Psychosocial Oncology and Palliative Care

Psychiatry

POPC Overview | Our Team

Psychiatry is one discipline within the core group of Psychosocial Oncology and Palliative Care (POPC). As such, it shares in the mission, vision, values and organizational structure of Psychosocial Oncology and Palliative Care.

The Psychiatry Coordinator facilitates the integration and organization of the clinical psychiatry service at Princess Margaret Hospital. As well, the Psychiatry Coordinator facilitates the flow of consultations. Psychiatry has a representative on the executive and other committees within POPC.

Psychiatrists have a line reporting relationship to the Chief of Psychiatry, University Health Network with respect to professional practice and to the Director of the Psychosocial Oncology Program for activities and responsibilities within the program.

As with other disciplines within the POPC, Psychiatry strives to have representation and become an integral component of care within each of the cancer treatment site.

The Clinical Service - Functions
Psychiatry consultation in the oncology setting involves:

• Psychiatric disorders/symptoms: assessment and treatment such as depression, mania, delirium, anxiety, sleep disturbances and psychosis;
• Symptom management: assistance with the assessment and treatment of physical symptoms such as pain, nausea, anticipatory nausea and vomiting , anorexia, sexual dysfunction, fatigue, etc;
• Psychological issues: assessment and treatment of psychological concerns like altered self-concept, body image, changed or problematic interpersonal relationships, existential issues and the meaning of cancer, denial, life disruptions, uncertainty, control, isolation, guilt, coping problems;
• Treatment crisis: legal issue, competency, treatment decision, adjustment to new diagnosis or new phase within cancer continuum, prolonged hospitalization, disengaging from the medical system during survivorship phase and end of life issues;
• Family issues
• Advocacy issues: communication with the healthcare team, difficulty with treatment decisions, competency evaluations;
• Rehabilitation issues: patients with difficulties achieving a stage of illness related recovery (apathy, noncompliance, lacking motivation) etc;
• Staff issues: management of difficult patients, staff stress.

Interventions
Types of interventions made by psychiatry include (but are not necessarily exclusive to psychiatry):

• crisis intervention
• individual psychotherapy
• group psychotherapy
• family therapy
• couples therapy
• psycho-educational work
• relaxation and stress-management
• advocacy
• psychopharmacology
• bereavement counseling
• referral to other resources within the POPC
• assist in referral to psychiatry resources in the community

Implementation
The psychiatrists work as part of an interdisciplinary cancer site and psychosocial teams. Patients are seen at any point within the cancer disease trajectory. The psychiatry service aims to provide continuity of care. Patients are generally followed by the same psychiatrist throughout their cancer care, as need dictates. For example some patients are followed continuously and others may choose to re-access the system at different nodal points or for different problems as the need arises. Emphasis is placed on early intervention in an attempt to prevent or minimize distress and suffering.