Allen, Social Work Practice in Healthcare Instructor Resource

Chapter 9: Social Work Practice in Oncology, Palliative, and End-of-Life Care

Multiple Choice
1. The death rate for all cancers, adjusted for the size and age of the population from 1950–
2005, has ___________________________.
a. Increased slightly
b. Decreased dramatically
*c. Decreased slightly
d. Increased dramatically
@ Cognitive domain: Knowledge ; Answer location: Survivability Factors; Question type: MC

2. The “code” word for a cancer diagnosis used to be ____________________.

a. Cancerology
*b. Big C
c. Pink
d. Project Omega
@ Cognitive domain: Knowledge; Answer location: Evolution Of Cancer Care: Question type: MC

3. ________________________ continue to suffer the greatest burden from common types of

cancer.
a. Hispanics
b. Asian Americans
c. Caucasians
*d. African Americans
@ Cognitive domain: Knowledge; Answer location: Cultural Issues; Question type: MC

4. ______________________________ was developed with the goal of eliminating barriers to

timely cancer screening, diagnosis, treatment, support, and end-of-life care.
a. Case management
*b. Patient navigation
c. Care coordination
d. Transitional care manager
@Cognitive domain: Comprehension; Answer location: Cultural Issues; Question type: MC

5. Distress risk screening should be conducted on ________________________________.

*a. All newly diagnosed patients
Allen, Social Work Practice in Healthcare Instructor Resource

b. Patients with head and neck cancers

c. Patients with breast cancer
d. Patients with stomach cancer
@ Cognitive domain: Application; Answer location: Current Trends In Psychosocial Care:
Functions And Roles Question type: MC

6. You are working with Helen, who has a diagnosis of breast cancer. Helen and her family have
adapted fairly well to her situation. What type of intervention would you use with Helen and her
family?
*a. Psychoeducation
b. Psychoanalysis
c. Cognitive behavioral therapy
d. Interpersonal therapy
@ Cognitive domain: Application; Answer location: Psychosocial Screening And Assessment:
Question type: MC

7. A tool that has been modified to measure patient distress in cancer patients is the
_____________________.
a. PHQ-9
b. Beck Depression Inventory
*c. Brief Symptom Inventory
d. Geriatric Depression Screen
@ Cognitive domain: Knowledge; Answer location: Psychosocial Screening And Assessment
Question type: MC

8. Rachel has been working with John since he was initially diagnosed with cancer. At the
beginning, John expressed shock and disbelief and described feeling almost “surreal.” It has
been 3 months since then. John comes to his biweekly chemotherapy appointments on Fridays
so he has the weekend to recover. He has only missed a couple days of work but went ahead
and completed FMLA paperwork with his employer’s human resources department in case he
needs to take more time off. John had experienced persistent diarrhea as a consequence of the
chemotherapy, but he made sure to discuss it with his physician, and with a change in diet and a
new prescription, it is now under control. Rachel and John reflect on John’s initial diagnosis and
note how John has ___________________________ to his cancer diagnosis.
a. Reconciled
*b. Adapted
Allen, Social Work Practice in Healthcare Instructor Resource

c. Reoriented
d. Disengaged
@ Cognitive domain: Analysis; Comprehension; Answer location: Psychosocial Screening And
Assessment; Question type: MC

9. Katrina has been working with a patient in the outpatient oncology clinic. The patient,
Norman, states he doesn’t know what to do. He is tired all the time, he can’t sleep, and nothing
tastes good. His affect is flat, his speech is slow, and he barely makes eye contact. Katrina asks
Norman if he still finds joy in anything, like seeing his grandchildren, who he has talked about at
every visit before this. Norman states he is ashamed to say it but “No, actually it is so hard to be
around them right now. I feel guilty about this. I must be a bad grandfather.” Katrina asks how
long Norman has been feeling this way, and Norman tells her it started about a month ago and
has gradually gotten worse. He describes the last two weeks as having been “the worst of my
life.” Concerned, Katrina asks Norman if it has gotten so bad that he has thought of ending his
life or harming himself. Norman says he had the thought once but has been able to “shake it
off.” Katrina should _____.
*a. Conduct a risk assessment and safety plan and then refer Norman to a psychiatrist
for an evaluation for possible antidepressants.
b. Provide psychoeducation highlighting the fact that many patients with cancer get
depressed.
c. Refer Norman to a support group
d. Begin existential therapy immediately with Norman.
@ Cognitive domain: Application; Answer location: Depression And Anxiety In Cancer Patients;
Question type: MC

10. ____________________________ and ___________________, often in combination with

antidepressant therapy, have been found to be effective with oncology patients.
a. Play therapy/Regression therapy
*b. Cognitive-behavioral therapies/existential therapies
c. Art therapy/Dialectical behavioral therapy
d. Interpersonal therapy/Eye movement desensitization and reprocessing therapy
(EMDR)
@ Cognitive domain: Comprehension; Answer location: Depression And Anxiety In Cancer
Patients: Question type: MC
Allen, Social Work Practice in Healthcare Instructor Resource

