Trauma-Informed Care and How to Help

A history of sexual trauma can greatly impact a cancer patient’s mental and physical health, so implementing trauma-informed care practices in oncology settings is essential. According to the Substance Abuse and Mental Health Services Administration, trauma-informed care involves policy and practice that fosters feelings of safety, trust, support, collaboration, and empowerment among patients.

Trauma-informed care involves recognizing signs of trauma from patients who are served, and staff understanding the impact that trauma has on patients. Patient behavior is viewed in a trauma-informed lens, and patients are given support around issues that arise. Policies and practices are put into place to avoid re-traumatizing patients.11

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Implementing trauma-informed care involves training staff on the impact of trauma and how to most effectively communicate and interact in a health care setting with patients who have a history of trauma. Sensitive screeners can be implemented to identify patients with a history of sexual trauma, as well as any triggers they may experience in a health care setting, so that staff can know how to avoid those triggers and best provide support.12

Health care providers and staff should also modify certain aspects of health care interactions. These could include offering choice and control to the patient whenever possible. For example, patients should be asked for consent before touching them. Procedures should be explained before they occur, so the patient understands what will happen during the interaction, what they can expect, and what tools may be involved. These types of practices help minimize feelings of vulnerability and help encourage the patient’s sense of partnership and power throughout the health care interaction.

Health care providers may need to take extra care to clearly communicate instructions and what to expect in between appointments, including side effects or common symptoms. Encouraging patients to bring someone who can take notes or record interactions with them to appointments may be useful.13 If the patient does not have someone in their life able to fill this role, advocate services offered through the health care setting can be a helpful support. Health care providers can also connect their patients to a variety of support services, which may include counseling or psychotherapy, psychopharmacology, support groups, peer support, and patient advocacy services.

References

  1. Smith SG, Zhang X, Basile KC, et al; Centers for Disease Control and Prevention; National Center for Injury Prevention and Control; Division of Violence Prevention. The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief — Updated Release. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; November 2018. Accessed August 31, 2022. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf
  2. Centers for Disease Control and Prevention. Intimate partner violence, sexual violence, and stalking among men. Last reviewed June 1, 2020. Accessed September 13, 2022. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/men-ipvsvandstalking.html
  3. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality; December 2016. Accessed August 31, 2022. https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf
  4. Spataro J, Mullen PE, Burgess PM, Wells DL, Moss SA. Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry., 2004;184(5):416-421. doi:10.1192/bjp.184.5.416
  5. Hughes K, Bellis MA, Hardcastle KA, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356–e366. doi:10.1016/S2468-2667(17)30118-4
  6. Alcalá HE, Keim-Malpass J, Mitchell EM. Sexual assault and cancer screening among men and women. J Interpers Violence. 2021;36(11/12):NP6243-NP6259. doi:10.1177/0886260518812797
  7. Coker AL, Garcia LS, Williams CM, Follingstad D, Crawford TN, Bush HM. Association of intimate partner violence and childhood sexual abuse with cancer-related well-being in women. J Womens Health (Larchmt). 2012;21(11):1180-1188. doi:10.1089/jwh.2012.3708
  8. Schnur JB, Dillon MJ, Goldsmith RE, Montgomery GH. Cancer treatment experiences among survivors of childhood sexual abuse: a qualitative investigation of triggers and reactions to cumulative trauma. Palliat Support Care. 2018;16(6):767-776. doi:10.1017/S147895151700075X
  9. Schnur JB, Goldsmith RE. Through her eyes. J Clin Oncol. 2011;29(30):4054-4056. doi:10.1200/JCO.2011.37.2409
  10. Clark L, Beesley H, Holcombe C, Salmon P. The influence of childhood abuse and adult attachment style on clinical relationships in breast cancer care. Gen Hosp Psychiatry. 2011;33(6):579-586. doi:10.1016/j.genhosppsych.2011.07.007
  11. Substance Abuse and Mental Health Services Administration (SAMHSA) Trauma and Justice Strategic Initiative. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: Office of Policy, Planning and Innovation, Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4884. Accessed August 31, 2022. https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf
  12. Schnur JB, Chaplin WF, Khurshid K, et al. Development of the healthcare triggering questionnaire in adult sexual abuse survivors. Psychol Trauma. 2017;9(6):714-722. doi:10.1037/tra0000273
  13. Havig K. The health care experiences of adult survivors of child sexual abuse: a systematic review of evidence on sensitive practice. Trauma Violence Abuse. 2008;9(1):19-33. doi:10.1177/1524838007309805

This article originally appeared on Oncology Nurse Advisor

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General Oncology