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Tuesday, August 23, 2011

Psychologists with Cancer: Clinical, Ethical, and Practical Challenges

Helen L. Coons, Ph.D., ABPP
Jana N. Martin, Ph.D.
From The Pennsylvania Psychologist

Psychologists living with cancer face clinical, ethical and practical challenges while coping with their own diagnosis and treatments. This brief article offers several suggestions to psychologists in practice and other professional settings who are coping with an early or advanced diagnosis of cancer.

Seek support and supervision. While most individuals are remarkably resilient in coping with cancer and its treatments, a new or recurrent diagnosis and the complex treatment decisions which follow can be highly stressful and frightening. Reaching out to colleagues early for support and supervision is important for psychologists with cancer. Ask colleagues if they know psychologists (or other mental health providers) who have experienced cancer treatment. Practical, informational and emotional support from someone with an insiders’ view is invaluable. The PPA listserv and APA Division listservs may also be helpful in identifying other psychologists with cancer.

Formal supervision from a respected colleague is essential to address clinical, ethical and practical issues that emerge as psychologists cope with cancer, and to support them in developing a practice management plan during and after treatments.

Develop a practice management plan. A cancer diagnosis will typically be followed by  treatment decisions related to surgery, chemotherapy, and/or radiation as well as acute, late, and long-term side effects. At any point in the treatment course, psychologists often face a series of challenging questions related to their practice and other professional roles. Some individuals are too ill, tired, or uncomfortable to work during treatment; some will have to work to maintain their income; and most will likely work part- or full-time with breaks for treatment. Psychologists undergoing cancer treatment are confronted with questions such as: (1) should they continue to see patients, teach, supervise, etc; (2) should they work full- or part-time; (3) if, how and when to disclose their diagnosis to patients, keeping in the mind their practice focus (e.g., children, teens, adults); (4) how to deal with breaks in treatment resulting from additional surgery or side effects of chemotherapy and/or radiation; (5) whether or not to treat patients who have or had cancer, are “at risk” for cancer, have lost a loved one to cancer, have significant attachment issues, or require a high degree of treatment consistency, etc; and (6) clinical, ethical and practical issues when closing a practice. Developing a practice management plan in consultation with a supervisor to address these and other questions can be helpful and empowering (Coons, 2010).

A practice management plan during and after cancer treatment may include creating flexibility in the psychologist’s schedule. For example, some psychologists reduce their patient and teaching load, and/or block their schedule after each chemotherapy cycle when side effects (e.g., nausea, fatigue, pain, low blood counts, etc.) are more likely to emerge and may adversely affect one’s ability to work. Some individuals undergoing chemotherapy have also shifted the focus of their clinical work to more testing or consultation so that they can schedule evaluations between cycles when they have more energy. Others have found that the familiarity of work is a healthy break from cancer treatment. A management plan should include finding colleagues to be on standby to call and re-schedule clients (who have provided informed consent) so that psychologists do not have to explain to patients how they are feeling.

Pace yourself during and after treatment. Throughout and after cancer treatment, psychologists need to be mindful of their physical, emotional and cognitive well-being. Psychologists have an ethical obligation to ensure that their own physical and psychological well-being is healthy enough to care for patients, teach, supervise, etc. Fatigue, pain, nausea and vomiting and the medications used to treat these symptoms or side effects may compromise some individuals’ ability to meet the demands of clinical practice. Chemotherapy and other medications used in cancer treatment, for example, can diminish cognitive functioning. While changes in concentration, memory, processing speed, and the ability to multitask are likely to be mild and time-limited, high level clinical decision-making is essential for differential diagnosis and treatment. Psychologists undergoing cancer treatment must evaluate if they are healthy enough to meet the demands of practice and other professional responsibilities.

Designate a clinical power of attorney. Consistent with the APA Ethical Principles of Psychologists and Code of Conduct (2002), psychologists are obligated to ensure that patients will be taken care of if they are not able to meet professional responsibilities because of personal problems or when there are interruptions in therapy or termination. While many psychologists with cancer will continue to practice during and after treatment, it is important to designate a clinical power of attorney in the event that the psychologist is unable to take care of patients. This colleague should be able to access the psychologist’s office (i.e., they have door and file keys), patient lists, appointment schedules, and records; will contact patients and can either reschedule or provide care to patients, or refer them to other colleagues with the appropriate clinical expertise. See Pope and Vasquez, (2007); Spayd & O’Leary Wiley (2009); and www.apapracticecentral.org for more detailed discussions on closing a practice.

Personal experience with cancer and expertise in psychosocial oncology.  Psychologists who undergo their own cancer treatment will have a special understanding of the experience faced by so many adults across the life span. After treatment, they may even consider taking care of patients with cancer. While well meaning, the psychologist’s own treatment experience is very different from having the expertise in psychosocial oncology necessary to provide evidence-based assessment and treatment to adults with early and advanced cancers. Treating patients with cancer requires a highly specialized fund of knowledge and clinical competencies to ensure quality care and outcomes. While psychologists may want to help others deal with this challenge, they still have the ethical obligation to practice within their scope of expertise. Again, supervision from a respected colleague can be invaluable to sort out if and when a psychologist should treat others with or affected by cancer.


References

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

Coons, H. L. (2010). Psychologists with early and advanced breast cancer: Clinical, ethical and practical challenges. Manuscript submitted for publication.

Pope, K. S., & Vasquez, M. J. T. (2007). Ethics in psychotherapy and counseling: A practical guide. San Francisco: John Wiley.

Spayd, C. S., & O’Leary Wiley, M. (2009, December). Closing a professional practice: Clinical and practical considerations. The Pennsylvania Psychologist, 69(11), 15-17.


Helen L. Coons, Ph.D., ABPP, is a board certified clinical health psychologist who is President and Clinical Director of Women’s Mental Health Associates in Philadelphia. She has specialized in psychosocial oncology for 30 years, mentors psychologists and other health care providers with cancer, and underwent treatment for breast cancer. Dr. Coons may be reached at hcoons@verizon.net or 215-732-5590.

Jana N. Martin, Ph.D., is a licensed psychologist in independent practice in Long Beach, CA. Some of her work with children, adults, and families has focused on coping with chronic diseases such as cancer, and she is in remission from lymphoma. She may be reached at drjanamartin@verizon.net.