Mental Health and Cancer Addressing Caregiver Needs

Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com Mental Health and Cancer Addressing Caregiver Needs
CEUs are available at https://www.allceus.com.
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Objectives
- Explore the unique needs of loved ones and caregivers of people with cancer
Diagnosis
- 650,000+ people die of cancer EACH year
- When someone is diagnosed, the patient and loved ones grieve
- Even if the cancer is “cured” or goes into remission there may be lasting disabilities and/or losses
- Loss of security (health anxiety in the patient and SOs)
- Loss of function or changes in appearance
- Cognitive impairment (“chemo-brain”) impacts attention, working memory, executive function, and processing speed
- Unmet needs of caregivers and patients were associated with increased physical symptoms, anxiety, and reduced QoL
- Not everyone experiences grief in the same way
- Families need to be educated about the grief bill of rights
Bill of Rights for Cancer-Related Grief
- To know the truth and have questions answered honestly
- To be heard with dignity and respect and able to talk about it as much as needed OR to be silent and not talk about emotions and thoughts.
- To not agree with your perceptions and conclusions
- To see the person with cancer
- To grieve in my own unique way without hurting self or others
- To feel all my feelings and to think all my thoughts
- To not have to follow the “stages of grief” as outlined in a book
- To be angry at death, cancer, the patient, god, myself, and others
- To have “griefbursts”
- To not be taken advantage of
- To feel guilt
Unmet Needs
- Prominent unmet needs
- Fatigue
- Due to around the clock caregiving
- Due to insomnia associated with grief
- Nutrition deficiencies
- Blood sugar
- Coordination of services
- Emotional support
- Anxiety
- Anger
- Anticipatory grief

- Guilt over
- Past issues
- Being happy
- Being informed about:
- Benefits and side-effects of all treatment options
- Illness information (causes, course, care) (esp. men)
- Information about preventive, maintenance & restorative strategies
Other Unmet Needs
- Current Caregivers
- Managing daily activities
- Maintaining intimacy with partner
- Managing emotions about prognosis
- Balancing own needs and patient’s needs
- Impact of caring on work
- Making decisions in the context of uncertainty
- Financial concerns
Other Unmet Needs
- Former Caregivers (up to 5 years post remission)
- Managing emotional distress
- Intrusive thoughts about cancer coming back
- Managing interpersonal relationships
- Reducing patient stress associated with cancer
- Medical
- Stress related illnesses
- Consequences of neglected health
- Financial
- Daily activities—Getting their groove back
Other Unmet Needs
- Bereaved Caregivers
- Guilt over perceived failings with the patient or family
- Working through the grief process
- Reintegrating into daily life

Cancer-Focused Cognitive Processing
- Contextual Facts about…
- This illness in this patient at this time
- The loss of this patient at this time
- Addressing Cognitive Distortions
- All or nothing thinking
- Catastrophizing
- Personalization
- I should be able to make her comfortable
- It is my fault that…
- I made her angry (displaced anger; cognitive issues)
- Mind reading

Cancer-Focused Cognitive Interventions
- Distress Tolerance (TAGS)
- Thoughts
- Activities
- Guided Imagery
- Sensations

Other Issues
- Paternalization of the patient
- Needing assistance explaining things to children
- Coping with child behavior issues
- Health anxieties
- Separation anxiety
- Increased behavioral problems
- Refusal to go to bed
- Magical thinking

Summary
• Counselor Interventions
• Information provision (informing individuals use verbal and written)
• Support (acknowledging experience, connecting with others; facilitating expressions of feelings or emotions)
• Encouraging acquisition of new coping skills and promoting emotion regulation and distress tolerance
• Spiritual or existential therapy to help the person find meaning