Workshop Descriptions

Thursday, 14 February 2013 - Morning Sessions (8:00 am - 12:30 pm)

Meaning-Centered Psychotherapy in Cancer

Chair: William Breitbart MD, Memorial Sloan-Kettering Cancer Center

Speakers: William Breitbart MD, Memorial Sloan-Kettering Cancer Center; Allison Applebaum PhD, Memorial Sloan-Kettering Cancer Center

Target Audience: Researchers, Clinicians, Advocates, Graduate Students, Trainees

Intermediate – Expert

This four hour experiential workshop provides an overview of a novel counseling intervention for patients with advanced cancer, titled “Meaning Centered Psychotherapy.” Participants will be introduced to the topics of meaning and spirituality as they relate to cancer care and the experience of patients with cancer. The basic concepts of Meaning Centered Psychotherapy will then be described. Meaning Centered Psychotherapy is based on the concepts of meaning as derived from the work of Viktor Frankl MD and adapted for use in cancer populations by our team at Memorial Sloan-Kettering Cancer Center. Two forms of Meaning Centered Psychotherapy have been developed: Meaning Centered Group Psychotherapy (eight weekly one and one-half hour sessions; Individual Meaning Centered Psychotherapy (seven weekly one hour sessions). Both interventions are manualized, and randomized controlled trials are currently being conducted. Preliminary data from these studies will be presented as well. During the workshop participants will have the opportunity to participate in experiential exercises used in Meaning Centered Psychotherapy.

Hands on Experience in How to Build Integrated Interdisciplinary Supportive Care Programs of Patient-Centered Care

Chair: William Redd PhD, Mount Sinai School of Medicine

Speakers: Matthew Loscalzo LCSW, City of Hope; Paul Jacobsen PhD, Moffitt Cancer Center; Karen Clark MS, City of Hope

Target Audience: Researchers, Clinicians, Advocates, Administrators, Educators, Leaders

Beginner – Expert

Traditionally, supportive care programs have been built around silos fortressed by profession-based prerogatives that are perhaps more professionally driven and not fully patient centered. This model is not reflective of the way patients and families access services. If psychosocial professionals are to maximize the benefits from the growing awareness and acceptance of biopsychosocial domains, services must be provided that address the needs of institutions, patients, their family caregivers and the society at large simultaneously. Fortunately, there are evolving models for this endeavor.

This highly interactive workshop will build on the years of leadership experience and accomplishments of the facilitators in creating successful interdisciplinary supportive care programs. This unique workshop is organized to clearly demonstrate and to have the participants experience, first-hand, a staff leadership model that focuses on creating leadership opportunities for all members of the health care team in creating patient-centered programs. Under the guidance of the facilitators, small groups will be challenged to develop a comprehensive list of potential barriers related to their individual situations. The groups will then work together to develop a variety of creative strategies to identify and maximize strengths and opportunities unique to their settings.

Application of the Group Medical Visit Model to Cancer Survivors

Chair: Kristin Kilbourn PhD, MPH, University of Colorado Denver

Speakers: Linda Overholser MD, MPH, University of Colorado School of Medicine; Catherine
Janokowski PhD, University of Colorado Denver; Betsy Risendal PhD, University of Colorado Denver; Andrea Dwyer, The Colorado School of Public Health

Target Audience: Researchers, Clinicians, Administrators

Beginner – Intermediate

As cancer is evolving to fit more with the chronic disease model of care, WIN (What is Next) is a group medical visit intervention for survivors delivered by interdisciplinary providers to improve the management of treatment-related side-effects and chronic disease symptoms. WIN uses evidence-based strategies of goal setting and tailored one-on-one counseling for health behavior change, and is “problem-focused” rather than “information driven.” The workshop will present an overview of the topics covered in the six session WIN intervention. Additionally, participants will learn about the process of developing, delivering and evaluating a medical group intervention program. The workshop will also present valuable information regarding the process of implementation, cost effectiveness of the program , downward revenue generation and dissemination. Practical issues such as marketing, facilitator training, and billing procedures will also be discussed. The workshop will include a discussion of the challenges of developing and delivering a new model of care for cancer survivors and will present some of the lessons learned. This interactive workshop will involve interdisciplinary presenters representing primary care, psychology, public health and exercise physiology. The workshop will include interactive presentations, clinical demonstrations and role-playing. Participants will leave this workshop with a greater understanding of the group medical visit model as well as ways to apply this novel evidence-based approach to cancer survivors.