11. Carol walked into the exam room and saw the new patient, Tracey, sitting on the edge of the
exam table. Tracey had just recently been diagnosed with cancer and was here for her initial
meeting with the oncologist. Tracey appeared very small. Her shoulders were hunched forward,
her face was flushed, and her voice shook when she spoke. When Carol asked Tracey to
complete the Distress Thermometer, Tracey marked her anxiety as a 10 out of 10, the worst it
could be. Carol noticed that Tracey already had a prescription for medication to help with
anxiety, and when she asked Tracey how long she had been on the medication, Tracey said, “For
years.” Tracey most likely has ________________.
a. Situational anxiety
*b. Psychiatric anxiety
c. Organic anxiety
d. Existential anxiety
@ Cognitive domain: Comprehension; Answer location: Evolution of Medical Social Work
Practice: Question type: MC

12. Norma has had a diagnosis of Stage IV breast cancer for several years. Her condition has
been stable but is terminal. It is impossible to know how long she may live. Norma phones the
doctor’s office frequently and insists on having tests more often than her physician feels she
should. The rest of the staff express to the social worker, Fran, feeling that Norma is a “difficult
patient.” Norma confides to Fran that she used to work as a nurse, and she saw how
paternalistic physicians could be. She says her biggest fear is that she will not be told she is dying
until “the end.” Because of this, “all I can think about is if I am dying or not. All day, every day, I
am mentally checking for any changes in my body.” Norma is experiencing _________________.
a. Situational anxiety
b. Psychiatric anxiety
c. Organic anxiety
*d. Existential anxiety
@ Cognitive domain: Comprehension; Answer location: Anxiety And Depression In Cancer
Patients: Question type: MC

13. Cancer tumors that have spread to the brain and spinal cord and tumors in the lungs can
cause other health problems with the symptoms of anxiety. This is _________________.
a. Situational anxiety
b. Psychiatric anxiety
*c. Organic anxiety
d. Existential anxiety
Allen, Social Work Practice in Healthcare Instructor Resource

@ Cognitive Knowledge: Comprehension; Answer location: Anxiety And Depression In Cancer

Patients: Question type: MC

14. Jen’s patient, Dennis, was told he would need a feeding tube. Dennis argued that he would
be fine without one and said he would refuse to undergo the procedure. When Jen asked Dennis
why he felt this way, he told Jen, “I am afraid if I have anesthetic, I will not wake up.” Dennis was
exhibiting ________________________________.
*a. Situational anxiety
b. Psychiatric anxiety
c. Organic anxiety
d. Existential anxiety
@ Cognitive domain: Comprehension; Answer location: Depression And Anxiety In Cancer
Patients: Question type: MC

15. Counseling approaches that are effective for helping patients with posttraumatic stress
disorder are ______________________________.
a. Play therapy/Regression therapy
*b. Cognitive-behavioral therapies/Eye movement desensitization and reprocessing
therapy (EMDR)
c. Art therapy/Dialectical behavioral therapy
d. Interpersonal therapy/Motivational interviewing
@ Cognitive domain: Application; Answer location: Depression And Anxiety In Cancer Patients
type: MC

16. All of the following are risk factors for posttraumatic stress disorder except
__________________.
a. History of trauma
b. Avoidant coping
c. Social isolation
*d. Physical exercise
@ Cognitive domain: Knowledge; Answer location: Depression And Anxiety In Cancer Patients:
Question type: MC

17. Macy’s patient Tom has Stage IV lung cancer. Macy and Tom had been working together
since he was diagnosed with cancer. Despite aggressive treatment, the cancer continued to
spread, and Tom’s condition is now terminal. Tom only has a few weeks at most to live. Macy
Allen, Social Work Practice in Healthcare Instructor Resource

asks Tom if he would like to do __________________________________________. She

explained that she would provide him with a list of questions about his life and give him a couple
of days to think about them. They would meet a few days later, and she would ask Tom the
questions and record the interview. Macy would then have the interview transcribed, edit it to
ensure it provided a precise and flowing account of what Tom had said, and then review the
document with Tom to make sure it was correct. Tom would then be given the document to
keep.
a. Cognitive-behavioral therapy
b. Psychodrama
*c. Dignity therapy
d. Guided imagery
@ Cognitive domain: Application; Comprehension; Answer location: Depression And Anxiety In
Cancer Patients: Question type: MC

18. ________________________________________ is a type of care that provides medical and

supportive services to help alleviate pain and other symptoms of illness. Currently, few payment
models are in place to provide this care on an outpatient basis.
a. Hospice
b. Primary
c. Chiropractic
*d. Palliative
@ Cognitive domain: Comprehension; Answer location: Evolution of Medical Social Work
Practice: Question type: MC

19. According to the IOM, many cancer patients feel ________________________ at the end of
their cancer treatment.
*a. Lost
b. Elated
c. A sense of “letdown”
d. Victorious
@ Cognitive domain: Comprehension; Answer location: Current Trends In Psychosocial Care:
Functions And Roles: Question type: MC

