Transcript Psychosocial Issues In Bone Marrrow Transplant

Psychosocial Issues In
Bone Marrrow Transplant
Jennifer Blosser, LCSW, ACSW, CSWHC & Susan Striano, MSW
November 2011
Objectives
 Identify Biopsychosocial and Spiritual
issues in BMT
 Understand patient and caregiver issues
 Identify resources and strategies to assist
 Identify components of a patient
evaluation that elicits important factors
predictive of coping
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Bio-psychosocial?
 The biological, psychological and
social affect a person’s response to
illness and treatment
 The mind and body connection
 Health care staff need to address the
person holistically
 Contrasts with a reductionist model
of disease
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Constellation
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Family
Work
Health
Spirituality
 Genetics
 Life Experience
 Resilience
 Temperment
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Who Cares?
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BMT is extremely rigorous
Long recovery times
Side effects
Late effects/Survivorship
High risks of mortality
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Practical Matters
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Patient and caregiver may relocate
Need plans for home and family
May be out of work
Resources stretched thin
 Patient pay amounts
 Gas mileage
 Dreaded doughnut hole
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Spiritual
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Chronic sorrow (Olshansky, 1962)
Role loss
Facing mortality
Wearing out the system
Sin and Salvation
Search for meaning
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Mental/Emotional
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Anxiety and Depression
Denial/Minimization
Anger
Fears of the unknown
Loss of control
Dependence
Deterioration
Side effects/Pain/Suffering
Reaction of others
Fear of relapse
ENGULFMENT
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Physical
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Fatigue/sleep disturbance
Sexual dysfunction
Side effects of medicine
Side effects of GVHD
Where is my wellness
Cognitive changes
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Young Adults
 Ill at transitional time in
development
 Tasks of individuation interrupted
 Negotiating friendships and intimate
relationships
 Moving back home
 Some treated first when children
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Continuum of Coping
 Emotional acceptance . . . Cognitive
awareness . . . Adherence to
treatment
 What led them to decision
 What have they read/heard about
process (did they read materials)
 Glass half full or half empty?
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Risks
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Decreased adherence
Failure to thrive
Increased somatization
Question quality of life
Failure of expectations for recovery
Need to adjust to new baseline
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Caregivers
Have different experience
Extra duties/roles
Finances/job pressures for time off
Anticipatory grief
Loss of self care
Bringing baggage with you (pt., too)
Overwhelmed by systems (pt.,
too)(medical/insurance)
 Resources dedicated to patients
 Distress higher than patients
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Special Situations
 Gay, lesbian and transgender
partners as caregivers
 Homosexual persons with cancer
 Caregivers with disabilities
 Language and multicultural
differences from treatment staff
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Survivorship
 BMTInfoNet survey 2007
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Emotional/Psychiatric
Late Effects
Fatigue
Worry about family/caregivers
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COOL!
 Psychosocial support and emotional
issues can be predictive of well-being
following transplant (Hoodin, et al,
2006)
 Hypothesis: emotional adjustment
and psychosocial support can be
immune modulatory
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Case Example
 Medical
 History of illness experience
 Past medical history
 Home and family
 Environmental issues
 Pets
 Health of family
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Financial
 Education/Employment
 Status of finances
 Insurance ok?
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Copays
Deductables
Out of pocket maxes
Medicines
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Substances/Mental
Health/Legal
 History of substance use
 Patient
 Family
 Potential caregivers
 Mental health history
 Legal issues
 Court hearings, financial, incarcerations,
wills/advanced directives/POAs
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Learning and Education
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Patient and family learning style
What have they received
Did it meet their needs
Was is understood
History of learning problems or
literacy issues
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Adjustment
 General impressions of mood and
coping for patient and family
 Relevant history
 History with medical situations
 Specific phobias
 Coping with staff, long waits, when
things go wrong
 Conclusions/Needs
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How to Cope
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Exercise (Wiskman&Huber, 2008)
Education
Nutrition
Medicine
Counseling
Get a role!
Clergy
Family/community
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 Integrative approaches
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Yoga
Visualization/guided imagery
Prayer/Meditation
Journaling
Celebrate landmarks (Stronach, 2002)
Acknowledge loss, consider gains
Value in being vs. doing
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Community Resources
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Organizations related to patient diagnosis
Grants/fundraising
Social Security
Medicaid/Medicare
Grief/bereavement support
Support groups
Churches
Family/friends/neighbors/other patientsfamilies
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Emotional Support
 American Psychosocial Oncology
Society 1 866 276 7443, apossociety.org
 Cancer Info and Counseling Line
1 800 525 3777
 bmtinfonet.org
 thewellnesscommunity.org
 cancercare.org 1 800 813 4673
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Fatigue
 National Comprehensive Cancer
Network www.nccn.org
 Oncology Nursing Society
www.ons.org/outcomes/volume1/fatig
ue.shtml
 American Cancer Society, National
Cancer Institute, Livestrong.org
 Your local cancer rehab program
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Cognitive
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Meds
Behavioral interventions
Relaxation/stress management
Job retraining
Treatment of underlying medical
conditions
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Caregivers
 Family Caregiver Alliance www.caregiver.org
 National Family Caregivers Association
www.nfcacares.org
 Wellspouse Association www.wellspouse.org
 Caringbridge and Carepages
 Young Spouses www.youngcancerspouses.org
 www.strengthforcaring.com
 www.familycaregiving101.org
 www.sharethecare.org
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Young Adults
www.Planetcancer.org
www.stupidcancer.com
www.CampDream.org
www.Fertilehope.org
www.preparetolive.org
www.pregnantwithcancer.org
www.vitaloptions.org
www.cancer.gov/cancertopics/aya/resourc
es
 www.cancercare.org
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Humor
 Laughter known to reduce blood
pressure, increase feel-good
neurochemicals and reduce
subjective feelings of depression.
 “I may not be totally perfect, but
parts of me are excellent,” (Ashleigh
Brilliant).
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 [email protected] for questions!
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