Chloe is a psychologist in the Northern Territory who has chosen to specialise in psycho-oncology. She talks about the importance of support groups and organisations and shares advice for health professionals on starting the conversation.
I had an interest in psychology and pursuing a career in this field from when I was quite young. It wasn’t so much a choice as just feeling very certain that this is what I wanted to do.
The rewards are many, especially in my chosen specialty area of psycho-oncology. Working with people and their families who are living with a cancer diagnosis feels very meaningful.
Whilst there are definite moments of sadness, it has always felt like a privilege to work with this group, to hear their stories and support them during an incredibly challenging time. Sometimes I’m the only person they share their fears and struggles with, and I don’t take that lightly.
The challenges can be seeing the emotional distress someone is experiencing and knowing you can’t ‘fix it’ for them. Clinically I like to have very open and honest conversations with people about their challenges or fears, which includes having discussions around fear of their own mortality and death and dying.
What should health professionals, particularly those treating people with breast cancer, look out for in their patients? What are the signs of distress, and what should they recommend as interim strategies while patients are waiting for mental health support?
Signs of distress can be very subtle in people with breast cancer, and some people minimise what they’re experiencing emotionally, especially if they are expecting themselves to ‘keep positive’ and not worry or burden others. I encourage health professionals to actively ask about a patient’s emotional well-being.
Check in to see if your patient subjectively feels their distress is higher than usual or if they are experiencing changes in mood. It’s important to check if they are communicating their feelings and fears with family/friends, or if they are trying to just push through on their own. Screening tools such as the National Comprehensive Cancer Network (NCCN) Distress Thermometer are helpful ways of identifying patients’ levels of distress and specific areas of distress.
Getting them in touch with local or national support services while waiting to be seen for a psychology appointment is important.
Sometimes I’m the only person they share their fears and struggles with, and I don’t take that lightly.
Move the discussion with your patient from the medical/physical by making a normalising statement such as: ‘It’s also really important that I’m not just checking in on you medically/physically. I was wondering if it would be OK if we had a chat about how you’re coping emotionally at the moment?’.
Then give them an opportunity to speak. If they deny experiencing any distress but you still have concerns, asking them to complete a screening tool can be helpful to identify any underlying areas of difficulty.
We as health professionals shouldn’t shy away from being direct with patients about mental health and emotions. If we’re uncomfortable or tip toe around it, then we’re sending the message that this isn’t an ok subject to discuss openly.
Patients face several challenges in terms of access to mental health services across the Northern Territory. For those in remote areas there are often very few mental health professionals who are close enough to have face-to-face consultations.
We acknowledge the importance of all patients having access to mental health services and have an agreement for patients in this area to be referred to our service without charge via Telehealth appointments.
The number of psychologists who practice in the area of cancer care in the NT is another challenge. I have been the senior psychologist in cancer care for the last seven years and the size of our team fluctuates, which is usual for Darwin as it can be a transient population.
Know what supports work best for you. ‘Self-care’ can be touted as a bit of a fix-it, and I agree that it’s important, but it looks different for everyone. Some people need to focus on those good daily-living routines of eating, sleeping and exercising, for others it is more complex than that.
See a psychologist if you need to and seek regular supervision with a senior clinician to safely and appropriately debrief following something challenging. Be aware of your own emotional triggers and don’t just suppress them. Implementing boundaries such as not being available 24/7 and not checking emails/messages routinely even when not at work, are also important.
Support groups and organisations can be incredibly important while waiting for psychology services, as well as throughout treatment.
People need to choose these with caution and be aware of the negative impact that misinformation can have. Facebook or other social media ‘support’ groups can seem helpful on the surface; however, people can be exposed to very biased information or just flat-out incorrect information which leads them to question their own treatment and whether it’s appropriate.
This is where resources such as BCNA's Upfront About Breast Cancer podcast series with Dr Charlotte Tottman can be so helpful. She gives incredible evidence-based and very accessible information and talks about realistic strategies.
You don’t need to decide where you want to work clinically straight away. Allow yourself time to work in a number of different specialties before moving towards a specific area of practice.
Don’t be afraid of applying for positions (like the ones we have available in Cancer Care and Top End Health currently!) because you think you aren’t experienced enough.
As senior clinicians we want to help grow our next generation of psychologists, and in most organisations, we are happy to teach and help you expand your clinical knowledge and skills.
I am a board approved supervisor and am always happy to have discussions with new career psychologists who have either started in the health sector or are curious about pursuing this. If this is you, please get in touch.
Samantha was diagnosed with stage three breast cancer in 2014, followed by metastatic breast cancer in 2019.
Alison shares her experience of living with breast cancer. From the intensity of diagnosis to the life lessons she’s learned along the way
Strategies to help those affected by an early breast cancer diagnosis
Reduce stress and enhance wellbeing during breast cancer care
Let’s be upfront about behavioural changes.
Let’s be upfront about the challenges for those living with metastatic breast cancer.
Let’s be upfront about anxiety in a cancer context.