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Our interdisciplinary patient-centred approach uses music therapy, counseling/therapy, hypnosis, relaxation, and cognitive-behavioral techniques as complementary to the medical interventions of our colleagues. Pain is viewed as physiological and psychosocial. We acknowledge the psychological, social and spiritual factors of suffering held by our clients as key factors in pain management and recovery from cancer. The intention of our work in pain management is to invite patients and their families to experience interventions that stimulate creativity as an expression of self, and to reshape their experience of pain in the cancer continuum.

After a brief introduction of the supporting data for the efficacy of our techniques, delegates will have the opportunity to experience interventions from music therapy and clinical hypnotherapy that are utilized in the management of pain and suffering. Music and imagery will be used to encourage insight pertaining to current pain or challenges, and to support a move towards a place of strength. Following the experiential component, questions will be addressed during debriefing.

• Beyond Relaxation: Experiential Techniques of Pain Relief. Pandora Cummine, BMT; Karen Flood, RhD, RCC.

Spiritual beliefs and practices are significant resources that inform the ways in which many families make meaning and alleviate suffering in the midst of their cancer experience. The preponderance of the empirical literature demonstrates a positive link between spirituality and health professionals to address spirituality and health, well-being, quality of life, and healing. Although researchers have found that many patients want health professionals to address spirituality in their health care, health professionals themselves often feel inadequately prepared to address such issues when they emerge in practice.

The ‘Illness Beliefs Model’ (IBM) embodies the assumption that the beliefs that persons hold are a powerful influence in shaping both problems and solutions. Therapeutic conversations about spiritual beliefs, guided by the IBM, have been clinically shown to be a powerful intervention in alleviating suffering and enhancing healing for families living with cancer and other serious illnesses. Drawing on the authors’ analysis of clinical case studies, this interactive workshop will provide opportunities for participants to: 1) Discuss a clinical practice model, the Illness Beliefs Model, a therapeutic approach that opens space in therapeutic relationships for spiritual beliefs. 2) View and discuss videotapes of therapeutic conversations about spiritual beliefs, exploring the benefits and difficulties of such conversations. 3) Explore successes and barriers to the participants’ own therapeutic work with spiritual beliefs.

• Meaning in the Midst of Cancer: Spiritual Beliefs and Therapeutic Conversations. Deborah McLeod, RN, PhD; Lorraine M. Wright, RN, PhD.

The issue of violence in intimate relationships is a common and difficult problem that most health professionals encounter in their practices at one time or another. At various points in the cancer illness trajectory, persons are known to be more likely to experience distress, and increased distress is known to be a contributing factor in the escalation of violence. However, there is little discussion in the psychosocial oncology literature that identifies violence as a problem for persons living with cancer, or that explores either the assessment or the treatment of violence in the population.

In this clinically based session, participants will have the opportunity to review the current therapeutic literature about intimate relationship violence and briefly discuss the variety of theories that attempt to explain violence. Drawing on Alan Jenkins “theory of restraints”, participants will explore the use of narrative therapy approaches to both the assessment and the treatment of violence. Clinical case examples and videotape excerpts, drawn from the author’s experience in applying the model in practice, will be provided. Recommendations for couples vs. individual therapy in the context of violence will be explored with a discussion of relevant safety issues. While an overview of all stages of the therapeutic process will be provided, emphasis will be placed on the initial assessment and intervention as a way of “setting the stage” for referral to more specialized resources.

• Invitations to Change: Addressing Intimate Partner Violence in Psychosocial Oncology. Deborah McLeod, RN, PhD.

Families living with a life-threatening illness such as cancer often suffer as much or more than the family member with the disease, yet health care systems are often organized to attend primarily to the needs of individuals. In addition, the state of the science in the area of families and illness is such that a great deal more is known about families’ experiences with illness than about how to help alleviate the suffering that families may experience.

This session reports the findings of a study of a family systems intervention with 28 families living with a variety of serious illnesses including cancer. The intervention, therapeutic conversations guided by the Illness Beliefs Model (IBM), was found to contribute to therapeutic change and family satisfaction in varying ways. Therapeutic change themes included: finding new perspectives (to solve problems or alleviate suffering); improving communication; sharing the illness burden; getting along better as a family; finding space to live life separate from the illness; and strengthening personal and family resources. Family satisfaction with the intervention was high and one conclusion drawn from the study is that families often benefit from conversations about their illness experiences, whether or not they are expressing a need for family help.

In addition to the study findings, this session will present the IBM as one approach to developing therapeutic conversations with families. Clinical exemplars will be used to highlight the application of the IBM, and explore strategies to incorporate aspects of the IBM in practice.