20. Treatments for cancer have become _________________________________.

*a. Less harsh, surgery is less disfiguring, and chemotherapy is less disabling
b. Less harsh, surgery is less disfiguring, but chemotherapy is more disabling
Allen, Social Work Practice in Healthcare Instructor Resource

c. More harsh, surgery is more disfiguring, and chemotherapy is more disabling

d. Less harsh, surgery is more disfiguring, but chemotherapy is less disabling
@ Cognitive domain: Knowledge; Answer location: Survivability Factors; Question type: MC

21. Severe symptoms of depression in cancer patients are of concern because of their
association with a reduced quality of life. Additional concerns about depression in cancer
patients include all of the following except
a. They incur more frequent and prolonged hospitalizations.
b. They have an increased desire for hastened death or suicide.
*c. It reduces the experience of physical distress
d. They exhibit poorer treatment compliance
@ Cognitive domain: Comprehension; Answer location: Depression And Anxiety In Cancer
Patients: Question type: MC

True/False
1. Social workers are the only professionals employed as patient navigators.
a. True
*b. False
@ Cognitive domain: Knowledge; Answer location: Current Trends In Psychosocial Care:
Functions And Roles; Question type: TF

2. In order to be accredited by the College of Surgeons, all cancer centers must implement
patient navigation, distress risk screening, and survivorship care plans by 2015.
*True
False
@ Cognitive domain: Knowledge; Answer location: Current Trends In Psychosocial Care:
Functions And Roles; Question type: TF

3. The rates of depression in people with cancer are at least three times as common as those
found in the general population.
*a. True
b. False
@ Cognitive domain: Knowledge; Answer location: Depression And Anxiety In Cancer Patients;
Question type: TF
Allen, Social Work Practice in Healthcare Instructor Resource

4. As terminally ill cancer patients reach the end of their lives, their quality of life and sense of
well-being deteriorate. This leads to suffering, depression, and a loss of dignity that can only be
addressed with antidepressant medications and strong pain medications.
a. True
*b. False
@ Cognitive domain: Comprehension; Answer location: Depression And Anxiety In Cancer
Patients; Question type: TF

5. Benefits of group counseling with cancer patients are the reduction in feelings of isolation and
“normalizing” the cancer experience.
*a. True
b. False
@ Cognitive domain: Comprehension; Answer location: Group Counseling; Question type: TF

6. One difficulty with conducing family counseling with cancer patients is that the cancer
patient’s and family members’ concerns are disparate.
a. True
*b. False
@ Cognitive domain: Comprehension; Answer location: Family Counseling; Question type: TF

7. The majority of patients enrolled in hospice services have a diagnosis of cancer.

a. True
*b. False
@ Cognitive domain: Knowledge; Answer location: Hospice And Palliative Care; Question type:
TF

8. Posttraumatic stress disorder (PTSD) can occur as a result of cancer-related traumatic events.
*a. True
b. False
@ Cognitive domain: Knowledge; Answer location Depression And Anxiety In Cancer Patients;
Question type: TF

9. With the advances in medical science, it has gotten easier to give an accurate prognosis and
know when to make an appropriate referral to hospice.
a. True
*b. False
Allen, Social Work Practice in Healthcare Instructor Resource

Cognitive domain: Analysis; Answer location: Hospice And Palliative Care; Question type: TF.

Short Answer/Essay
1. ________________________________ is done at the end of treatment to help ensure
patients do not feel lost and confused about follow-up and recommendations.
a. Survivorship care planning
@ Cognitive domain; Application; Answer location: Current Trends In Psychosocial Care:
Functions And Roles; Question type: FIB

2. A patient with a terminal illness who has 6 months or less to live and is no longer receiving
treatment with a curative intent may chose to enter _______________________________ care.
A patient with a grave but not necessarily terminal prognosis who is still receiving treatment
aimed at remission or cure may chose _________________________ care.
*a. Hospice/Palliative
@ Cognitive domain; Comprehension; Answer location; Hospice And Palliative Care; Question
type: FIB

3. What are two reasons cancer-related depression can be difficult to diagnose?

a. Ambiguous boundaries between realistic sadness, subthreshold depression, and
major depression; b. Symptoms of cancer or its treatment overlap with symptoms of
depression; c. Patients who are not depressed may still experience a sense of demoralization.
@Cognitive domain: Analysis; Answer locations: Depression And Anxiety In Cancer Patients
Question type: ESS

4. The oncology social worker should be aware of the specific points of vulnerability for cancer
patients and be ready to intervene at any of these points. List four specific points of vulnerability
for cancer patients.
*a. Diagnosis; b. Beginning of treatment; c. Changes of treatment; d. Development of
complicated side effects; e. End of treatment; e. Recurrence of disease, and f. Terminal illness
@Cognitive domain: Application; Answer locations: Individual Counseling; Question type: ESS