Team member highlight: Tamara Orr
Can you describe your role at Massey?
I am clinical psychologist in the Division of Hematology, Oncology and Palliative Care at VCU Health and Massey Cancer Center. My specialty training is in health psychology, which is concerned with the psychological and behavioral processes of health and illness. I provide mental health services to cancer patients who are hospitalized as well as those in the outpatient clinics.
When did you start working at Massey, and how has your role changed?
I’ve been working at Massey and VCU Health since 2006. When I began, I worked primarily in the Dalton Oncology Clinic, Massey’s main outpatient treatment clinic, and the inpatient Oncology and Palliative Care Units. I provided supportive and interpersonal counseling to patients and their caregivers.
Over the last four years, I have shifted to mainly working in Massey’s Supportive Care clinics downtown and at Stony Point. These clinics have grown and developed under the leadership of Egidio Del Fabbro, M.D., director of the Palliative Care Program at Massey, and are now open five days per week. Supportive care clinics deliver specialized medical care for our cancer patients and focus on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
All new patient visits include a clinical interview to obtain a psychiatric history and assess current psychological and social functioning that may impact health and treatment outcomes. It’s really important to have a comprehensive evaluation so our team can develop a plan of action to meet each patient’s needs. If someone’s mental health problems are severe, then we can triage care and refer them to the appropriate professional. My clinical practice in this setting includes brief interventions, psychoeducation, teaching the techniques of behavior change, stress management, and psychotherapy.
How did you get into psychological counseling for cancer patients?
In 1984, I graduated with a degree in nursing from a hospital-based program in Dayton, Ohio. During nursing training, I worked as a nurse’s aide on the cancer wards and following graduation my first job was with hospice. This was during the early hospice movement in the United States, and there were no inpatient services at that time. All services were delivered in the home, and I was one of just two hospice nurses covering the entire area.
Through this work, I realized I was drawn to the mental-emotional processes of medical illness. I decided to further my education, and was accepted into the Clinical Psychology Doctorate program at VCU in 1997. My dissertation addressed the doctor-patient relationship and its impact on psychological function and quality of life in cancer patients. I completed a post-doctoral fellowship in neuropsychology and another NCI-funded post-doctoral fellowship in the Genetics Department. I was offered the current job as a clinical psychologist at VCU Health in Oncology and Palliative Care in 2006, and I’ve enjoyed working here ever since. In 2014, thanks to the wonderful VCU education benefit, I completed a psychiatric mental health nurse practitioner training program.
What are some of the most common challenges your patients face?
It really depends on where someone is in the trajectory of the cancer experience. Coping with the initial diagnosis and adjustment to life changes are common challenges for patients. Managing all the other aspects of their life and work in addition to attending medical appointments can be quite stressful, especially for patients who have limited resources. For many, it’s the first time they’ve confronted their own mortality. People sometimes struggle with questions about whether they did something to cause the cancer or feel they are being punished for something. Stress, anxiety and depression can increase during transition points such as disease progression, recurrence or changes in care goals (e.g. transitioning from curative treatment to palliation).
For those who are reaching end of life, coping with the prognosis and preparatory grief can be challenging for the patient and family. Some individuals talk about regrets and wish that they lived their life differently. People also mourn the physical toll that cancer has taken on their body and the limitations it has put on their life. They may worry about whether they will be a burden to their family or whether they will die in pain. They also begin to grieve the loss of future dreams and relationships.
How do you work with caregivers?
Caregiver burnout and depression is quite common. Cancer patients are surviving longer, though their quality of life may be impacted. Caregivers often take on the roles that the patient fulfilled within the family system and this can be mentally and physically exhausting.
When caregivers accompany patients to clinic appointments, it provides an opportunity to check in with them to see how they’re coping with this life altering experience. I find that patients and family members are often uncomfortable discussing certain topics, so I can bring those issues out into the open and encourage them to talk. I also offer individual counseling for family members or grief counseling following the death of a loved one.
What is the most rewarding part of your job?
The most rewarding part of my job is to be a listening presence and to provide the space for patients to express their thoughts and feelings. Sometimes I may be the only person that the patient has discussed certain issues with such as death or expressing uncomfortable emotions. For me, it’s the real human connection and providing comfort to someone who is suffering that is most fulfilling.
What is the most challenging part of your job?
The most challenging part of my job, as is the case in most of healthcare, is witnessing the sheer amount of human suffering and not being able to meet all the needs or to provide enough resources.
How do you take care of yourself?
As I have grown professionally, I have learned better boundaries and self-care strategies. There are times when I’ve been emotionally or spiritually exhausted by this work, however, this provided an excellent opportunity for personal growth and to consider my health and wellness as a priority.
Spending time alone, in silence or in meditation is what works best for me. I am an introvert at heart. Spirituality is another way I care for myself, and I sing in a church choir, attend bible study and a women’s spirituality group. Being in nature, gardening and bicycling outdoors are other self-care activities.
I have three sons, and now that they’re independent adults, I’ve been able to devote more time to philanthropy and volunteerism. I participate in charity bicycling events. I recently concluded a four-year term serving on the board of Side by Side (formerly ROSMY), a nonprofit dedicated to the development of LGBTQ+ youth. For the past seven years, I have engaged in mission work to rebuild homes in New Orleans following Hurricane Katrina. I also volunteer at CrossOver Ministry providing psychiatric mental health nurse practitioner services.
What improvements could be made in the way psychological care is incorporated into oncology?
I think the integrative model we use in the Supportive Care Clinic is quite effective. When mental health care is a routine part of oncology care, distress and mental health issues can be identified early and treated before negatively impacting patient outcomes.