Thursday, 14 February 2013 - Afternoon Sessions (1:30 pm - 6:00 pm)

Teaching a Psychotherapy Designed for Elders: The Care Model
(2 hours, 1:30 pm - 3:30 pm)

Chair: Jimmie Holland, MD

Speakers: Chris Nelson, PhD, Memorial Sloan-Kettering Cancer Center; Andy Roth, MD, Memorial Sloan-Kettering Cancer Center; Elizabeth Harvey, PhD, Memorial Sloan Kettering Cancer Center; Mark Moore, PhD, Joan Karnell Cancer Center at Pennsylvania Hospital

Target Audience: Clinicians

Intermediate

This workshop will teach attendees how to deliver a psycotherapy intervention designed specifically for elders with cancer, the CARE MODEL (Cancer and Aging: Refections for Elders). Based on Erikson’s concepts and from interviews with “expert” elders, this 5 session intervention has been developed and its feasibility and tolerability tested in a telephone format. Data from the first 36 patients, followed at 2 months, showed that those who received the intervention, as compared to standard care, had reduced depression and anxiety, demoralization and loneliness with an increase in coping and spiritual well being. Effect sizes were small to moderate (d=.2 to .5). The CARE Model concepts are applied to a clinical ongoing group, the Cancer and Aging Group, where innovations can be tried and tested. A subgroup now participate in the Vintage Readers Book Club, in which classics from the literature are being read and discussed as a way to stimulate an activity at home and to view current issues, personal and social, from a broader historical perspective. The workshop will have two parts: (a) Background for psychotherapies in elders and background for the CARE MODEL with presentation of preliminary results from 50 patients by the time of the workshop; and, (b) Presentation of the manual and the content of each session with role play to illustrate how to conduct the key sessions on loss iolation. Innovations and other formats for delivery will be discussed, as well as opportunities for collaboration.

Palliative Care

Chair: William Pirl MD, MPH, Massachusetts General Hospital Cancer Center

Speakers: Scott Irwin MD, PhD, Institute for Palliative Medicine at San Diego Hospice; Joseph Greer PhD, Massachusetts General Hospital Cancer Center

Target Audience: Clinicians

Beginner

Over the last decade, palliative care has been growing in terms of both number of programs and acceptance within healthcare. Palliative care improves quality of life, reduces the cost of care, and may even extend the survival of patients with advanced cancers. Psychosocial oncology and palliative care overlap in their care of patients with advanced cancers, and this workshop focuses on the role of mental health clinicians in palliative care. Didactics, case-based learning, and skills training will be used in this workshop. Dr. Scott Irwin, Chief of Psychiatry and Psychosocial Services at San Diego Hospice and The Institute for Palliative Medicine, will provide an introduction to palliative care and systems of care for patients at the end of life. He will describe the development of a mental health service within a hospice system and identify roles for mental health clinicians in delivering palliative care. Drs. William Pirl and Joseph Greer from the Massachusetts General Hospital Cancer Center will describe the practice of early palliative care for patients with metastatic cancer from their trial with Dr. Jennifer Temel, published in the New England Journal of Medicine, and the components that can be delivered by mental health clinicians. Drs. Irwin and Pirl will present cases that illustrate the diagnosis, treatment, and management of psychiatric disorders that are common in patients with cancer at the end of life. These cases will include depression, anxiety, and delirium. Standard cognitive behavioral models need to be adapted for patients with terminal cancers, and Dr. Greer will teach an evidence-based cognitive behavioral therapy he developed for the treatment of anxiety in patients with metastatic cancers. In addition, a detailed description of the intervention and the content of each session will be provided.

Interdisciplinary Professionalism in Psycho-Oncology: Modeling Patient-Centered Collaborative Care

Chair: Donald L. Rosenstein MD, University of North Carolina

Speakers: Matthew Loscalzo LCSW, City of Hope; Selma Schimmel, Patient Advocate, Vital Options International

Target Audience: Researchers, Clinicians, Advocates, Educators, Administrators

Discipline-related sub-specialization provides the context for competent and ethical professional practice but may also interfere with the teamwork, diversity and inherent creativity of a diverse group of professionals working together toward common goals. The lack of integrated interdisciplinary teamwork may also result in role diffusion and clinical work that is plagued by confusing, conflicting, competitive, redundant and inefficient activities. The diverse faculty (psychiatrist, psychologist, patient advocate and social worker) will address professionalism issues through the lens of interdisciplinary training, roles and responsibilities specific to supportive care clinicians. The barriers and potential synergies to patient and family centered care will be explored within the context of a rapidly evolving health care system that will increasingly require integration of effort that is coordinated and evidence-based. This workshop will apply an interactive adult learning model to identify and discuss core elements and quality indicators that should drive any supportive care program. Participants will also be encouraged to share experiences, resources and create an ongoing supportive network.

