Addressing the Emotional Components of Care
The emotional dimensions of a chronic illness are often overlooked in the context of a medically centered care plan.8 For example, fatigue, a feature of many rheumatologic illnesses, can lead to frustration and a sense of helplessness, anger, fear, hopelessness, and defeat.9 This can often lead to low self-efficacy, compromising a patient’s competence to manage their illness. Medications that treat the illness can affect mood, as well as overall disease burden.8 It’s important that a patient’s risk factors for mental illness, such as depression, be assessed on a continuous basis. Even mild depression may reduce a person’s motivation to access medical care or to follow treatment plans.8 Through comprehensive assessments, a social worker identifies and addresses these issues to make appropriate referrals to community agencies or other members of the team, ensuring that these confounding concerns don’t jeopardize the success of the treatment plan or affect the patient’s medical outcome.
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Explore This IssueDecember 2013
Frequently, patients feel like they’re on a perpetual illness roller coaster. They can feel emotionally vulnerable, especially when their chronic illness is characterized by periods of flares and remission, resulting in heightened stress. Coping with the uncertainty of the future, disability, financial, and relationship challenges can compromise a patients’ physical, emotional, and spiritual well-being.8 Social workers use strategies to help patients and their families gain a sense of control over their changing life situation, using the relationships that they establish to help patients to regain a sense of hope. Social workers also help patients make behavioral changes that will sustain them throughout the lifetime of their illness.
Patients with chronic illnesses often report a sense of grief and loss, thus having to define a new identity for themselves after being diagnosed or experiencing profound life changes due to their illness. As patients move through stages of grief and loss, a social worker can help to facilitate their emotional needs, providing support, assessing safety, and determining if the treatment plan is being affected by the emotional well-being of the patient. In addition, the social worker can also act as a support to colleagues on the interdisciplinary team, providing a place to hold feelings, express some of the challenges that are inherent in working with a chronically ill population, and problem solve.
“At critical times in a rheumatology patient’s life, the social worker becomes the most important part of the healthcare team because they are uniquely able to integrate medical, financial, emotional, and practical issues in a manner that can quickly and effectively facilitate a patient and [his or her] family’s ability to navigate through a crisis and an increasingly insensitive and complex healthcare system. At other times, they are as important a part of the care of patients as the physicians,” says Stephen A. Paget, MD, physician-in-chief emeritus and rheumatology leadership chair at the Hospital for Special Surgery.