Treating rheumatic disease
It's imperative that health-care providers address the anxiety, depression, fear and other emotions that patients experience when diagnosed with rheumatoid arthritis or another rheumatic disease, say experts from Hospital for Special Surgery (HSS).
During a presentation at the annual meeting of the American College of Rheumatology recently, they said it’s also important for health-care providers to acknowledge their own feelings when treating chronically ill patients in order to provide the best care possible.
The session focused on the impact of living with a rheumatic illness, how patients’ culture and socioeconomic conditions come into play, and the psychological effect on clinicians who treat chronic conditions on a daily basis. “It’s essential to consider all of these factors in order to provide appropriate interventions and referrals,” said Adena Batterman, LCSW, senior manager, inflammatory arthritis support and education programs in the Department of Social Work Programs at HSS.
People diagnosed with a rheumatic disease tend to experience a range of reactions, including shock, anger, fear, denial, anxiety, depression or despair, according to Joan Westreich, LCSW-R, social work coordinator of the Early Arthritis Initiative at HSS.
Westreich says it’s imperative that physicians and other health care providers take a patient’s emotional state into account. “It could have an impact on how well patients are able to hear and understand medical information and treatment options, partner with their health-care team, advocate for themselves and adhere to treatment.”
With time limitations and other constraints in the health system, Westreich underscores the importance of having a team of experts in place to help patients. “At Hospital for Special Surgery, we work as part of an interdisciplinary team, which taps into each provider’s unique training and skills ” she explains. A licensed clinical social worker has expertise in evaluating and working with patients to help promote their psychosocial functioning and adaptation to their illness. Offerings such as the Early RA Support and Education Program and Living with RA Program at HSS provide essential information and aim to enhance coping efforts by patients. The groups are led by a clinical social worker and a rheumatology nurse.
“Early intervention is just as critical in the psychosocial/emotional realm as it is in the medical,” Westreich explains. “Depression and anxiety, prevalent in people diagnosed with rheumatoid arthritis and other conditions, adversely affect health outcomes and quality of life. If we can intervene early with patients, it may be possible to help validate and normalize a range of responses and forestall maladaptive patterns, or help reframe the patient’s experience of living with a chronic illness.”
It’s also essential to acknowledge that patients’ culture and social determinants of health, such as socioeconomic conditions, play a role in how they respond to and manage their illness, according to Jillian Rose, LCSW, MPH, assistant director, Community Engagement, Diversity and Research in the Department of Social Work Programs at HSS.
“Many rheumatic illnesses disproportionately affect minorities, and there are rampant disparities in outcomes,” she says. “Cultural values, patient attitudes, and physician bias, which is often subconscious, all come into play. If clinicians don’t ask the right questions, they may miss information that is essential in developing a successful treatment plan.”
Rose notes that to enhance patient engagement and connection, it’s important for doctors to be knowledgeable about the patient population they are serving and the particular challenges individuals may face in their environment that can impede care.
“It’s an evidence-based best practice to include the psychosocial needs of the patient in the plan of care, but we know this isn’t always put into practice and can be a driver of health disparities. That’s why having an interdisciplinary team is so valuable,” she explains.
At HSS, doctors, nurses, social workers, physical therapists and nutritionists all have a role in treating the whole person.
Despite major advances in medications to treat rheumatic diseases, not all patients do well, and this can have an impact on clinicians who often develop long-term, sometimes life-long relationships with patients. “Bearing witness to progressive, unrelenting illness and ongoing fear, sadness and loss in patients they may be treating for years can have a psychological impact on clinicians,” Batterman said.
Working with ongoing illness and loss may tap into health-care providers’ own fears about these topics, and that can be difficult. “Emotional work in health care can be as challenging as the physical and intellectual work that we do. It’s important for clinicians to be aware of their own emotions in a nonjudgmental way,” Batterman says.
“When they fail to acknowledge and address their feelings, there can be long-term consequences on their ability to connect with patients. They can become desensitized and detached and lose the capacity to deliver empathic care. This is significant because it’s an essential component of a healing and therapeutic relationship”
Batterman recommends the establishment of formal and informal support systems to help physicians and other health-care providers deal with what they are experiencing. At HSS, she co- leads an ongoing peer group in which they can discuss the emotional challenges they face in facilitating patient support groups, including coping with grief and loss.
She also underscores the importance of clinicians taking time for themselves and being mindful of self-care so they can be at their best when caring for patients.