Deck 9: Social Work Practice in Oncology, Palliative, and End-Of-Life Care

Question 1

The death rate for all cancers, adjusted for the size and age of the population from 1950-2005, has ___________________________.

A) Increased slightly
B) Decreased dramatically
C) Decreased slightly
D) Increased dramatically

Answer 1

Decreased slightly

Question 2

The "code" word for a cancer diagnosis used to be ____________________.

A) Cancerology
B) Big C
C) Pink
D) Project Omega

Answer 2

Big C

Question 3

________________________ continue to suffer the greatest burden from common types of cancer.

A) Hispanics
B) Asian Americans
C) Caucasians
D) African Americans

Answer 3

African Americans

Question 4

______________________________ was developed with the goal of eliminating barriers to timely cancer screening, diagnosis, treatment, support, and end-of-life care.

A) Case management
B) Patient navigation
C) Care coordination
D) Transitional care manager

Question 5

Distress risk screening should be conducted on ________________________________.

A) All newly diagnosed patients
B) Patients with head and neck cancers
C) Patients with breast cancer
D) Patients with stomach cancer

Question 6

You are working with Helen, who has a diagnosis of breast cancer. Helen and her family have adapted fairly well to her situation. What type of intervention would you use with Helen and her family?

A) Psychoeducation
B) Psychoanalysis
C) Cognitive behavioral therapy
D) Interpersonal therapy

Question 7

A tool that has been modified to measure patient distress in cancer patients is the _____________________.

A) PHQ-9
B) Beck Depression Inventory
C) Brief Symptom Inventory
D) Geriatric Depression Screen

Question 8

Rachel has been working with John since he was initially diagnosed with cancer. At the beginning, John expressed shock and disbelief and described feeling almost "surreal." It has been 3 months since then. John comes to his biweekly chemotherapy appointments on Fridays so he has the weekend to recover. He has only missed a couple days of work but went ahead and completed FMLA paperwork with his employer's human resources department in case he needs to take more time off. John had experienced persistent diarrhea as a consequence of the chemotherapy, but he made sure to discuss it with his physician, and with a change in diet and a new prescription, it is now under control. Rachel and John reflect on John's initial diagnosis and note how John has ___________________________ to his cancer diagnosis.

A) Reconciled
B) Adapted
C) Reoriented
D) Disengaged

Question 9

Katrina has been working with a patient in the outpatient oncology clinic. The patient, Norman, states he doesn't know what to do. He is tired all the time, he can't sleep, and nothing tastes good. His affect is flat, his speech is slow, and he barely makes eye contact. Katrina asks Norman if he still finds joy in anything, like seeing his grandchildren, who he has talked about at every visit before this. Norman states he is ashamed to say it but "No, actually it is so hard to be around them right now. I feel guilty about this. I must be a bad grandfather." Katrina asks how long Norman has been feeling this way, and Norman tells her it started about a month ago and has gradually gotten worse. He describes the last two weeks as having been "the worst of my life." Concerned, Katrina asks Norman if it has gotten so bad that he has thought of ending his life or harming himself. Norman says he had the thought once but has been able to "shake it off." Katrina should _____.

A) Conduct a risk assessment and safety plan and then refer Norman to a psychiatrist for an evaluation for possible antidepressants.
B) Provide psychoeducation highlighting the fact that many patients with cancer get depressed.
C) Refer Norman to a support group
D) Begin existential therapy immediately with Norman.

Question 10

____________________________ and ___________________, often in combination with antidepressant therapy, have been found to be effective with oncology patients.

A) Play therapy/Regression therapy
B) Cognitive-behavioral therapies/existential therapies
C) Art therapy/Dialectical behavioral therapy
D) Interpersonal therapy/Eye movement desensitization and reprocessing therapy (EMDR)

Question 11

Carol walked into the exam room and saw the new patient, Tracey, sitting on the edge of the exam table. Tracey had just recently been diagnosed with cancer and was here for her initial meeting with the oncologist. Tracey appeared very small. Her shoulders were hunched forward, her face was flushed, and her voice shook when she spoke. When Carol asked Tracey to complete the Distress Thermometer, Tracey marked her anxiety as a 10 out of 10, the worst it could be. Carol noticed that Tracey already had a prescription for medication to help with anxiety, and when she asked Tracey how long she had been on the medication, Tracey said, "For years." Tracey most likely has ________________.

A) Situational anxiety
B) Psychiatric anxiety
C) Organic anxiety
D) Existential anxiety

Question 12

Norma has had a diagnosis of Stage IV breast cancer for several years. Her condition has been stable but is terminal. It is impossible to know how long she may live. Norma phones the doctor's office frequently and insists on having tests more often than her physician feels she should. The rest of the staff express to the social worker, Fran, feeling that Norma is a "difficult patient." Norma confides to Fran that she used to work as a nurse, and she saw how paternalistic physicians could be. She says her biggest fear is that she will not be told she is dying until "the end." Because of this, "all I can think about is if I am dying or not. All day, every day, I am mentally checking for any changes in my body." Norma is experiencing _________________.

