Episode 434: Oncology–Psychiatric RN Collaboration to Support Psychosocial Health

“Nurses are the front line. Oncology nurses see their patients almost all day. If you’re noticing that anxiety is causing significant distress or anxiety is disrupting a patient’s ability to concentrate during medical conversations or decision-making—anytime you’re seeing significant distress or disruption to functioning, that’s a pretty good indicator that referral to a psychiatric nurse and psychiatric care could be very helpful for that patient,” Amber Altidor, DNP, APRN-FPA, PMHNP-BC, assistant professor at Rush University College of Nursing and psychiatric nurse practitioner at Optimal Mental Health PLLC and Rush MD Anderson Cancer Center in Chicago, IL, told Katie Hubbard, MSN, RN, OCN^®, NPD-BC, oncology clinical specialist at ONS, during a conversation about oncology and psychiatric nurse collaboration to support psychosocial health.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD), by listening to the full recording and completing an evaluation at courses.ons.org by September 25, 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 of how oncology nurses can collaborate with psychiatric nurses to support the psychosocial health of people with cancer.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
  • Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology
  • Episode 421: Medical Trauma in Oncology
  • Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
  • Episode 240: Spirituality in Cancer Care
  • Episode 219: Use Acupuncture and Acupressure to Manage Cancer Symptoms and Side Effects
• ONS Voice articles:
  • Anxiety and Depression Are Biggest Concerns for Patients With Cancer, Survivors, Caregivers
  • AYA Cancer Survivors Experience Five Times Higher Depression Rates Than Individuals Diagnosed at Older Ages
  • Guidelines Define the Role of Integrative Oncology Care for Managing Anxiety and Depression in Adults With Cancer
  • Natural Language Processing Can Tell You Which Patients May Benefit From Psychosocial Referrals
  • Physical Activity, Psychological Care Reduce Cancer-Related Fatigue
  • What Assessment Tools Are Used for Patients With Cancer and Psychiatric Diagnoses?
• ONS course: Psychosocial Dimensions of Cancer Care^™
• Clinical Journal of Oncology Nursing articles:
  • Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach
  • Psychosocial Distress Screening: An Educational Program’s Impact on Participants’ Goals for Screening Implementation in Routine Cancer Care
• Oncology Nursing Forum articles: 
  • Effects of Expressive Writing on Psychosocial Symptoms and Quality of Life in Patients With Breast Cancer: A Systematic Review and Meta-Analysis
  • Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers
  • The Distress Thermometer: Cutoff Points and Clinical Use
• ONS Symptom Management Resources: 
  • Anxiety
  • Depression
  • Fatigue
• ONS Coping Huddle Card
• American Cancer Society: Therapy, Counseling, and Support Resources for People With Cancer
• American Psychological Association: Patient Health Questionnaire-9 (PHQ-9)
• American Psychosocial Oncology Society: 
  • Distress Screening
  • Resources for Psychosocial Oncology Professionals
• Columbia-Suicide Severity Rating Scale (C-SSRS)
• Generalized Anxiety Disorder 7-Item (GAD-7) Scale
• National Comprehensive Cancer Network 

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 [email protected].

Highlights From This Episode

“Cancer is traumatic. It’s sudden. And many patients have not previously had a serious health condition, so in the beginning, they’re just kind of focused on survival. Get the biopsy done. Have the conversations with teams. Have the imaging that’s recommended. Many, many appointments. The medical appointment burden is very high. Sometimes patients are not processing what’s happening in the moment. Sometimes we also see some lingering symptoms of trauma as care goes on as well. Sometimes patients are having intrusive thoughts and flashbacks to their cancer experience too.” TS 4:55

“The National Comprehensive Cancer Network, or NCCN as we commonly refer to it, created a distress thermometer that can be provided to patients each during each encounter at a cancer center. It has an actual written thermometer on it where patients can rate their distress from 0–10: 0 being none, 10 being the most extreme that they could imagine. A score of 4 or higher for most cancer centers would indicate that the patient needs further evaluation and referral to psychosocial or supportive care services. There’s also a section on the distress thermometer handout where patients can identify specific areas for concern. And that’s really helpful for the healthcare team because we can take a look at exactly what that patient is noting as contributing to their distress.” TS 9:33

“When we start to notice that there are significant sleep issues that are not responding to just psychotherapy on its own, or if there is significant depression, anxiety symptoms that are moderate to severe, or other underlying psychiatric concerns that are more chronic in nature ... at that point, it’s important for the multidisciplinary team to start thinking about a referral to psychiatry and medication management. Medications can be very effective for treating those symptoms, so it’s important for nurses to assess using the skills that we discussed to identify those categories for severity and think about medication management at that point.” TS 16:01

“I think that it’s important to remember that there’s a stigma about cancer, but there’s also a stigma about accessing mental health care as well. As nurses, we definitely want to be aware of that and address that with patients. Do you have any specific concerns about what it means to be someone who is seeking therapy services or someone who’s seeking medication for symptom management? What does that mean to you, to your community, to others in your religion? Talk with me about this stigma that you’re experiencing. Patients need a chance to process that. Oncology nurses certainly can identify if a patient has some ambivalence towards seeking psychosocial care and explore that with them or refer them to a therapist or a psychologist.” TS 23:09

“Grief is not linear, so it’s important to educate patients after you tell them about the stages that we talked about earlier. Remind them that grief is not linear. It’s very common to at one time feel like you’re angry, and then also feel sad, then also go back to a sense of, ‘This is not real. This is not happening.’ So remind your patients that it’s not linear. This is something that we can continue to talk about, continue to process, so that they can feel a sense of acceptance. We don’t want grief to become complicated and just kind of persist long term. We talked about how there’s that survival mode that patients are in, so they don’t always have a chance to process in the moment.” TS 30:14