How to Use Cognitive Therapy to Help People With Cancer

Chair: Tomer T. Levin MD, Memorial Sloan-Kettering Cancer Center

Speakers: Allison J. Applebaum PhD, Memorial Sloan-Kettering Cancer Center

Target Audience: Clinicians

Intermediate

Cognitive Therapy (CT) is increasingly being used by clinicians to help patients cope with cancer diagnosis, treatment, and survivorship. A large and growing body of literature has demostrated the efficacy and effectiveness of cognitive therapy in addressing the concerns of cancer patients across the illness trajectory, including anxious, depressive, and post-traumatic symptomatology, insomnia and cancer related fatigue, and adherence to cancer treatment. This workshop will give clinicians basic CT tools that may be used to address the various conerns of patients at all stages of their illness.

This workshop is divided into five lectures. Lecture I, Principles/Formulation of CT in Psycho-Oncology, focuses on how principles of CT are applied and modified in psycho-oncology and how they are used to promote adaptation across the cancer trajectory. This lecture includes an interactive formulation exercise that allows participants to create and discuss a cognitive conceptualization (including the identification of core and intermediate beliefs and automatic thoughts) of a case presented to the group. Lecture II, Starting Treatment: Coping and Reframing, discusses specific CT techniques to help patients cope with cancer, including reframing thoughts and images, decatastrophizing, reviving hope, problem-solving, and concerns around seeking second opinions and fear of recurrence. This lecture ends with two role-play exercises in which participants are invited to play the cognitive therapists working with two patients (portrayed by the workshop leaders). Lecture III, Behavioral Strategies, focuses on behavioral strategies (i.e., behavioral activation, relaxation/breathing, exposure/self-injection) and psychoeducation, key components of comprehensive CT programs in psycho-oncology. This lecture also ends with two role play exercises, which encourage participants to use specific behavioral strategies targeted towards the unique needs of cancer patients (i.e., how to work with a patient who misinterprets breathlessness as a sign of advancing lung disease, or a patient with MRI claustrophobia). Lecture IV, Dying and Bereavement Issues in CT, focuses on how to discuss death and dying using a a CT framework, the important distinction between normal bereavement and pathological grief, desire for hastened death and suicide (risk, prevention, and safety plans) in cancer patients, as well as the clinician’s emotional reaction (CER/countertransference), and how clinicians’ feelings impact work around these challenging topics. Lecture V, New Directions for CT in Psycho-Oncology: Prognosis, Resilience, Self-Injection, Stem-Cell Transplants, covers critical topics in psycho-oncology, including prognosis/prognostic awareness, realistic optimism, and resilience, and the use of CT when working with patients receiving stem cell transplants. This final lecture also covers termination and important countertransferntial issues which often arise when concluding CT with patients with cancer.

Facing The Mirror: Treating Adult Cancer Patients Struggling With Body Image Changes And Disfigurement (2 hours, 4:00 pm - 6:00 pm)

Chair: Michelle Cororve Fingeret PhD, MD Anderson Cancer Center

Speakers: Erin Buck PhD, MD Anderson Cancer Center; Wyona Freysteinson PhD, MN, Texas Woman’s University, College of Nursing; Amy Deutsch, DNP, RN, CNS, AOCNS, Memorial Hermann Healthcare System

Target Audience: Clinicians

Beginner – Expert

This workshop is designed for clinicians across a variety of disciplines who work with patients experiencing distress about body image changes resulting from cancer and its treatment. The session will include conceptual models of disfigurement and body image that have been applied to the oncology setting. Presenters will discuss a breadth of empirically validated treatment strategies for the treatment of body image disturbance as well as new found evidence that supports the use of mirror interventions for further clinical research in this population. This will include problem-solving, cognitive-behavioral, mindfulness and acceptance and commitment-therapy based approaches. Particular attention will be given to identifying practical strategies to assist patients with mirror viewing following disfiguring cancer treatments. Our discussion of treatment strategies will focus on unique roles that each member of a multidisciplinary treatment team may take in assisting patients with body image distress. In addition to providing hands-on practice with different intervention strategies, we will also provide a number of education handouts to facilitate use of these strategies in the clinic setting. We will discuss community resources that can be provided to patients struggling with body image concerns.