Whole Person Care to Better Treat Cancer – Anxiety – Depression (Part II)
By Richard Maye
In Part I, we identified the importance of changing the Siloed approach to providing healthcare to one with a focus on Whole Person Care. Whole Person Care is a system of Care Coordination that includes the importance of recognizing the direct interplay between one’s physical and mental health by merging the care of these two wellness points.
With the view of how this relates to men with Prostate Cancer, the information in Part I discussed how the urologist could improve the care and methods of disease management with their patient by discerning the person’s emotional status. By taking a few minutes at the point when the patient enters their care to administer tools that assess the presence and level and anxiety and depression, the urologist can better understand how to approach the individual when discussing cancer.
Several different assessment tools exist that are used to detect and measure the presence of various types of mental health issues. In regard to anxiety and depression, two of the more common tools that are accepted as being Evidenced Based and widely used include: The Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) tool. Each of the assessment tools is available online at no cost. Neither tool requires someone present to administer the instrument to you. You take it on your own, at your time and it can be done in private.
You can access these tools by using your search engine, such as Google, and type in PHQ-9 or GAD-7. Several sites will appear from which to choose. Look for Patient Health Questionnaire -9 and General Anxiety Disorder –7. Choose one and you should see the list of questions for each tool along with the scoring sheet.
Patient Health Questionnaire (PHQ-9)
As the name indicates it consists of nine questions that look back at a recent two-week period to assess if depression exists and to what degree. A numerical scoring system is used to demonstrate the value of each answer. Each answer's numerical value is added for a total score that indicates a level of depression ranked as mild, moderate, moderately severe, and severe.
General Anxiety Disorder (GAD-7)
Again, as indicated by the name, this tool consists of seven questions using a numerical scale for scoring each. The most recent two-week look-back period is also used. The values assigned to each answer provide a total that measures the presence of anxiety and are ranked as; minimal, mild, moderate, severe.
(Richard Maye)
Each assessment tool includes a self-scoring worksheet so the person using the tool can see the results shortly after answering the questions. Since these tools provide an indicator of the presence of depression and/or anxiety and rank the level of each, take your time in selecting your answers. Some will ask a person they are close with to take the assessment to serve as a sort of second opinion as to how the other person views their status. Or the other person (such as your spouse) may wish to take the assessment for their own purposes to determine how your health is impacting them.
Evidenced Based means that the assessment tests have been validated by others in providing usable and accurate information to use in diagnosing the presence or lack thereof of a mental health issue.
If you are on Medicare and visit your primary care physician's office for your annual free Wellness checkup, the office is supposed to administer a test that measures anxiety and depression. My doctor’s office hands me an electronic tablet for me to use to take the test while in the waiting room.
Since these two assessment tests are self-administered, it is critical that the person provide truthful answers to the questions, whether you are taking them in a doctor’s office or at home. Remember that the results guide your Whole Person Care which is vital to your well-being. Be honest with yourself and your caregiver, do not feel ashamed or embarrassed. The people who manage your care need this critical information to make important decisions and you do as well.
As men progress on what can be a long journey of Active Surveillance anxiety and depression can be a factor as to how long they remain on that status or go off AS to seek treatment. Periodically monitoring your emotional resilience is simple and is time well used. On AS we are confronted with events that require decisions such as having another biopsy, an MRI, waiting for PSA lab results, should you seek treatment and if so which type of treatment is best. Not only is a decision required to undertake one of these events, but as you wait for the results and then receive the actual outcome of the procedure each step along this pathway may cause one to experience anxiety and/or depression.
In the March 15, 2022, email edition of mHealth Intelligence, an article by Mark Melchionna reported on a study conducted by Wake Forest University that was published in JAMA Network Open pertaining to how the use of a self-administered app using an electronic tablet for patients at Family & Internal Medicine practices doubled the detection of depression, fall risk, and intimate partner violence. The researchers at Wake Forest University Health Sciences Institute created their own assessment tool App called mPATH and implemented the app at six physician practices that included 23,026 patients.
(https://mhealthintelligence.com/)
Renal & Urology News reported on a study on March 18, 2022 conducted by researchers led by Amy N. Luckenbaugh, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, that appeared in the Journal of Urology. One finding in the report indicated that establishing a baseline of a patient’s mental health is an important factor in measuring the impact of localized prostate cancer treatment choices post-treatment. Dr. Luckenbaugh made an interesting comment that goes a long way towards validating the subject of this article. Her comment was: “While psychological interventions are beyond the scope of most clinicians treating prostate cancer, we ought to appropriately screen and subsequently refer those at risk.”
(Reference: https://www.renalurologynews.com/home/news/urology/prostate-cancer-treatment-decision-surgery-radiation-vs-surveillance)
I could not agree more. I hope to press this issue further to arrive at the point where urologists and other specialty practitioners will follow the advice of Dr. Luckenbaugh.
If your urologist is not interested in your emotional well-being, you should be. Now you have information that you can use to answer the question:
How Are You Holding Up?
Bio: Richard Maye was almost 71 when had a 12-core transrectal biopsy in late October 2018 and received the diagnosis in November of three cores with a Gleason Score of 3+3 = 6 and one core that was 3+4 = 7. The 4 core was less than 5% involved with cancer. He underwent a Oncotype DX, a genomic test that indicated there was less 1% chance that the cancer would lead to death in 10 years and less than 4% of metastasis within 10 years.
Richard’s urologist suggested that he go Active Surveillance with a follow-up confirmatory biopsy in one year and a PSA every six months.
Richard has had 50 years of senior-level management and administration experience, primarily in the healthcare and human services industries, including behavioral health, acute care hospitals, and outpatient rehabilitation. His career experience includes serving as Chief Financial Officer, Chief Operating Officer, and Chief Executive Officer.
He is the Founder & President of Strategic Integration Solutions, Ltd., a healthcare consulting firm that focuses on providing organizations with the Strategic Solution that forms a Clinically Integrated Patient Care System, which includes the Integration of Behavioral Health and other clinical service lines with Primary Care.
Prior to forming his consulting practice, Richard served as Senior Vice President of Physician Integration for Mary Rutan Hospital in Bellefontaine Ohio. He led the effort to have all employed physician practices achieve accreditation recognition.
Richard and his wife Monica have two adult children and currently reside in Elida, Ohio just outside of Lima.
Go to the Barniskis Room: https://www.gotomeet.me/AnswerCancer Or call +1 646 749 3129 Access Code: 222-583-973 (Barniskis Room)
Don’t miss this program: Top docs—including Dr. Laurence Klotz, who named AS; Dr. Peter Carroll and Dr. Peter Albertsen, who helped develop the approach, and Dr. E. David Crawford, who believes it’s time to move beyond AS— will be exploring the future of Active Surveillance at 11 a.m. Eastern April 22/5 p.m. CET. Register here ASAP: https://zoom.us/meeting/register/tJEtfuuqrzwtHNPuqzkigx65YBk8vV-teUdy
