I am writing in response to the interview with Dr. Jimmie Holland, speaking for both myself and as a member of the professional discipline of oncology social work. Dr. Holland is indeed a pioneer in the recognition and assessment of psychosocial distress in cancer patients. For that work, she has received appropriate recognition and appreciation from her colleagues in cancer care.
But why at this stage in an illustrious career, does Dr. Holland still feel the need to perpetuate a thoroughly outdated view of the skills of oncology social workers, some of us who have been at this for as long as she has? We can't get past paragraph 3 in this article before she's suggesting that oncologists utilize the following “guideline” in deciding to whom they will make a referral—“to a social worker if it's practical, to a mental health professional if it's a mental health issue,” etc.
Yes, we provide practical assistance along with help with the myriad emotional and psychological problems that often accompany cancer diagnosis and treatment. Like it or not, oncology social workers provide the bulk of mental heath services to people with cancer and their families, and we happen to be very good at it.
According to the Substance Abuse and Mental Health Services Administration, “professional social workers are the nation's largest group of mental health service providers.” Where oncology is concerned, we are specialists in identifying those among the cancer population who are at high risk for difficulties in coping and helping them to identify problem solving strategies in support of their adaptation to a life-altering illness experience.
Patients are viewed from a very holistic and “strengths” perspective, meaning that it is within their capability to master the skills necessary to cope with cancer. For some people, psychosocial education is all that is necessary, as in “these are some ways other families have tackled these problems.”
For others, the interventions might include a more intensive level of service delivery, based on preexisting family dysfunction, history of poor coping, socioeconomic difficulties, cultural factors that influence how people adapt to illness, etc. This is not psychological “hand-holding”—it is the ability to accurately assess a person's needs and apply those interventions that will help them best manage the medical crisis they are experiencing with the least amount of emotional damage.
I suggest that most of the work we do should be based on a prevention model—how can we help families avoid the kinds of problems that will make coping more difficult? People don't come into this world knowing how to cope with cancer, but these skills are “learnable”—it is the role of the oncology social worker to help patients “problem solve,” based on our experiences with the demands of the illness along with an inherent belief in the ability of people to cope with life's adversities.
For instance, the simple question, “What do you plan to tell your children about your illness?” sets up a problem-solving scenario that is designed to empower people to include their children early in the cancer experience in a way that feels safe to the parent. Thus, we have the opportunity to educate parents about how to best help their children cope, avoiding the phenomenon of a possible school phobia because the child with inadequate information is afraid of what's happening to Mommy at home.
This is a little more complicated than Dr. Holland's view of the social worker dealing with “practical” problems and the “mental health professionals” with everything else. Why would oncology social workers need, at a bare minimum, to be master's-prepared to practice their profession if all we had to offer patients is assistance with practical problems?
There is a skill required in even getting patients to the point that they can accept help, which is what makes what we do different from the efforts of a concerned friend or neighbor.
It is also within our expertise to monitor the patient's utilization of and experience with the interdisciplinary team. We play a key role in facilitating communication among team members so that patients can efficiently utilize the specific contributions of each discipline and experience maximum benefit from each professional's interventions.
The process of how cancer care is delivered and experienced is ultimately in the best interests of improved quality of life for patients and their families and a valuable component of the repertoire of services social workers bring to the illness experience.
I do not understand taking snipes at another professional discipline. Patients have enough problems that they can benefit from the specific talents of each professional discipline involved with them. We needn't waste our energies engaging in turf battles. They deserve the very best we have to offer, as they are fighting for their lives. They need professionals who are secure in who they are and who can totally engage with them in their fight for survivorship. A little professional respect does not seem to be too much to ask.
Joan F. Hermann, LSW
Director Social Work Services Fox Chase Cancer Center Member, OT Editorial Board