Chapter 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

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Chapter 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

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Dr. Rodriguez discusses the Department of Chaplaincy and Pastoral Education and its focus on spiritual concerns. She lists the kinds of issues that arise for cancer patients. Dr. Rodriguez explains that, historically, MD Anderson has sustained linkages with spiritual/religious organizations and communities. This is one reason the Department of Chaplaincy at MD Anderson is so robust. She then talks about the future of psychosocial approaches at MD Anderson, looking ahead to the creation of a Division of Psychosocial Oncology. She list some research studies the faculty are conducting in this area.

Identifier

RodriguezA_04_20150605_C23

Publication Date

6-5-2015

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Topics Covered

Building the Institution; MD Anderson Culture; Patients; Patients, Treatment, Survivors; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Institutional Processes; Devices, Drugs, Procedures; Institutional Mission and Values; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; MD Anderson History Research, Care, and Education

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Tacey A. Rosolowski, PhD:

Yeah, makes perfect sense. You mentioned spiritual support. What does that look like? Because we talked about some social, some psychological, what about spiritual?

Alma Rodriguez, MD:

Well, we have a whole department of Chaplains.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

And I think compared to most hospitals, it is quite robust, in that we have full-time Chaplains of several denominations, but they all have to be certified in healthcare Chaplaincy. And there is actually a whole discipline for that, and certification process for that. And the difference between healthcare Chaplaincy and, of course, a position of clergy in the religious communities is that a healthcare Chaplain, if you will, needs to focus more on the spiritual concerns around illness; the questions or relationship, if you will, to a higher spiritual being. Questions of, or issues of existential anxiety, for lack of a better word. Why am I here? Why did I get this illness? Why did I survive, versus my friend, my child, my neighbor? So Chaplaincies that are linked to healthcare are aligned with those—along those lines, that is, how illness then brings to the surface, the existential questions of why I exist, and what is my relationship to a—or do I have a relationship? Or am I worthy of a relationship to a higher entity, or higher spiritual being?

Tacey A. Rosolowski, PhD:

Is it unusual that a cancer center has a department devoted—you said that “The department is robust.” I mean, is that—

Alma Rodriguez, MD:

Robust in numbers. Also in—

Tacey A. Rosolowski, PhD:

Yeah, I’m just wondering if it reflects sort of a different level of investment in this particular issue for patients.

Alma Rodriguez, MD:

Mm-hmm. I’m sure, very likely. Again, when the hospital was established, remember that it was in the 1940s. Cancer, hardly anybody survived.

Tacey A. Rosolowski, PhD:

Survived, yeah.

Alma Rodriguez, MD:

And so in those days, I think it was seen very much—if you asked people what was important, psychology or spirituality, they would have said spirituality over and above everything else, right? So I think it just has to do with the roots of how the organization was built.

Tacey A. Rosolowski, PhD:

Interesting.

Alma Rodriguez, MD:

Or when it was built. But also, in addition, that I think although it may not seem this way, but I think that Houston as a community has very deep religious roots and deep spiritual roots. We have an established Jewish community, we have, of course, a Catholic community. We have Baptists, Methodists. The interesting thing is that one of our most supportive organizations comes from the Lutheran church. So it wasn’t necessarily—so there’s, across the board, a very broad, if you will, support for the Chaplaincy service here. It had the benefit of several lines, if you will, of spiritual practice and viewpoints to be built. So in addition to our full-time staff, we also have volunteer staff from the community, and we also have students who come to train here.

Tacey A. Rosolowski, PhD:

This is in the Chaplaincy department?

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

Wow!

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

Well, you know, I often ask interview subjects about their own spiritual beliefs; I mean, if I kind get a sense, you know, that that’s an issue. And I’ve been really surprised at how people have said, yeah, you know, everything in my medical practice is very deeply embedded in my spiritual life.

Alma Rodriguez, MD:

Mm-hmm.

Tacey A. Rosolowski, PhD:

I mean, and so at the level of individ—on the provider’s side, you know, you find that as well, that it’s a very important, maybe not very often talked about—

Alma Rodriguez, MD:

Right.

Tacey A. Rosolowski, PhD:

—but certainly a very important part of the ethos, if you will, of the institution.

Alma Rodriguez, MD:

Mm-hmm.

Tacey A. Rosolowski, PhD:

Yeah, very interesting. So what’s the future, do you think, of the Psychosocial Council and this whole movement? Kind of what’s the next big thing to work on, and what’s the prognosis for—

Alma Rodriguez, MD:

Well, it’s really interesting. We’re asking ourselves that.

Tacey A. Rosolowski, PhD:

Uh-huh?

