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In The Name of God

In The Name of God. Psycho-Oncology. MR Sharbafchi, MD. Assistant Professor of Psychiatry. Cancer Epidemiology. Iran Cancer Population: 600,000 New Cases: 100,000/Year Advanced disease (need for end of life care): 240,000

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In The Name of God

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  1. In The Name of God

  2. Psycho-Oncology MR Sharbafchi MR Sharbafchi, MD. Assistant Professor of Psychiatry

  3. Cancer Epidemiology Iran • Cancer Population: 600,000 • New Cases: 100,000/Year • Advanced disease (need for end of life care): 240,000 • The second most common cause of death after heart disease, accounting for one in every four deaths MR Sharbafchi

  4. Palliative Care World Health Organization (WHO, 2002)* Palliativecareis an approach that improves the Quality of Life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other Physical, Psychosocialand Spiritualproblems. * http://www.who.int/cancer/palliative/definition/en/Last accssed on 2017 MR Sharbafchi

  5. Palliative Care MR Sharbafchi

  6. Palliative Care Relief from physical, psychosocial and spiritual problems can be achieved in over 90% of advanced cancer patients through Palliative care. MR Sharbafchi

  7. Defining Psycho-OncologyCanadian Association of Psychosocial Oncology, 1999 & Holland JC, 1992 • Study, understanding and treatment of different aspects of cancer along the continuum from prevention to cure or bereavement. • Social • Psychological • Emotional • Spiritual • Quality of life • Functional • Ethical MR Sharbafchi

  8. Defining Psycho-OncologyCanadian Association of Psychosocial Oncology, 1999 & Holland JC, 1992 Two major psychological dimensions of cancer: • The psychological response of patients, their families, and health care providers to cancer • The psychological, behavioral and social factors that may influence the disease process. • Cancer risk • Detection • Survival MR Sharbafchi

  9. Defining Psycho-Oncology The multidisciplinary psycho-oncology teams: • Psychiatry, Psychology, Social work, Nursing, and Clergy • Medical oncology, radiotherapy, surgery, pediatrics, epidemiology, palliative care, rehabilitation medicine, …. MR Sharbafchi

  10. Rationale for Developing a Psycho-Oncology Model of Care Cancer patients suffer from fear of: • Death • Dependency • Disfigurement • Disability and abandonment • Disruptions in relationships • Disruptions in role functioning • Disruptions in financial status MR Sharbafchi

  11. Rationale for Developing a Psycho-Oncology Model of Care Psychosocial distress has a major impact on: • The person’s functioning and that of their family • Posing a major occupational and economic burden • Capacity to cope with disease burden • Reduce patient adherence to recommended treatments MR Sharbafchi

  12. Psychiatric Disorders in Cancer Patients

  13. Psychiatric Disorders in Cancer PatientsClinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (2003) Psychiatric disturbances is relate to the cancer itself or treatment side effects. • Up to 66% of people with cancer experience long term distress • Adjustment disorders: 30 -35% • Clinically significant anxiety disorder: 30% • Major Depression: 20-35% • Delirium: 10% Treatable syndromes, such as major depression and delirium, continue to be underdiagnosed and undertreated MR Sharbafchi

  14. Psychosocial needs common to cancerpatients and their families • Understanding of illness, treatments and services • Patient provider education: Written information, cancer nurse coordinators, … • Coping with emotions surrounding illness and treatment • Peer support groups, counselling/psychotherapy, pharmacological management of symptoms • Managing illness and health • Comprehensive self-management /self-care programs MR Sharbafchi

  15. Psychosocial needs common to cancerpatients and their families • Behavioral change to minimize disease impact • Behavioral/health promotion interventions such as smoking cessation assistance, patient education etc. • Managing disruptions in work, school and family life • Family and caregiver education, assistance with Activities of Daily Living. • Financial assistance • Financial planning, info re: wills, eligibility and assistance with applications for disability pension, carer’s allowance etc. MR Sharbafchi

