Clinical experiences of working in oncology and palliative care

I have worked in oncology and palliative care for ten years now, as a cognitive behavioural therapist on a chemotherapy unit as part of an acute service. When I qualified as a counselling psychologist, I moved into a role that covered both acute and community care. 

In this article I share my reflections of my experience of working with this client group.

Psychological support for patients

There is plenty of NICE guidance on the nature of support that should be available for patients experiencing cancer and / or palliative care. For instance Macmillan is just one of the national charities that specialises in providing support and guidance for such patients and their families. With cancer diagnoses on the increase this support is becoming increasingly valuable.
 
From a psychological perspective there is so much that patients and families experience, from potential diagnosis to treatment and beyond. This includes the uncertainty of their health for the future as well as the impact it can have upon their relationships and finances. Common themes can include the fear of recurrence, the impact of treatments, and the uncertainty around death. 

Psychological support can be in the form of supportive sessions with the presence of someone who isn't going to judge them. Here the patient can share their inner thoughts with an outsider, which they may find easier than with their loved ones as usually there is a desire to protect them. Alongside this different therapeutic modalities can be used to support patents. Some of these are mentioned in more detail further on. 

A person centred approach

An expectation patients will often put on themselves is 'my treatment is now complete and I should be ok'. This can be reflected in others' expectations of them too. However, lot of people don't fully process their emotions until their medical care starts to complete or reduce. 

A person-centred approach can work well with such patients. The likes of CBT, EMDR and hypnosis can be considered, alongside exploratory work that may lead to incorporating other therapies. 

I also do group work with patients on managing stress mindfully, fatigue, anxiety and sleep, and sometimes include their loved one in the sessions. There are other groups run within the service too, including a men's group, as usually more women are open to having these conversations than men.

Working with a team

In terms of staff support, I deliver clinical supervision to groups of colleagues who support these patients. They are predominantly clinical nurse specialists, but they can also be allied health professionals and medical doctors. Alongside this I am also involved in delivering teaching and training to help supporting patients and their families emotionally.
 
Working within a wider integrated team is very helpful as there is a great source of support there. As a team we are able to support each other in a number of ways, including multi-disciplinary team meetings.

The emotional impact of my work

One of the main difficulties I have experienced in working with this client group is the emotional impact it can have upon myself when a patient's health is deteriorating, and they have been told they don't have long left to live. This can be quite emotive to work with especially if you are also indirectly supporting their family members too. 

There's an added element too. As humans we have our personal lives to consider, as there could be something similar in our own lives mirroring our work content. Therefore, self-care is key for us as psychologists to ensure we are not leading to burnout. Identifying triggers and managing this as soon as possible by using self-care measures is vital to ensure that we can keep giving our best at work, especially with a client group like this.
 
Overall, I find working with my clients extremely rewarding - most are very grateful for any support they receive from professionals. Alongside managing their physical health, they are managing their mental health too. I feel privileged to be able to be a part of the patient's journey. 

Being mindful of burnout is very important but when you have been working in this area for a while identifying triggers can start to become a little easier. The take home message here is about providing compassion to yourself so you're then able to provide such compassion to others. 

Dr Sindeep Lehl is a Principal Counselling Psychologist, working within the NHS. She specialises in physical health, especially in cancer & palliative care as well as obesity, and is a member of the BPS, BABCP, SIGOPAC, and the EMDR academy.