Physicians are asking psychologists for help

To improve patient treatment, more oncologists are calling in psychologists.

By Lisa Rabasca
Monitor staff

In New York City recently, the mother of a five-year-old cancer patient became so distressed when her son was given an intravenous needle that she disrupted his treatment. But a psychologist on the treatment team suggested the mother hold her son's leg while the needle was being inserted. It gave her a nondisruptive role to play in the boy's treatment, and it also gave her son's physician a way to ease the mother's concerns and eventually gain her support.

It was not an isolated case, for oncologists are starting to regularly turn to psychologists for help when cancer patients and their families become apprehensive about treatment.

"Patients view us differently than they view their physicians," says David Bearison, PhD, adjunct professor of pediatrics at Mount Sinai Medical Center and School of Medicine in New York City. "We're not making life-and-death decisions and we have an opportunity to spend more time with them, so we can often detect when someone is engaging in a behavior that will undermine treatment."

Bearison's colleague and wife, Linda Granowetter, MD, will often ask him to help her patients and their families cope with illness and comply with treatment.

"When people can't cope, they can't comply with their treatment and that could endanger their lives," says Granowetter, clinical director for pediatric oncology at Mount Sinai Medical Center and School of Medicine.

Treatment teams such as Granowetter and Bearison are becoming more common as physicians recognize that psychologists can help patients weigh treatment options, manage pain, cope with side effects and talk with family and friends about their illness.

"As behavioral issues are becoming more accepted, physicians are more willing to bring in psychologists," says Bearison.

And when that happens, the psychologist becomes a translator for the patient and the physician, says Leslie R. Schover, PhD, staff psychologist at the Cleveland Clinic Foundation in Ohio. For example, she says a psychologist may be better able explain to patients and their families what to expect during treatment.

"Physicians don't always have a good understanding of the gap between what they are saying and what the patient understands," she says.

Granowetter agrees that it's often difficult for physicians to anticipate all of the patient's concerns.

"No matter how empathic we think we are, to a certain extent we lose touch with being the patient and the one who is scared," she says. "As much as I think I'm talking clearly, anticipating fears and addressing them, patients will surprise me with worries that I wouldn't have thought to consult them on."

But, communication is a two-way street and psychologists can also teach patients how to ask physicians direct questions when they're worried.

"Many times patients don't know how to formulate a question in a way that it can be answered," says Sandra B. Haber, PhD, a private practitioner in Manhattan who treats cancer patients. For example, she says, patients tend to ask open-ended questions such as, "I'm going to be okay, aren't I?" rather than specific questions, such as, "will this treatment cure me or extend my life?"

Psychologists can help patients narrow their concerns and structure questions so that their physician understands their specific anxieties.

Psychologists also help physicians manage those patient anxieties during treatment. Maria Prendes Lintel, PhD, for instance, makes relaxation tapes for cancer patients based on their specific concerns about surgery. Recently, a breast-cancer patient was anxious about her surgery because of past difficulties coming out of anesthesia. Prendes Lintel recorded a relaxation tape to help her visualize coming out of the anesthesia and breathing without difficulty after the surgery.

Most physicians are receptive to their patients using relaxation tapes to prepare for surgery, especially if they're given a transcript of the tape, says Prendes Lintel, a private practitioner in Lincoln, Neb.

Following treatment, psychologists can identify and address patients' fears about taking medications to control pain.

"People who are afraid of becoming addicts often wait until they hurt to take medication," says Haber of New York City. "But many pain medications work best when taken around the clock."

Psychologists can also be helpful in pain management by encouraging patients to keep a pain diary that clarifies exactly when pain occurs and what makes it better or worse, says Haber. This can help patients communicate with their physicians and clarify if any changes are needed in pain medication. It can also help patients anticipate problem times of the day or night so they can plan to have a companion with them or anticipate using an additional pain control such as self-hypnosis or additional medication.

Psychologists who have successfully integrated their care with that of an oncologist stress the importance of showing physicians exactly how their interventions can enhance the treatment of cancer patients. Among their suggestions:

* Put together a proposal that shows what psychology offers patients, says Leslie Schover of Ohio. Some oncologists might be interested in having a full- or part-time psychologist on staff to improve their patients' quality of life.

* Find a creative way to fund your position on a hospital treatment team, either through research or in billing the patient for services, says Mount Sinai's Granowetter.

* Establish your credibility with the medical team says Mount Sinai's Bearison, by spending time at the hospital attending teaching rounds and volunteering with patients.

* Master the medical terms, procedures and medicines, says Bearison. "Recognize whose turf you're on," he says. "You can't expect to use psychological jargon."

* Contact local hospitals or physicians in private offices and offer to give a free workshop on coping with cancer or using self-hypnosis during chemotherapy, says Haber of New York City.

* Develop a relationship with the physician's office staff. They're often the ones suggesting providers or making referrals for the physicians, says Haber. Offer to give a free stress management workshop to help the office staff deal with their emotional needs, she says.

APA Home Page . Search . Site Map