Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology

“When people with PTSD [post-traumatic stress disorder] get quite avoidant—and that can be expressed in so many different ways—the implications can be really profound. I think an important invitation to oncologists and oncology nurses and primary care providers who care for people battling cancer is let’s explore what's underneath these avoidant behaviors. Is it a very practical thing? Or is it that underneath this avoidant behavior is really profound fear?” James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN™, oncology clinical specialist at ONS, during a conversation about addressing medical trauma in oncology.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 31, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to medical trauma in oncology care.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
• Episode 421: Medical Trauma in Oncology
• Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
• Episode 264: Stop the Stressors and Improve Your Mental Health as a Nurse
• ONS Voice articles:
• Help Caregivers Control the Chronic Stress of Cancer Care and Manage PTSD [post-traumatic stress disorder]
• Past Trauma Lowers Hope, QOL, and Coping Ability During Cancer
• Managing Cancer-Related PTSD Starts With Acknowledgement
• Moral Injury and Trauma in Nursing
• Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress
• Clinical Journal of Oncology Nursing articles:
• How Can a Trauma-Informed Care Approach Be Applied to Patients With Gynecologic Cancer?
• Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach
• Oncology Nursing Forum articles:
• Post-Traumatic Distress and Symptom Experience in Patients With Head and Neck Cancer–Related Tracheostomy and Family Caregivers
• The Effect of Neuroticism, Fear of Progression, and Self-Efficacy on Post-Traumatic Growth in Patients With Lung Cancer Undergoing Chemotherapy
• The Relationship Between Colorectal Cancer Survivors’ Positive Psychology, Symptom Characteristics, and Prior Trauma During Acute Cancer Survivorship
• ONS course: Psychosocial Dimensions of Cancer Care™
• ONS Huddle Card: Coping
• Screening tools
• Clinician-Administered PTSD Scale for DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, 5th edition] (CAPS-5)
• Hospital Anxiety and Depression Scale
• Primary Care PTSD Screen for DSM-5
• PTSD Checklist for DSM-5
• Trauma Screening Questionnaire
• International Society for Traumatic Stress Studies: Free Resources
• PESI
• Reclaiming Your Life From Medical Trauma by James C. Jackson

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“For many people who have been traumatized, if they can avoid it, they will. They may not avoid the annual evaluation that is so hugely consequential—they might not avoid that. But they may well avoid a routine visit for a checkup to their oncologist. They very well may avoid a visit with a psychologist who is wanting them to talk about hard things. They may avoid visiting a friend in the hospital because it reminds them of really upsetting things. So, this issue of adherence and compliance is a really big problem.” TS 3:19

“Screening tools for things like PTSD can be very useful. They’re quite practical, and they’re appropriate to use. I really like something called the Post-Traumatic Stress Disorder Checklist. ... Using it is going to be very straightforward. You’re going to want to map it onto a 30-day window, and you’re going to employ it with patients. It’s a 20-item self-report. It assesses 20 DSM-5 symptoms of PTSD. It’s not diagnostic, but if people score in this range of 30, 31, 33, we typically are going to believe that that is very suggestive of significant PTSD.” TS 9:17

“One of the things we should be doing all the time is modeling and attempting to normalize this idea of being open about mental health difficulties. When I say modeling, this is a complicated issue. ... I’m very open talking about my own battles with mental health. And in some ways, that invites my patients to do the same. I don’t recommend necessarily that a nurse says, ‘Oh, by the way, I have PTSD. I’m going to tell you about mine. I want you to tell me about yours.’ That’s a boundary issue. But I think it does behoove us as clinicians to create a culture as much as we’re able, where we can talk about mental health difficulties in a matter-of-fact way, acknowledging that mental health is health. These tools, to me, go a long way in that direction.” TS 13:41

“The survivorship process is ongoing. I think a nurse can assist a patient in so many ways longitudinally over time. ... One of those ways is to continue checking on mental health outcomes in patients. Continuing to check on mental health outcomes, continuing to explore them, and continuing to invite patients to talk about things that other people might not be asking about. It’s easy for family members to assume, ‘Hey, you know, you’re cancer free now. You look fine, so you must be fine.’ It’s very possible that the patients we’re talking about are not fine. They’re far from fine. For that oncology nurse at a follow-up clinic or in an oncology setting to talk about this, continuing to affirm that it would be okay for patients to struggle, continuing to put this issue on a front burner—I think that’s really important.” TS 21:17

“I’m aware of nurse-led support groups where nurses can talk very freely about their own challenges, in a safe space. ... Working to build cultures in the context of the intensive care unit, let’s say, where we have a lot of patients with cancer that prioritize well-being nurse driven programs. ...  The bottom line is if there is a warning light that is blinking, nurses need to attend to that. And in attending to it, they’re going to be more present for their patient. They’re going to be better able to support their patient. They’re going to be better able to support each other. And I think often, in the culture of nursing and psychology, too, people just put their head down, their shoulder down, and they just plow through in ways that are really counter to their mental health.” TS 29:56

“The truth is medical trauma can be well-managed. It’s not simple. It’s not always intuitive. There are all sorts of caveats with regard to this, but the truth is people with medical trauma can live really rich and meaningful lives. ... So, the default setting, I think, should be not one of pessimism. It should be that people with medical trauma can and do get better. If you are a patient with medical trauma and you are in my purview, until proven differently, I’m going to assume that you can get better too.” TS 36:28