Psychiatric liaison with a cancer research center

Abstract

A clinical research center for the study of cancer patients represents an unconventional subculture within the general hospital setting. Psychological stresses on patients and staff are described from the vantage point of the liaison psychiatrist. The resident physician is restricted to minor decisions concerning patient care, because major treatment choices are predetermined by research protocols. His identity and research goals and his time limited rotation on the unit form natural points of conflict with the nursing and paramedical staff, whose priorities center on patient care, and whose time commitment to the unit is indefinite. The admission period is critical for information exchange between patient and physician, but the patient who has only recently been told his diagnosis may be too preoccupied to understand the detailed explanations of the research team. Details of the hospital environment and admission criteria to the protocol are not well known by physicians who refer patients to the center. Rejection from the protocol in the evaluation period may be experienced by the patient as tantamount to a death sentence. The standardization introduced by a research protocol, and the similarities of patients' diagnoses contribute both discordant and supportive aspects to patient care. The liaison psychiatrist should be prepared to spend an initial learning period before understanding the complex motivational interactions which characterize the combined research-service setting. Five specific suggestions to reduce stresses are presented. A liaison psychiatrist is most valuable if he can model his interviewing expertise with patients for members of the ward staff. In addition, he can be helpful as both a formal educator and as a constructive agent of change by identifying inter-group conflicts and selectively allowing them to become explicit at conferences designed to increase the understanding of issues and priorities which most concern each group on the research unit.