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For Physicians

Psychosocial Oncology Fellowships

  • This year-long program is designed to help psychiatrists acquire knowledge and skills in the psychosocial care of patients and families at all stages of cancer, including the end of life.

    Fellows receive supervision in the psychiatric care of both oncology outpatients at the Dana-Farber Cancer Institute and inpatients at Brigham and Women's Hospital (BWH). They develop collaborative relationships with oncology subspecialty practices and other disciplines, teach non-psychiatric staff and trainees, and undertake a scholarly project for presentation and/or publication.

    Responsibilities include clinical services to cancer patients and their families; consultation and follow-up with inpatients; development of collaborative relationships with oncology subspecialty practices; and other disciplines. Mentored research and teaching opportunities are also available.

    Fellows work closely with the Palliative Care Service at Dana Farber/Brigham and Women’s Cancer Center and Brigham and Women’s Hospital. The fellow will be supervised by Psychosocial Oncology Program faculty.

    The Harvard Medical School Center for Palliative Care, along with the faculty at Massachusetts General Hospital (MGH), provide enhanced opportunities for focused clinical learning about palliative care and the emotional support of patients with cancer.

    The fellowship runs for a full year, from July 1 through June 30.


  • Specifically, fellows learn to:

    • Assess and co-manage (a) anxiety, depression, delirium, and other common problems oncology patients experience in psychiatric consultation, and (b) emotional components of distressing symptoms such as pain, nausea, dyspnea, and insomnia.
    • Identify, assess, and work therapeutically with patients who are fearful, uncertain, or struggling with dependency, loss of control, and other psychosocial issues associated with life-threatening illness.
    • Apply pharmacologic principles to the treatment of seriously ill patients needing psychotropic and/or analgesic or other palliative medications. Choose non-pharmacologic therapies appropriate to the patients needs, using a psychodynamic understanding of the patient's personality style, values, relationships, and other resources.
    • Work effectively with an interdisciplinary team of oncology and palliative care professionals (representing medicine, anesthesia, psychiatry, pharmacy, nursing, social work and chaplaincy) in the emotional care of patients and their families.
    • Articulate ethical principles involved in choices regarding end of life care, such as designation of DNR, DNI, the use of proxies and living wills, withdrawal of treatment, and assisted suicide.
    • Understand hospice services and refer appropriately to community hospice providers.
    • Identify needs and provide psychosocial support to families dealing with life-threatening illness.
    • Describe the bereavement process and implement appropriate interventions to support families in bereavement.

  • Sejal B. Shah, MD
    Director, Medical Psychiatry Service
    Director, Psychosomatic Medicine Fellowship
    Department of Psychiatry
    Brigham and Women's Hospital
    Instructor in Psychiatry, Harvard Medical School
    60 Fenwood Road
    Boston, MA 02115
    sshah@bwh.harvard.edu 

  • Clinical Activities

    • Comprehensive assessments of patients referred to the Psychosocial Oncology Service, including communication with the patients' primary treatment team, and follow up of these patients during their hospital stay. The fellow will consult on cases with supervisory physicians, who will, in turn, be available for guidance and support. A supervising attending will be readily available at all times.
    • Psychiatric care of patients on the inpatient palliative care unit.
    • Consultation and treatment of scheduled outpatients at Dana-Farber (expected target: 12 hours/week).
    • Availability to respond to urgent requests for outpatient consultation during the work week.
    • Availability by beeper during evenings and weekends, or arrangement of appropriate coverage.
    • Multidisciplinary meetings of clinical staff and families regarding patients.
    Elective
    • Home visits with hospice staff of various disciplines, and participation in one or more interdisciplinary hospice meetings.

  • Educational Activities

    • Orientation activities
    • Two hours of clinical supervision per week, including case-by-case supervision of inpatients.
    • Ongoing Mentoring: Each fellow will chose a mentor with whom to meet monthly.
    • Reading: Each fellow will receive a syllabus of basic readings in psychosocial oncology and palliative care.
    • Scholarly project: Development and presentation of a research or writing project, in collaboration with supervising faculty.
    • Rounds and conferences
    Elective
    • Exchange rotation. Fellows will spend one month, part-time, doing inpatient consultation on the BWH medical psychiatry service. During these afternoons, a BWH Medical Psychiatry fellow will cover Dana-Farber inpatient consultation responsibilities.
    • Rounds and conferences, including:
      • Palliative Care Grand Rounds
      • Schwartz Center Rounds
      • Psychosocial Rounds for Oncology Fellows
      • Living with Life-Threatening Illness lectures
      • Harvard Longwood Psychiatry Grand Rounds

    Enrichment. Fellows can arrange opportunities through the fellowship program director (depending on scheduling and availability) to individualize and enhance their educational experience. Elective options include:

  • Teaching Activities

    • Fellows will supervise fourth-year medical students in the Psychosocial Oncology and Palliative Care elective.
    Elective:
    • Teaching medical students taking Introduction to Psychiatry and Psychopathology and Living with Life Threatening Illness.
    • Teaching and liaison activities within a disease program at Dana-Farber or an inpatient unit at BWH.
    Faculty

    John Peteet, MD
    Fellowship Site Director, Department of Psychosocial Oncology and Palliative Care
    Associate Professor of Psychiatry, Harvard Medical School

    Ilana M. Braun, MD, Chief, Division of Psychosocial Oncology
    Assistant professor of Psychiatry, Harvard Medical School

    Fremonta Meyer, MD
    Clinical Instructor in Psychiatry, Harvard Medical School

    Halyna Vitagliano, MD 
    Clinical Instructor of Psychiatry, Harvard Medical School