Mental Health and Cancer Addressing Caregiver Needs
Dr. Dawn-Elise Snipes
CEUs are available at https://www.allceus.com.

Objectives
– Explore the unique needs of loved ones and caregivers of people with cancer
Diagnosis
– 650,000+ people die of cancer EACH year
– When someone is diagnosed, the patient and loved ones grieve
– Even if the cancer is “cured” or goes into remission there may be lasting disabilities and/or losses
– Loss of security (health anxiety in the patient and SOs)
– Loss of function or changes in appearance
– Cognitive impairment (“chemo-brain”) impacts attention, working memory, executive function, and processing speed
– Unmet needs of caregivers and patients were associated with increased physical symptoms, anxiety, and reduced QoL
– Not everyone experiences grief in the same way
– Families need to be educated about the grief bill of rights
Bill of Rights for Cancer-Related Grief
– To know the truth and have questions answered honestly
– To be heard with dignity and respect and able to talk about it as much as needed OR to be silent and not talk about emotions and thoughts.
– To not agree with your perceptions and conclusions
– To see the person with cancer
– To grieve in my own unique way without hurting self or others
– To feel all my feelings and to think all my thoughts
– To not have to follow the “stages of grief” as outlined in a book
– To be angry at death, cancer, the patient, god, myself, and others
– To have “griefbursts”
– To not be taken advantage of
– To feel guilt
Unmet Needs
– Prominent unmet needs
– Fatigue
– Due to around the clock caregiving
– Due to insomnia associated with grief
– Nutrition deficiencies
– Blood sugar
– Coordination of services
– Emotional support
– Anxiety
– Anger
– Anticipatory grief

– Guilt over
– Past issues
– Being happy
– Being informed about:
– Benefits and side-effects of all treatment options
– Illness information (causes, course, care) (esp. men)
– Information about preventive, maintenance & restorative strategies
Other Unmet Needs
– Current Caregivers
– Managing daily activities
– Maintaining intimacy with partner
– Managing emotions about prognosis
– Balancing own needs and patient’s needs
– Impact of caring on work
– Making decisions in the context of uncertainty
– Financial concerns
Other Unmet Needs
– Former Caregivers (up to 5 years post remission)
– Managing emotional distress
– Intrusive thoughts about cancer coming back
– Managing interpersonal relationships
– Reducing patient stress associated with cancer
– Medical
– Stress related illnesses
– Consequences of neglected health
– Financial
– Daily activities—Getting their groove back
Other Unmet Needs
– Bereaved Caregivers
– Guilt over perceived failings with the patient or family
– Working through the grief process
– Reintegrating into daily life

Cancer-Focused Cognitive Processing
– Contextual Facts about…
– This illness in this patient at this time
– The loss of this patient at this time
– Addressing Cognitive Distortions
– All or nothing thinking
– Catastrophizing
– Personalization
– I should be able to make her comfortable
– It is my fault that…
– I made her angry (displaced anger; cognitive issues)
– Mind reading

Cancer-Focused Cognitive Interventions
– Distress Tolerance (TAGS)
– Thoughts
– Activities
– Guided Imagery
– Sensations

Other Issues
– Paternalization of the patient
– Needing assistance explaining things to children
– Coping with child behavior issues
– Health anxieties
– Separation anxiety
– Increased behavioral problems
– Refusal to go to bed
– Magical thinking

Summary
• Counselor Interventions
• Information provision (informing individuals use verbal and written)
• Support (acknowledging experience, connecting with others; facilitating expressions of feelings or emotions)
• Encouraging acquisition of new coping skills and promoting emotion regulation and distress tolerance
• Spiritual or existential therapy to help the person find meaning

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