What began as ambivalence emerged into enlightenment. In the beginning, the academic woods of research seemed quite dim with overcast and fright. However, my love for learning and desire to be involved in research that would both stretch me as an individual and professional outweighed the fear. Therefore, I ventured into the woods, eager to gain a new perspective of a very challenging and rewarding specialty area in social work. It became a personal goal to learn from this research experience so the knowledge acquired could transcend my perception of this illness.

As my ambivalence subsided, I remained aware that I was partaking in research on a topic people often shy away from saying the full name of the illness. Instead of saying the word "cancer," many people will label it the “Big C.” Another factor that seeped into my awareness was the character and astounding strength of individuals who work in this field, particularly oncology social workers. Oncology social workers involved in A Project to Assure Quality Cancer Care (APAQCC) have provided me with a wealth of insight into the world of oncology social work.

APAQCC is a national social work research project that evaluates oncology distress screening practices. Spending time with the qualitative data from key informant interviews and surveys has allowed me the opportunity to really comprehend what oncology social workers and their co-workers find to be most challenging and rewarding about implementing and fine tuning distress screening procedures. If we start on a macro level and whittle our way to the micro level, the first prominent collective barrier that is present in the data is lack of stakeholder buy-in. Many of the oncology social workers in the study highlighted investment and support as being critical to both doing the distress screening research as well as the delivery of the service. Support from your institution, department, leadership and other professions is a vital part in the effectiveness of improving a psychosocial care practice.

In addition to receiving support from leaders and fellow colleagues, the social workers deemed education and training on distress screening and psychosocial needs to be essential. Education and training present one avenue to getting all providers, not limited to but including social work and nurse navigators, to understand how crucial it is to have consistent standardized distress assessments. Education on the need for distress screening and how to both effectively and briefly screen can lead to timely follow-up. With timely follow-up, social workers and other healthcare providers can deliver patient-centered care, provide and connect the patient to the best referrals and resources in their ability, and reduce recidivism. As in any business, it is important to all stakeholders to reduce costs and increase the bottom line. With appropriate distress screening measures in place, there is the potential to reduce unwanted hospitalizations and their astronomical costs.

Continuing on the subject of costs, the data from the APAQCC survey reflected a widespread cry for additional funding, more time with patients and personnel support. It may be difficult to systematically address each of these needs, but using the data collected to support requests for additional help in your department is a great place to begin. Until the need for increase in physical and financial support can be addressed for your institution, the data from the interviews and surveys suggest the power of listening to the patient.

A patient’s narrative, which may illustrate a variety of needs from transportation, family issues, and financial barriers to medication or disruption to daily tasks, can explain a great deal about how they will or will not adhere to treatment. For some institutions, getting an accurate narrative could prove difficult in the face of cultural and language barriers. Nonetheless, the oncology social workers in this study expressed that in our line of work, it is helpful to be resourceful and creative. The key is to figure out what resources are currently available to you.

In the situation of cultural and language barriers, your institution may have interpreters, you could enlist the help of the patient’s family members, offer distress screens translated to the appropriate language, or simply do the best you can to find other unique ways to communicate. Overall, I learned the message here is to communicate and listen with all your senses and using the resources available.

Thus far, this has been an eye-opening and very pedagogical experience. Through not only reading and analyzing, but also coming to wholeheartedly comprehend the concerns addressed by the oncology social workers in this study, I have been able to increase my limited knowledge of oncology social work and overcome that original fear of working in cancer research. More importantly, I found that above all the wonderful and diverse trainings and duties a medical social worker possesses, the most important tool in our arsenal is the daily defiance of the cognitive bias of functional fixedness.

Meaning, there is often a fixed mindset associated with the title social work that we have to educate against. I make it my mission to see all things outside of their original purpose and function by taking an all-encompassing point of view, making me a creator, administrator, one’s social support, therapist, manager, program-evaluator, researcher, presenter, mediator, advocator, policy maker, and—well, the list could go on. This research study has taught me that we have to break the functional fixedness our organizations, teams and co-workers have of our clinical roles, social workers in research and systematic change.

From listening to key informant interviews, analyzing the data and writing the community blog for this study, oncology social workers have taught me to demystify any preconceived notions I may have about components involved in the roles of social workers in oncology. I come to a close with a sincere thank you to all the oncology social workers involved in the APAQCC research study for the insight and educational benefits I have received from your input and commitment to improving psychosocial care practices in your institutions.