Health Psychology and Behavioural Medicine
“We know that vaccine uptake varies depending on the vaccine. Even before COVID-19, certain vaccines like MMR [Measles Mumps Rubella] had higher uptake rates than the flu vaccine. There is also a difference between childhood and adolescent vaccines. You could see that with HPV [human papillomavirus] which was administered in schools to adolescents.”
Health Psychologists and Behavioural Scientists have expertise that spans a very wide variety of specialties and disciplines. Many are also clinical psychologists, licensed to provide psychological services and therapies. Clinical Health Psychologists help people through medical issues, diseases, and chronic conditions. Behavioural Scientists study all of this, especially when it comes to preventative behaviours and behaviours that can affect the progression of a medical diagnosis. What helps a person with a heart condition maintain a strict diet? What affects the consistency with which a diabetic takes their insulin? And – very importantly of late, what factors influence a person’s acceptance and willingness to be vaccinated?
Imagine you have just been diagnosed with cancer. You probably have hundreds of questions and even more fears suddenly thrust upon you. There may be other factors that compound that stress, like the possibility of infertility, the loss of income, or the need to arrange childcare while receiving treatment. You might also now have a whole bunch of new doctors and specialists you never had before – oncologists, oncology nurses, patient navigators, genetic consultants. It’s a lot to handle, on top of trying to come to grips with the diagnosis itself.
One of the people who might help you through this difficult time is a psychologist, like Dr. Gilla Shapiro at Princess Margaret Cancer Centre in Toronto. Dr. Shapiro is a clinical and health psychologist, a behavioural scientist, and a psycho-oncologist (a specialist in cancer). She works with people who have received a diagnosis, with those who are undergoing treatment, and also with people receiving end-of-life care.
“There are many people who experience elevated distress [related to cancer and its treatment] so having a specialized treatment team to support them and their loved ones is really important.”
Some of this takes the form of supportive therapies, and some of it has to do with decision-making. If a person experiencing cancer must make a decision as to whether to begin a chemotherapy regimen, given the devastating toll that takes on the body and a certain percentage chance of it working, talking that through can be very helpful in the process. Trying to decide whether to join a clinical trial can be an overwhelming choice a person with cancer has to make. A psychologist like Dr. Shapiro approaches this in a few ways ̶
“People need support in different ways and have different concerns that could be social, practical, psychological, or emotional. Some may wonder, how am I going to approach cancer with my children? Others may require support with symptoms like pain, insomnia, anxiety, or depression. There are some types of cancer for which there is a genetic predisposition. So if genetically tested, some people wonder who should I tell, and how do I tell them?”
A team at Princess Margaret is working on developing evidence-based interventions to reduce distress and improve patients’ cancer experience. For example, an intervention called CALM (Managing Cancer And Living Meaningfully) is designed to help patients adjust to living with advanced cancer. It draws from a number of theories in psychology and mental health – relational, attachment, and existential theories – the goal being to address a number of different domains in an individualized way. Symptom management, changes in a patient’s relationship with themselves as well as their loved ones, a sense of meaning and purpose in life, and hopes and concerns relating to the future are all factors that are considered in CALM therapy and are all experienced differently by every person who receives a terminal cancer diagnosis.
One of the reasons Dr. Shapiro chose to come to Princess Margaret was that her supervisor, Dr. Gary Rodin, along with his colleague Dr. Sarah Hales, had developed CALM. Dr. Rodin and his colleague Dr. Madeline Li were also doing interesting work in understanding what factors impact individuals in make difficult health decisions. One big decision in cancer care, one that has come about much more recently, is medical assistance in dying, or MAID. Dr. Shapiro wanted to bring a health equity and policy lens to this work. Dr. Shapiro didn’t start her work in psycho-oncology and behavioural science there though, she began her work in psycho-oncology in cancer prevention and working on vaccines. Vaccines like the HPV vaccine, and how we can prevent viruses that cause cervical and other cancers by supporting individuals in making behavioural choices, like getting vaccinated.
Less than two years before COVID-19 was declared a pandemic by the World Health Organization (WHO), Dr. Shapiro completed her PhD on human papillomavirus (HPV) vaccine hesitancy in Canadian parents. With colleagues at McGill University, she developed scales to measure vaccine attitudes and conducted research to understand the behavioural and social drivers of vaccination in the Canadian population.
. In 2019, she began working with the WHO developing tools for routine childhood vaccination and to measure the behavioural and social drivers of vaccination globally. When the pandemic hit, that work pivoted to understanding adult vaccine acceptance and intention to the COVID vaccines, as they became available
During the COVID-19 pandemic Dr. Shapiro has been a member of Ontario’s COVID-19 Science Advisory Table’s Behavioural Science Working Group and she and her colleagues at the COVID-19 Science Advisory Table for Ontario (many of whom are also members of the Health Psychology and Behavioural Medicine Section of the CPA) published the brief ‘Behavioural Science-Informed Strategies for Increasing COVID-19 Vaccine Uptake in Children and Youth [link]’ in October.
While understanding the behavioural and social drivers that impact COVID-19 vaccine acceptance, she has also developed an interest in another cascading impact of the pandemic: missed or delayed routine vaccinations. Dr. Shapiro and colleagues at the WHO and elsewhere have recently completed a study looking at missed routine childhood vaccinations in 26 countries during the pandemic [link - COVID-19 and missed or delayed vaccination in 26 middle- and high-income countries: An observational survey].
Imagine you have been through a cancer diagnosis, have been through surgery and radiation, and are now on the other side with a (relatively) clean bill of health as a result. A clinical health psychologist may have helped you through that process, but now there is another, out-of-your control existential threat – a global pandemic. Your continued safety, in your immunocompromised state, relies on those around you getting vaccinated against that pandemic. It’s not an easy place to be, but it is nice to know that Health Psychologists and Behavioural Scientists like Dr. Shapiro are out there, working on that as well.