A) Situational anxiety
B) Psychiatric anxiety
C) Organic anxiety
D) Existential anxiety

Question 13

Cancer tumors that have spread to the brain and spinal cord and tumors in the lungs can cause other health problems with the symptoms of anxiety. This is _________________.

A) Situational anxiety
B) Psychiatric anxiety
C) Organic anxiety
D) Existential anxiety

Question 14

Jen's patient, Dennis, was told he would need a feeding tube. Dennis argued that he would be fine without one and said he would refuse to undergo the procedure. When Jen asked Dennis why he felt this way, he told Jen, "I am afraid if I have anesthetic, I will not wake up." Dennis was exhibiting ________________________________.

A) Situational anxiety
B) Psychiatric anxiety
C) Organic anxiety
D) Existential anxiety

Question 15

Counseling approaches that are effective for helping patients with posttraumatic stress disorder are ______________________________.

A) Play therapy/Regression therapy
B) Cognitive-behavioral therapies/Eye movement desensitization and reprocessing therapy (EMDR)
C) Art therapy/Dialectical behavioral therapy
D) Interpersonal therapy/Motivational interviewing

Question 16

All of the following are risk factors for posttraumatic stress disorder except __________________.

A) History of trauma
B) Avoidant coping
C) Social isolation
D) Physical exercise

Question 17

Macy's patient Tom has Stage IV lung cancer. Macy and Tom had been working together since he was diagnosed with cancer. Despite aggressive treatment, the cancer continued to spread, and Tom's condition is now terminal. Tom only has a few weeks at most to live. Macy asks Tom if he would like to do __________________________________________. She explained that she would provide him with a list of questions about his life and give him a couple of days to think about them. They would meet a few days later, and she would ask Tom the questions and record the interview. Macy would then have the interview transcribed, edit it to ensure it provided a precise and flowing account of what Tom had said, and then review the document with Tom to make sure it was correct. Tom would then be given the document to keep.

A) Cognitive-behavioral therapy
B) Psychodrama
C) Dignity therapy
D) Guided imagery

Question 18

________________________________________ is a type of care that provides medical and supportive services to help alleviate pain and other symptoms of illness. Currently, few payment models are in place to provide this care on an outpatient basis.

A) Hospice
B) Primary
C) Chiropractic
D) Palliative

Question 19

According to the IOM, many cancer patients feel ________________________ at the end of their cancer treatment.

A) Lost
B) Elated
C) A sense of "letdown"
D) Victorious

Question 20

Treatments for cancer have become _________________________________.

A) Less harsh, surgery is less disfiguring, and chemotherapy is less disabling
B) Less harsh, surgery is less disfiguring, but chemotherapy is more disabling
C) More harsh, surgery is more disfiguring, and chemotherapy is more disabling
D) Less harsh, surgery is more disfiguring, but chemotherapy is less disabling

Question 21

Severe symptoms of depression in cancer patients are of concern because of their association with a reduced quality of life. Additional concerns about depression in cancer patients include all of the following except

A) They incur more frequent and prolonged hospitalizations.
B) They have an increased desire for hastened death or suicide.
C) It reduces the experience of physical distress
D) They exhibit poorer treatment compliance

Question 22

Social workers are the only professionals employed as patient navigators.

Question 23

In order to be accredited by the College of Surgeons, all cancer centers must implement patient navigation, distress risk screening, and survivorship care plans by 2015.

Question 24

The rates of depression in people with cancer are at least three times as common as those found in the general population.

Question 25

As terminally ill cancer patients reach the end of their lives, their quality of life and sense of well-being deteriorate. This leads to suffering, depression, and a loss of dignity that can only be addressed with antidepressant medications and strong pain medications.

Question 26

Benefits of group counseling with cancer patients are the reduction in feelings of isolation and "normalizing" the cancer experience.

Question 27

One difficulty with conducing family counseling with cancer patients is that the cancer patient's and family members' concerns are disparate.

Question 28

The majority of patients enrolled in hospice services have a diagnosis of cancer.

Question 29

Posttraumatic stress disorder (PTSD) can occur as a result of cancer-related traumatic events.

Question 30

With the advances in medical science, it has gotten easier to give an accurate prognosis and know when to make an appropriate referral to hospice.

Question 31

________________________________ is done at the end of treatment to help ensure patients do not feel lost and confused about follow-up and recommendations.

Question 32

A patient with a terminal illness who has 6 months or less to live and is no longer receiving treatment with a curative intent may chose to enter _______________________________ care. A patient with a grave but not necessarily terminal prognosis who is still receiving treatment aimed at remission or cure may chose _________________________ care.

Question 33

What are two reasons cancer-related depression can be difficult to diagnose?

Question 34

The oncology social worker should be aware of the specific points of vulnerability for cancer patients and be ready to intervene at any of these points. List four specific points of vulnerability for cancer patients.