Teresa L. Deshields, Ph.D., ABPP, is a licensed clinical psychologist and clinical associate professor in the departments of medicine and psychiatry at Washington University School of Medicine in St. Louis. She is a Fellow of the American Psychosocial Oncology Society and its past-president.
She was the manager of the Siteman Counseling Service for the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital for 20 years. Her clinical practice is devoted to treating cancer patients and survivors and their family members, throughout the cancer continuum – diagnosis, treatment, survivorship, end of life, and grief. Her research is focused on issues related to psychological adjustment and quality of life in cancer patients and survivors.
Financial: Teresa Deshields is a clinical associate professor at Washington University School of Medicine. She receives a speaking honorarium from PESI, Inc.
Non-financial: Teresa Deshields is a member of the American Psychological Association.
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- Determine the psychological challenges for the medically ill and their family caregivers.
- Choose psychological/behavioural interventions to address psychological distress and distressing symptoms.
- Point out challenges in communication with different disciplines.
- Specify the differences between supportive care, palliative care and hospice care.
- Utilize mindfulness-based strategies, ACT and CBT tools to decrease symptoms of pain, nausea, fatigue and insomnia.
- Assess the psychological, social and behavioural factors that contribute to chronic illness and articulate their treatment implications.
Establishing Whole Person Care
- Formal assessments to identify physical and emotional stressors
- How to ask “What do you think is wrong”
- The client who considers their problem only medical and isn’t open to behavioural interventions
- Setting a collaborative agenda
- Addressing quality of life concerns
Psychological Distress in the Medically Ill
- Manifestations in medical populations
- Distress screening tools
- Balance efficiency with depth
- Identify changing feelings related to disease progression
- Is it really “expected” after diagnosis of an illness?
- What to do when symptoms of disease overlap with signs of depression
- Measuring depression
- Cognitive-Behavioral Therapy interventions
- Creating balance with ACT
- Establish an integrated approach
- Forms of anxiety that are particularly prevalent in medical illness
- Assessment measures
- Interventions when anxiety threatens tolerance for treatment
- Specific mindfulness and relaxation therapy exercises and scripts
- CBT tools to address worry and illness related anxiety
- Strategies to address: “I’m not the same physically and emotionally …”
- Tools for releasing negative and obsessive thinking
- Working with the emotions and turmoil of Anticipatory Grief
Behavioural Interventions for Physical Symptom Management
- Addressing physical issues
- Motivational interviewing to help the client process lifestyle changes
- Self-management skill development
- Strategies to minimize symptoms
- Help the client determine the what and how of symptom relief
- Addressing pain with ACT
- Exercise recommendations for fatigue
- Increase the likelihood of adherence
- CBT for insomnia
- Mindfulness techniques for nausea
- The clinicians “tool box” for symptom management
- Ensure a wide array of options
- Determine the next step
End of Life Considerations
- Quality vs. quantity of life
- Assessing patient preferences
- The difference between supportive, palliative, and hospice care
- Managing family disagreements related to treatment options
- What about family dysfunction
- Decision to withhold or withdraw care
- With clients
- Client-centered communication
- Breaking bad news with the SPIKES protocol
- With healthcare professionals
- Efficient but effective interprofessional communication with the SBAR method
- Sharing information without breaking confidentiality
- Sociodemographic changes & changes in medical care that make caregiving even more challenging
- Impact of the family caregiving on the caregiver’s health
- Caregiver psychological issues
- Prevalence of depression and anxiety in caregivers
- Relationship with client’s distress
- Financial toxicity
- Limitations of the research and potential risks
- Social Workers
- Occupational Therapists
- Marriage and Family Therapists
- Case Managers
- Physical Therapists
- Physical Therapy Assistants
- Nurse Practitioners
- Other Helping Professionals
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