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Creating an Informed Approach to Mental and Emotional Trauma Experienced by Cancer Patients: Elizabeth Archer-Nanda, DNP, PMHCNS-BC, & Meagan Dwyer, PhD

In this interview from the 48th Oncology Nursing Society (ONS) Congress, Elizabeth Archer-Nanda, Founding Member of the Behavioral Oncology Program and Clinical Director of Advanced Practice Providers at Norton Cancer Institute, and Meagan Dwyer, a Licensed Clinical Psychologist, discuss their presentation Compassionate Cancer Care: A Trauma-Informed Approach to Mental and Emotional Patient Health Needs. Their talk encompasses the mental health concerns experienced by cancer patients and how clinicians can apply self-care with a trauma-informed approach.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here at ONS Congress, and I'm joined by Elizabeth Archer-Nanda and Meagan Dwyer. Thank you both so much for joining me.

Elizabeth Archer-Nanda, DNP, PMHCNS-BC: Thanks, Keira. I'm Elizabeth Archer-Nanda. I'm a Psychiatric Clinical Nurse Specialist at Norton Cancer Institute in Louisville, Kentucky, and the Immediate Past President of the American Psychosocial Oncology Society (APOS).

Meagan Dwyer, PhD: Yes, thanks so much for having us. I'm Meagan Dwyer. I'm a Clinical Health Psychologist based out of Kansas City, newly in private practice, but used to work in academic medicine. And I serve as the current Director of Professional Education for APOS.

Oncology Data Advisor: Great, thank you. You both just presented a session titled Compassionate Cancer Care: A Trauma-Informed Approach to Mental and Emotional Patient Health Needs. What are some of the unique mental health concerns that patients with cancer may face?

Dr. Archer-Nanda: I think it's important to recognize that patients with a new cancer diagnosis will experience a broad range of normal emotions at diagnosis, including sadness, fear, anxiety, worry, and difficulty with uncertainty. Recognizing normal emotions, and then also recognizing difficulty with psychiatric sequela, is really important. Sometimes patients will experience adjustment disorders, anxiety, depression, delirium, and other mental health conditions in the context of their cancer. It would not be the norm to have a new onset of a severe psychiatric illness in the context of cancer. Anything to add, Meagan?

Dr. Dwyer: I think all of those that you hit upon are true. We also see a fair amount of sexual dysfunction and insomnia, especially depending on the type of cancer and the type of treatment that the person receives. Those can all disrupt the person's life. Sometimes I find that, in the face of cancer and all this change that's going on in all aspects of a person's life, people who typically have been able to cope with stressors like this before, or cope with other maybe less intense stressors, can just get overwhelmed. It's like the system gets overwhelmed by the wave of emotion and the intensity of it and the timeframe.

Oncology Data Advisor: With all these challenges, what are some strategies that nurses can employ to help care for their patients who are experiencing these issues?

Dr. Dwyer: I think one of the things we definitely tried to touch upon in our presentation, and that we do in our work, is how we can meet that patient where they are—sit with them and understand what's going on. Assuming isn't always good, but we can just assume in that generous way of coming in and knowing this person's going through a lot. Give them the space to share about that—what they feel comfortable with, acknowledging it, and being gentle in moving forward with them. I think nurses have that personal touch and opportunity to provide and spend that time with their patients, even briefly, to just say, "I know this is a lot. I'm sure that you're feeling overwhelmed. We're going to support you through this, and I'm here to listen if you need me." I think even those brief things can have a lot of power to the patient.

Oncology Data Advisor: Lastly, if anyone is interested in learning more about how to use a trauma-informed approach, where can they go to learn more?

Dr. Archer-Nanda: One place that we would recommend starting is the American Psychosocial Oncology Society. Our website is apos-society.org. I think that we have a lot of rich resources focused towards supporting patients going through cancer, and it will help guide you to other resources from there.

Dr. Dwyer: Even the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) definitely have some links and great resources for applying trauma informed-care or just considering the aspects of trauma, not only in health care, but in education and other things. I think once you learn a little bit about it, you can often find it has a very broad application of just understanding people's lived experiences. Everyone's had some challenges, and we all need to recognize that in the patients we care for and in ourselves, being gentle with ourselves when we're interacting in situations that can be traumatic and stressful, as well as for our staff.

Oncology Data Advisor: Absolutely. Well, thank you both so much for sharing this. It's really exciting to go back and share this with nurses.

Dr. Archer-Nanda: Thank you so much, Keira.

About Dr. Archer-Nanda and Dr. Dwyer

Elizabeth Archer-Nanda, DNP, PMHCNS-BC, is a Psychiatric Clinical Nurse Specialist and the Clinical Director of Advanced Practice Providers at Norton Cancer Institute in Louisville, Kentucky. She is a founding member of the Behavioral Oncology Program at Norton Cancer Institute and a former President of the American Psychosocial Oncology Society. Her clinical interests include end-of-life care, caregiver support, and hospital consultation-liaison care.

Meagan Dwyer, PhD, is a Clinical Health Psychologist and the founder of Starboard Therapy and Coaching in Kansas City, Missouri. In addition, she serves as Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Kansas Medical Center and as Director of Professional Education for the American Psychosocial Oncology Society. In her current practice, she offers individual, group, and organizational coaching and consulting regarding cancer-related grief, burnout and compassion fatigue, and wellness in the health care workplace.

For More Information

Archer-Nanda E & Dwyer M (2023). Compassionate cancer care: a trauma-informed approach to mental and emotional patient health needs. Presented at: 48th Annual Oncology Nursing Society Congress. Available at: https://ons.confex.com/ons/2023/meetingapp.cgi/Session/5125

American Psychosocial Oncology Society (2023). Available at: https://apos-society.org/

Centers for Disease Control (2022). Building trauma-informed communities. Available at: https://blogs.cdc.gov/publichealthmatters/2022/05/trauma-informed/

Grossman S, Cooper Z, Buxton H, et al (2021). Trauma-informed care: recognizing and resisting re-traumatization in health care. Trauma Surg Acute Care Open, 6(1):e000815. DOI:10.1136/tsaco-2021-000815

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor. 


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