• Gathering the Family: Therapeutic Change, Satisfaction and the Illness Belief Model. Deborah McLeod, RN, PhD; Shirley Urquhart, RN, BA; Deirdre Mombourquette, RN, BN.

Genetic testing for cancer generates potentially life-altering information about the self that may impact on physical and psychosocial wellbeing. The potential negative psychological labeling associated with fear-arousing information may impact a person’s self-concept and result in feelings of being “stigmatized” or “alienated”, “different from others” and “vulnerable”. These experiences may promote an altered self-view which can play a role in health behaviors, lead to psychological distress and interfere with the ability to plan for one’s future. Further systematic research is required to understand how an individual experiences being informed of a genetic mutation and how this information is internalized into his/her sense of self-identity. In order to accomplish this goal, valid and reliable quantitative measures designed for specific genetic risk populations are required as global measures of self-concept are less relevant for capturing the specific self-descriptors associated with the experience of being notified of a genetic mutation. Our team has launched a series of studies to develop interments that focus on self-concept among carriers for: FAP (adolescent/adult), BRCA1/2 and HNPCC. The method of scale development used is based on the multi-stage method of Jackson (1970), which takes validation into consideration at each stage of the scale development. We anticipate that these separate studies for each of the hereditary cancer populations will intersect at a later stage in our research. Data will be presented from the ongoing parallel studies, including specific items generated for the scales. In addition, the challenges in addressing the construct among these populations will be discussed.

• Self-Concept Instrument Development Among Individuals Testing Positive for Genetic Mutations in Cancer. M.J. Esplen; N. Stuckless; J. Hunter; G. Glendon; A. Liede; K. Metcalfe; M. Aronson; K. Bultler; H. Rothenmund; T. Berk; A. Lefebvre.
• Development of a Spiritual Care Guideline. Sue Morrison, RN, MN; Don Shipton, MTh, Mdiv; Brenda Sabo, RN, MA.

The Supportive Care Cancer Site Team of Cancer Care Nova Scotia has embarked on the development of interdisciplinary, provincial, evidence-based, Clinical Practice Guidelines for Cancer Care Symptom Management Spiritual Care Guidelines upon which to build. The guideline is intended for providers, largely, though not limited to, nurses and physicians, caring for any cancer patient in any setting anywhere in Nova Scotia.

Guideline development commenced with a small writing team. A literature search revealed papers largely from medical, nursing and spiritual care perspectives. Synthesis of this material produced a first draft of the guideline, which was circulated widely amongst a province-wide, interdisciplinary review panel. Based on feedback and consensus the guideline draft was revised.

The guideline contains sections from both the patient and provider’s perspectives. The patient perspective examines spirituality as a coping mechanism, as well as screening, assessment and self-report tools. The provider’s perspective includes boundaries, self-assessment for addressing provider’s own spirituality, and institutional responsibilities. Provider spiritual self-awareness can increase understanding of patient spiritual needs. Providers may find that the incorporation of the spiritual into clinical practice can enrich patient interactions and reduce provider burnout.

The presentation will be interactive, presenting briefly, the background and development process. Patient screening, assessment and self-report tools will be examined using a case study format. The health care provider self-assessment tool will also be examined.

1. An Examination of the Couples Collective Experience of Prostate Cancer. Karen D. Fergus.

2. Although a number of qualitative investigations have examined marital partners’ separate perceptions of the cancer experience, there have been very few studies to date where couples have been interviewed together. Little is therefore known about how the couple, as a dyadic entity, processes and experiences such events. Given that a diagnosis of cancer in one partner so profoundly affects the entire relational system, this absence of understanding sets significant constraints on the development of interventions designed to help couples cope with the illness. The present investigation sought to address this oversight by examining the couple’s dialectical co-construction of a mutual identity, and how the couple’s inter-subjective reality both influences and is influenced by the cancer experience.

   Participants consisted of five heterosexual couples in long term, satisfactory relationships where the male spouse had been treated for prostate cancer. Partners were interviewed together on two separate occasions enabling the couple to deepen their conjoint reflexive processing of their relationship from one interview to the next. An ethnographic mode of inquiry was combined with a grounded theory analysis of interview text. This analysis yielded four main themes defining the couple’s experience with prostate cancer: resisting separation; emotional vortex; stabilizing force, and asserting control. Findings suggest the male patients and female caregiver face differing but related challenges in adjusting to the exigencies of cancer. These will be elaborated upon in this presentation.