requisite skill for oncology social workers.
 Ef fective pain & symptom management is impossible without
understanding individual, family, and cultural perceptions,
values, and beliefs about pain, and developing interventions
that respect the unique, individualized experiences of
chronically ill patients and their families.
 Social workers have professional mandate to intervene on
multiple levels, ensure the provision of just and equitable
care to all patients, etc.
PATIENT EDUCATION
 Oncology social workers play a key role in educating patients
and their families about cancer and its anticipated disease
trajectory, treatment, common psychosocial responses,
community resources, and symptom management.
 Oncology social workers empower patients and families to be
more engaged in their care, by helping them ask to questions
and make informed decisions about all aspects of medical
treatment.
PALLIATIVE AND END-OF-LIFE
 Although cancer mortality has decreased, oncology social
workers should be skilled and comfortable in working with
chronically ill and dying patients.
 Oncology social workers service as consultants, mediators,
and advocates on transdisciplinary teams addressing complex
ethical dimensions of medical decision making, family
communication, and care preferences.
 In case of terminal cancer, social workers may provide end -oflife care to patients and family members by facilitating
discussion of the patient’s end -of-life wises and supporting
the selection of a healthcare proxy.
CHALLENGES
 Despite all that is known, the healthcare system has
not adequately addressed the psychosocial concerns
of cancer patients, cancer survivors, and their
families.
 A report by the Institute of Medicine (2007) suggests
that many of healthcare providers do not address
these concerns or consider psychosocial support to
be an integral part of quality oncology care.