Alma Rodriguez, MD:

You know, since we’ve been in existence now almost—it’s been, I mean, not quite there, but almost ten years since we were given the charge. And the institution has changed. You were going to bring up the issue of change. The question that we are asking ourselves, is it time to really shift in a different direction? And I don’t know the answer, actually. We’re still—we are exploring that. I think that as the, if you will, academic infrastructure for psychiatry, psychology—clinical psychology and other disciplines, as the academic infrastructure strengthens, where there are no longer just the rare and small services that embedded into other larger departments, as they come into their own being, perhaps they will take the banner on. And we may not need to have the Council as the support structure—

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

—for those efforts. So we’ll see. Only the future will tell. In fact, I’m rooting for the stronger formation of all of these professional groups to no longer be isolated in small, freestanding services, but that actually, hopefully, someday, there would be a division of what I would call, you know, psycho oncology medicine, or behavioral medicine, or behavioral and spiritual medicine—I don’t know what the office term would be, but that it would be its own entity, standing side-by-side with surgery and medical oncology and all the other disciplines of medicine.

Tacey A. Rosolowski, PhD:

Now, are academics in these various fields at MD Anderson also conducting research?

Alma Rodriguez, MD:

Yes. Yes.

Tacey A. Rosolowski, PhD:

And, I mean, what—because you know, I’ve been in so many conversations, I mean, this is an evidence-based institution. And so, you know, if something is going to have an impact, then you want to document that it does, indeed have the impact—

Alma Rodriguez, MD:

Right.

Tacey A. Rosolowski, PhD:

—I mean, for a whole variety of purposes; not only intellectual legitimacy, but also for, you know, the valued care movement.

Alma Rodriguez, MD:

Mm-hmm.

Tacey A. Rosolowski, PhD:

So what kind of research are individuals—you know, for example, what kinds of research projects are people doing in these fields?

Alma Rodriguez, MD:

Well, there’s one person who’s doing a project that we actually have supported through survivorship, through the survivorship grants mechanism, who has a very interesting field of study, which has to do with body image. How do we perceive—how does our physical—our perception of ourselves as a physical entity influence how we feel about ourselves, if you will, as a psychological entity as well. And her research has been predominantly with head and neck patients, although she also has done some work with breast cancer patients. But you know, when you have your face changed, you know, our face is actually the one physical entity of our bodies—if we lose our hand, we still consider ourselves to be the person we are. If we lose our legs, we still are the person we are. But if our face gets changed, how we feel about ourselves changes dramatically as well. And the degree to which—which is, of course that explains plastic surgery, right?

Alma Rodriguez, MD:

Right. Sure.

Alma Rodriguez, MD:

People want to improve their faces because they want to be more beautiful, for example. But imagine that your face is changed to the degree where you are less perfect, not more perfect, but less so. And in some cases, terribly disfigured.

Tacey A. Rosolowski, PhD:

Maybe unrecognizable.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

Yeah. Yeah.

Alma Rodriguez, MD:

That can have an enormous impact to psychological health, to the individual.

Tacey A. Rosolowski, PhD:

And I suppose there is even a complexity of people that have multiple surgeries, they have to kind re-go through that trauma—

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

—with each transformation.

Alma Rodriguez, MD:

Right.

Tacey A. Rosolowski, PhD:

Wow, that’s—

Alma Rodriguez, MD:

Right.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

So that’s her field of interest. And it’s interesting, we were talking about spirituality, but one of her observations is that people who have a stronger spiritual connection, in fact, deal with whatever change happens on the surface of their bodies much better.

Tacey A. Rosolowski, PhD:

Interesting.

Alma Rodriguez, MD:

And so that, in itself, is a very important observation, I think.

Tacey A. Rosolowski, PhD:

Yeah. Interesting.

Alma Rodriguez, MD:

So that’s one of the studies. Other people are doing studies on cognitive, the recovery of cognitive functions after people have brain surgery and after certain exposure to certain chemicals that can cause the so-called chemo brain. So the studies on the whole phenomenon of what is called “chemo brain,” what is it, to what degree is it reversible, versus not. Who might be at more risk for it than others.

Tacey A. Rosolowski, PhD:

Wow.

Alma Rodriguez, MD:

So those are just some examples of the, if you will, the psychological and the psychiatric aspects of cancer that are still being—that are just now, in many ways, still being—just being looked at.

Tacey A. Rosolowski, PhD:

So it’s kind of like entirely new fields—

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

—are evolving just as we’re watching.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

It’s pretty—in which, you know, there are any number of fields that have evolved at MD Anderson and other cancer centers since the 1940s.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

Pretty amazing.

Alma Rodriguez, MD:

New knowledge.

Tacey A. Rosolowski, PhD:

New knowledge being created, yeah.

Alma Rodriguez, MD:

And new ways of systematizing it.

Tacey A. Rosolowski, PhD:

From different perspectives.

Alma Rodriguez, MD:

Exactly. And even old knowledge now being reframed.

Tacey A. Rosolowski, PhD:

Yeah. Cool. Can we turn to the issue of Institutional change at this point?

Alma Rodriguez, MD:

Sure. Certainly.

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Chapter 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

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