Clinical management of emotions in patients with cancer: introducing the approach “emotional support and case finding”

Abstract

The current approach to the management of emotions in patients with cancer is “distress screening and referral for the provision of psychosocial care.” Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of “emotional support and case finding” as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.

Improved Communication Skills Assisting Cancer Patients Through Counseling Training Palliative Volunteers in Surabaya

“…These challenges include considering their obligations to patient autonomy while deciding how much information needs to be provided, and how much patients want to know from the caregivers. In addition, caregivers sometimes find it difficult to convey such information in a realistic way, but also keep the patient hopeful [8,11]. In an Australian study involving 126 patients diagnosed with incurable cancer, 59% were curious about the expected survival when first diagnosed; 34 and 40% wanted to be asked about when they would rather discuss expected survival and death, respectively.…”

“…It is hoped that with increased ability, volunteers will be able to develop their skills as the closest companions of patients in overcoming situations that change according to the circumstances of their disease or when facing rejection, lack of acceptance of their diagnosis, poor prognosis, news of death and sadness, lack of knowledge of medical science, distrust, and family-related resistance to open communication about cancer diagnosis and prognosis [17,18]. So it is expected that volunteers when meeting with patients are expected to be able to conduct motivational interviews and integrative therapy while using communication strategies such as empathic listening, being an active listener, normalizing, refraining, reflecting, validating, using hopeful language, and other therapeutic techniques including breathing exercises, behavioral interventions, decision balance, existential strategies, hereand-now, relaxation, visual techniques, written techniques, and psychoeducation when treating cancer patients [11,16,19]. Palliative care can offer high-value alternatives in care of advanced cancer patients.…”

Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses

“…These indicators can be found in various research areas, including emotional dynamics [32], emotion regulation [33], life goals, and subjective wellbeing [34], as well as the network theory on mental disorders [35]. In the field of psycho-oncology, distinguishing between adaptive and maladaptive emotions is a rather novel concept [12,36]. The dominant opinion at present is that intense emotions need to be treated [37].…”

“…Several screening instruments have been developed to help identify patients likely to require professional mental health care, one example being the Distress Thermometer [8]. However, it has been consistently observed that the majority of patients scoring above the cutoff for distress subsequently decline professional mental health care [9][10][11][12]. Typically, while over 30-40% of patients score above the cutoff for distress [12,13], only around 10-15% of patients report a need for professional mental health care [7,12,14].…”

“…However, it has been consistently observed that the majority of patients scoring above the cutoff for distress subsequently decline professional mental health care [9][10][11][12]. Typically, while over 30-40% of patients score above the cutoff for distress [12,13], only around 10-15% of patients report a need for professional mental health care [7,12,14]. It has been argued that this discrepancy is either due to suboptimal implementation of distress screening and referral programs or to mental health care-related stigma [15].…”