The Psycho-Oncology Service, part of the Psychological Medicine Service at St James’s Hospital, aims to provide expert, compassionate care to patients with cancer who are attending the hospital. Affiliated to Trinity College Dublin, the service also provides training for healthcare professionals. Its emphasis is on the early recognition of psychological distress, the delivery of best practice in terms of interventions and the promotion of psychological well-being. Through teaching and teamwork, it seeks to promote a culture of collaboration, compassion and respect, not only for patients but also for all those involved in providing healthcare.
The team operates from a single building on the hospital site, fostering collaboration between clinicians and helping to integrate the response to psychological distress within a medical setting.
The Psychological Medicine Service gives patients access to a broad range of interventions and expertise, ranging from psycho-education and self-directed learning to specific interventions provided by senior clinical nurse specialists, principal clinical psychologists and consultant psychiatrists. The service has led the field in providing innovative educational programmes for healthcare students and clinicians, both locally and nationally.
In constantly striving for excellence, the service has received several national awards, including the HSE Innovations and Quality Award (2005) and Best Hospital Project and An Duais Mhór at the Irish Healthcare Awards (2012). It was the first service to develop a clinical nurse specialist post in general hospital mental health, the first mental health team to develop an intern-training position.
Many patients who receive a cancer diagnosis experience a range of complex emotions: numbness, shock, fear, anger, guilt and sadness. These emotions can be short-lived, or they can continue and worsen, leading to significant and severe depression or anxiety. The Psychological Medicine Service helps to respond to this distress, developing interventions to match need, through:
In addressing the wide range of symptoms associated with cancer, the team provides expertise in psychological interventions, including Cognitive Behavioural Therapy (CBT) , Acceptance and Commitment Therapy (ACT), compassion focused therapy and Mindfulness Based Cognitive Therapy. They also provide expertise in psychiatric assessment and medical interventions.
In addition to working with a range of conditions such as depression, anxiety, body-image problems and steroid-induced illness, the service provides a range of specific interventions, some of which are listed below.
Cognitive Behavioural Therapy (CBT) and cancer-related fatigue
The service has developed specific interventions in the area of cancer-related fatigue using CBT techniques, either through one-to-one therapy or manual-guided intervention.
Group Interventions
The team has developed an intervention based on mindfulness, running mindfulness-based group sessions throughout the year. These address difficulties such as fear of cancer recurrence, living well after cancer, insomnia and sleep difficulties.
Support for patients undergoing bone marrow transplantation
The cancer team recognises the significant psychological effect of bone marrow transplantation. The Psycho-Oncology Service is available throughout the bone marrow transplant process, working closely with the transplant doctors and nurses to ensure patients’ psychological needs are addressed.
Medication-related illness
Sometimes the treatments used to treat cancer can in themselves, lead to (short-lived) psychological ill-health. This is particularly the case for those receiving high-dose steroids which are key to many treatment regimens for haematological, or blood-related, malignancies. These patients require rapid and specific response from the Psychological Medicine Team, which helps to identify those who may be at risk and then intervene.
Promoting self-care
Created with guidance from many of patients and their families, information booklets and self-help manuals seek to optimise patients’ abilities to self-care, promoting self-awareness and a sense of control over their treatment and the impact of a cancer diagnosis. In sharing others’ experiences, they help to validate each individual experience and create a sense of community amongst those adjusting to their illness.
Psycho-Oncology and palliative care.
The Psycho-Oncology team works closely with colleagues in palliative care to look after patients at every stage of their illness and ensure that each patient receives an intervention tailored to their specific needs.
Patients with genetic high-risk cancer (BrCaI and II) and others
The team works closely with colleagues in oncology to provide assessment and, where needed, intervention for patients at high genetic or familial risk of cancer. This ranges from a simple, single-visit intervention to more complex care, depending on the needs identified.
Radiation Oncology
Patients undergoing radiation treatment can have specific needs for which they may require referral for assessment. Depending on those needs, follow-up interventions are coordinated by the service for both inpatients and outpatients.
Karen Shine is the lead administrator for the Psycho-Oncology Service, coordinating clinics, teams and meetings. Together with Lorraine Quill, administrator with the Psychological Medicine Service, she provides the first point of contact for many patients and their families and serves as the link for referrers. She has been a key figure in the service since 2005.
Clinical Care
Dr Tara Kingston, MD MRCPsych MSc (CBT), is a consultant psychiatrist and the clinical lead for the Psychological Medicine Service in St James's Hospital. She completed her training in psychiatry in Ireland, received an MD from the Royal College of Surgeons in Ireland and an MSc in Cognitive Behavioural Therapy from Trinity College Dublin. She has published in the fields of first episode psychosis and mindfulness-based cognitive therapy and trained in group analytic psychotherapy. She was appointed as consultant in St James’s Hospital in 2014.
Dr Rosie Plunkett MD, MRCPsych, MCPsych, PGDip (CBT, MedED) is a consultant adult psychiatrist, with an annotation in liaison psychiatry and a special interest in Psycho- Oncology. Rosie joined the psychological medicine department as a consultant in 2022. Rosie completed both her undergraduate and post graduate medicine education in Trinity Collage Dublin (TCD), having been awarded a doctorate of medicine for her research into patient dignity in 2020. Rosie is a clinical senior lecturer in TCD and contributes to undergraduate and post graduate teaching, examining and mentorship. Dr Plunkett was elected to the Executive Committee of the Irish Psychosocial Oncology Network (IPSON) in 2023. Rosie also chairs the Faculty of Liaison Psychiatry in the College of Psychiatrists. Rosie has a keen interest in patient centred care, interdisciplinary teaching and multidisciplinary working.
Dr Sonya Collier, BA (mod) D.Clin.Psych Cert CBT,is a principal clinical psychologist with the Psychological Medicine Service and adjunct assistant professor at Trinity College Dublin (TCD). She completed both her undergraduate and doctorate training in TCD before completing specialised cognitive behavioural therapy training in Oxford University. She has worked in St James’s Hospital since 2000.
Dr Sharon O Sullivan( DClinPsych), is a principal clinical psychologist with the Psychological Medicine Service. Sharon received her doctorate in Clinical psychology from TCD in 2007, and has worked in the department since 2016.
Clinical Nurse specialists
Eugene Beirne and Nicola O’Connor are the Clinical Nurse Specialists (CNS) in the Psychological Medicine Service. Our clinical nurse specialists are usually the first point of contact for patients to the service, they offer assessments, psycho-education and inpatient and outpatient follow up. “
Social work
Catherine Fitzpatrick is a medical social worker, within the psycho oncology team and provides both short and medium term therapeutic support to patients experiencing cancer related distress. Recognising the impact of cancer on the entire family, MSW can offer support in managing the changing roles and relationships within the family and wider social network and can assist in identifying solutions to help patients and their families deal with a diagnosis of cancer. MSW can offer support, guidance, and resources for talking to children about their parents cancer diagnosis. The MSW service may also advise and advocate for additional community based resources and supports when needed.
Patients are usually referred to the Psycho-Oncology Service by their treating cancer team, who will contact the service directly. Patients can also ask to be referred. They will then be seen either in a dedicated outpatient session or on the Haematology Oncology Day Ward, depending on the treatment they are receiving.
Administration building, behind Hospital 2