Cancer/Psychosocial Oncology

Interns on this rotation will be part of the Oncology Behavioral Health Team within the Cancer Patient Support Program. The rotation is based on a scientist-practitioner model of training and is comprised of clinical and research activities that address the psychological, social, behavioral and symptom management needs of cancer patients.

The intern will gain experience in the role of a psychologist on a medical team and learn how to collaborate within and contribute to a multidisciplinary team.

Clinical activities are conducted as part of the Duke Cancer Patient Support Program and the Duke Adult Blood and Marrow Transplant Program.

The Duke Cancer Patient Support Program provides psychological services to cancer patients and their families in the outpatient clinics of the Duke Cancer Institute, a National Cancer Institute-designated comprehensive cancer center.

The Duke Adult Blood and Marrow Transplant Program, which is closely associated with the Duke Cancer Institute, is internationally recognized for its novel approaches to treating leukemia, lymphoma and myeloma through bone marrow and stem cell transplantation. The Duke Cancer Institute and the Duke Blood and Marrow Transplant Program treat patients from a range of ages, ethnic and racial backgrounds and socioeconomic statuses, and from rural and urban settings in North Carolina and the larger region.

Experiences on this rotation aim to increase the intern’s knowledge and skills for treating psychological, social, behavioral and symptom management issues that occur during the cancer experience. The intern in this rotation work works closely with the multidisciplinary Cancer Patient Support and Bone Marrow Transplant teams, including:

• Psychologists
• Psychiatrists
• Medical family therapists
• Social workers
• Physicians
• Nurse practitioners
• Pharmacists
• Nutritionists
• Physical therapists
• Patient financial advisors
• Patient and nurse navigators

Assessments

The intern is trained to conduct and interpret psychological assessments and health behavior evaluations for patients, their families and caregivers. Assessment techniques include behavioral observation, standardized psychological measures, semi-structured interviews and diagnostic interviews.
 
Through training and clinical experiences, the intern will become skilled at assessing the psychological, relationship and behavioral health issues that impact individuals and families affected by cancer.

Psychological Services

The intern will provide psychological services for patients, their families and caregivers. Clinical experiences include outpatient CBT-based psychotherapy, manualized behavioral interventions for symptom management and health behavior interventions. Psychological services are provided in individual, couples and group settings through face-to-face meetings, phone and web-based technologies.
 
The intern will also gain competence in developing treatment plans and choosing appropriate, evidence-based interventions for the range of issues and problems that arise for patients and their families when faced with a serious, life-threatening illness. For example, interns often work with patients and family members through adjustment to illness, trauma, depression, anxiety, body image related concerns, memory and cognition concerns, pain and other symptom management concerns.

Supervision

The intern will participate in weekly individual supervision sessions for psychological assessment and psychotherapy cases. The intern will participate in monthly group team meetings with other psychologists (e.g., faculty, post-doctoral fellows) working with the Cancer Patient Support Program. This meeting will provide group supervision on therapy cases and can be a forum for clinical research training.

Each month the intern will also participate in a multidisciplinary team meeting that includes members of our collaborating care teams (e.g., Cancer Patient Support Team, Blood and Marrow Transplant Team). Through regular participation in multidisciplinary team meetings, the intern gains a sophisticated conceptualization of patients. 

Educational Seminars & Research

During the rotation, the intern will attend educational seminars on psycho-oncology and related topics such as sexual health and behavioral symptoms management. A developmental approach is used. Initially the intern is given educational materials about cancer and the stem cell and bone marrow transplant process, and they work closely with a psychologist or other team member to develop an understanding of the treatment process and the clinic environment. Later, the intern is assigned their own patients and groups.
 
Finally, the intern will have the opportunity to participate in ongoing research activities. They are exposed to issues of research design, quality control and data analysis inherent in the testing of standardized treatment protocols and program evaluation.

Supervisors

• Caroline Dorfman, PhD
• Catherine Majestic, PhD
• Rebecca Shelby, PhD
• Tamara Somers, PhD
• Juliann Stalls, PhD

This rotation at the Duke Fertility Center provides training in an integrated Psychological Services Program through the Department of Psychiatry & Behavioral Sciences. The Psychological Services Program serves individuals and couples, including those with diverse gender identities and sexual orientations, who are working to build their families through fertility treatment.

Interns in this rotation learn about the psychological aspects of reproductive medicine and provide psychological services on-site alongside an interdisciplinary healthcare team. Interns may provide individual, couples, and group therapy to patients experiencing infertility and pregnancy loss.  They gain assessment experience with gamete donors and gestational carrier candidates by conducting structured diagnostic interviews and psychological testing. Interns also provide consultation and counseling to future parents who need an egg, sperm, or embryo donor or gestational carrier to build their family. 

Interns receive training in:

• Psychotherapy to patients facing fertility treatment, recurrent pregnancy loss, perinatal mood disorders, fertility preservation or embryo disposition concerns after conclusion of fertility treatment
• Evidence-based theory and interventions emphasizing ACT, CBT and trauma treatments
• Psychosocial consultation in complex medical decision-making  
• Crisis management intervention (e.g., ultrasound reveals no fetal heartbeat; panic attack prior to egg retrieval procedure, etc.)
• Administering and interpreting the Personality Assessment Inventory (PAI)

Diagnoses commonly seen include:

• Mood disorders
• Anxiety disorders (especially panic disorder, specific phobia, and general anxiety disorder)
• Adjustment disorders
• PTSD/trauma exposure
• Eating disorders (among both obese and underweight patients)
• ADHD

Therapeutic issues commonly addressed include:

• Grief and loss
• Relationship conflict / Couples therapy
• Existential concerns ("Why do bad things happen to good people?"; "Am I being punished?")
• Stress and coping
• Parenting concerns
• Alternate family-building strategies (e.g., donor egg/sperm, adoption)

Interns attend and/or present in a weekly Third-Party Reproductive team meeting (comprised of Reproductive Endocrinology physicians, APPs, REI Fellows, OBGYN residents, and nurses) and gain experience in contributing as a health psychologist within a multidisciplinary medical team.

Interns receive weekly, individualized supervision, partner with and observe supervisors in delivering care in complex case, and complete a year-long weekly didactic seminar on special topics in reproductive psychology. 

Supervisors

• Julia Woodward, PhD
• Stephanie Schuette, PhD