Seeking control
Holcombe Grier (left) and Lewis Silverman help children enjoy life around treatments.
Dana-Farber is taking steps to address such feelings. Each new patient and his or her family has access to a clinical social worker, either through the Care Coordination Department of the Dana-Farber/Brigham andWomen's Cancer Center (DF/BWCC) for adult patients or the Jimmy Fund Clinic's Pediatric Psychosocial Unit, run in conjunction with Children's Hospital Boston. Beyond psychosocial assessments and interventions, social workers tackle both emotional and logistical concerns.
In addition to meeting individually with patients, DF/BWCC psychologist Karen Fasciano, PsyD, and social worker Mary Ann Holcombe, LICSW, lead group sessions in which they teach emotional coping skills such as stress management strategies to alter negative thoughts, and behaviors to change one's mood. For example, they encourage patients to "schedule" worry time so they don't let fears overwhelm them, and to organize time or activities with loved ones that are free from discussions about cancer.
Another teaching device they use is cognitive restructuring. "We listen to peoples' thoughts and work with them to develop more adaptive ways of thinking about the same situation," Fasciano explains. "Instead of saying, 'Cancer has taken over my life,' we encourage them to replace it with something like, 'Cancer has taken over part of my life, but I'm not going to let it control all of my life.'"
Even when patients are too young to understand the implications of a diagnosis, the same fears are often there. In more than 25 years as a pediatric oncologist at Dana-Farber, Holcombe Grier, MD, has learned the importance of respecting young patients' intellects and easing their anxiety by always including them in conversations and decision-making about their care. And in the case of teenage patients, asking parents to leave the room so he can discuss more private matters like drug use and sex can both calm patients and win their trust and respect.
"At almost any age, except for the youngest babies, there is a desire to exert some control over your environment," Grier says. "When [medical] residents are doing rounds with me and ask a child, 'Do you mind if I listen to your chest?' I correct them.You're not giving the kid a choice; you're going to listen to it no matter what.You need to be thoughtful and say, 'I have to listen to your chest. Do you want me to do it here, or do you want to stand over by Mommy?'"
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