  16. Levels of Psychological Specialization in Palliative Care MR Sharbafchi

  17. General Principles of Assessment in Psycho-oncology There can be major discrepancies in understanding of the illnessamong patients, family members, and staff, which leads to unnecessary stress • Exploration of the patient’s understanding of the illness and its meaning. • What are the patient and family being told? • What are they absorbing? • Impact of medical factors on mental state • The role of the environment, especially the patient’s family and their interface with the health care system. MR Sharbafchi

  18. Base line Psycho-Social Assessment Psychometric tools • Distress Thermometer* • Similar to the rating scale used to measure pain: 0 (no distress) to 10 (extreme distress). • Arough single-item question screen. “How distressed have you been during the past week on a scale of 0 to 10?” • Scores of 4 or more indicate a significant level of distress * Roth, Kornblith & Batel-Copel et al,1998; & Ransom, Jacobsen & Booth-Jones, 2006 MR Sharbafchi

  19. Base line Psycho-Social Assessment Psychometric tools • Psychosocial Care Referral Checklist* • Physical • Practical (eg. transportation, financial) • Psychological • Social • Spiritual * NBCC & NCCI, 2003) MR Sharbafchi

  20. Base line Psycho-Social Assessment MR Sharbafchi

  21. General Principles of Treatment in Psycho-oncology The hallmark of treatment in psycho-oncology is: • Therapeutic activism • Simultaneous use of several modalities • Aggressive attempt for rapid relief of symptoms MR Sharbafchi

  22. General Principles of Treatment in Psycho-oncology Clinicians should: • Prepare for existential plight of the cancer patient, which may intensifies the expectable countertransference reactions. • Resist the urge to distance themselves from a painful situation • Be aware of the patient’s physical condition MR Sharbafchi

  23. General Principles of Treatment in Psycho-oncology Clinicians should: • Not allow acute physical or emotional distress, despair, and bars to communication, such as tracheostomies, to prevent a thorough evaluation. • Overcoming fear and guilt • Engaging the patient deeply MR Sharbafchi

  24. General Principles of Treatment in Psycho-oncology Clinicians should: • Not allow acute physical or emotional distress, despair, and bars to communication, such as tracheostomies, to prevent a thorough evaluation. • Overcoming fear and guilt • Engaging the patient deeply MR Sharbafchi

  25. General Principles of Treatment in Psycho-oncology Treatment modalities: • Psychopharmacology • Psychotherapeutic Interventions • Social Services • Chaplaincy Services MR Sharbafchi

  26. The core competences of a psycho- oncologist • Cancer (Principles in diagnosis and treatment) • Communication skills in Cancer care • Breaking bad news • Short Term, Structured, Psychoeducational Intervention for Newly Diagnosed Cancer Patients • Couple-Focused Group Intervention for Women with Early Breast Cancer and Their Partners MR Sharbafchi

  27. The core competences of a psycho- oncologist • Supportive Psychotherapy in Cancer Care • Cognitive-Behavioral Therapies in Cancer Care • Cognitive Analytic Therapy in Cancer Care • Mindfulness Interventions, Relaxation and Image Based Therapy in Cancer Care • Dignity Therapy in Cancer Care • Existential and Logo therapy in Cancer Care MR Sharbafchi

  28. The core competences of a psycho- oncologist • Meaning-Centered Group Psychotherapy • Written Emotional Disclosure in Cancer Care • Supportive-Expressive Group Psychotherapy • Ethical and Spiritual Issues • Communication with Terminally Ill Patients and Their Relatives • Care and Management of the Patient at the End of Life • Understanding and Managing Bereavement MR Sharbafchi

  29. The core competences of a psycho- oncologist • Couples Therapy in Advanced Cancer (Intimacy and Meaning) • Focused Family Therapy in Palliative Care and Bereavement • Reconstructing Meaning in Bereavement • Psychiatric Complications of Cancer (Depression, Suicide, Anxiety, Delirium) • Physical Symptom Management (Pain, Fatigue) • Burnout and Symptoms of Stress in Staff • Psychotherapy with Pediatric and Adolescent Cancer Patients MR Sharbafchi

  30. Thanks MR Sharbafchi

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