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On Demand

Extending Cancer Stress Management to the Rural Practice Setting

You may earn this many credits: 1.5

Shawna Ehlers, PhD |  Elizabeth Kacel, Ph.D.
1 Hour 34 Minutes
Audio and Video


Comprehensive cancer care includes mandated screening for and treatment of cancer distress (e.g., depression and anxiety symptoms). However, a gap persists between recognition of distress and access to evidence-based treatment, especially for rural populations. Rural populations face unique barriers, higher rates of mental health disorders, and limited access to mental and behavioral health services. Relatedly, rural cancer survivors report distress akin to anxiety and depressive disorders at a higher rate than urban survivors (18.8% vs. 12.8%, respectively). Unfortunately, geographic distance from Comprehensive Cancer Centers is a barrier to cancer distress treatment programs. These distress disparities exist in the larger context of disparities in health outcomes, mortality and morbidity rates, and health care access. Effective and robust interventions to reduce cancer distress exist. In order to reduce disparities in rural cancer care, it is critical that effective interventions for cancer distress are scaled to and adapted for rural settings.This presentation utilizes Social Cognitive Processing Theory and the Cognitive Behavioral Therapy Framework to outline the effects of Cancer Stress Management, based upon the scientific literature. Effects include reduced cancer distress, reduced symptoms of anxiety and depression, improved immune markers, and potentially improved rates of cancer recurrence and mortality based on two highly rigorous, independently conducted scientific studies that each lasted over 10 years. Patient feedback from a 5 session, 10-hour "dose" of Cancer Stress Management delivered in Minnesota will be reviewed to provide the patient perspective on how this intervention contributes to and improves upon cancer care. Next, barriers to receiving Cancer Stress Management will be reviewed, including most prominently greater geographic distance from a Comprehensive Cancer Center. Finally, facilitating factors be reviewed. Culturally, facilitators include the social values of strong community and self-reliance, which Cancer Stress Management promotes. Practically, facilitators include potential methods and modalities to extend the rigorous and effective Cancer Stress Management intervention to rural practice settings (e.g., telehealth).

This session is at the intermediate level and is designed for psychologists and other mental health professionals.

At the end of this presentation, participants will be able to:

1) Describe mental health care disparities among rural cancer survivors.

2) Describe psychological and behavioral health components of comprehensive cancer care.

3) Explain the effects and potential mechanisms of Cancer Stress Management in improving health.

4) List at least three modalities for extending integrated specialty care to the rural practice setting.

This session qualifies for 1.5 continuing education credits. You must attend the full 1.5-hour program to get continuing education credit for the event.

The Minnesota Psychological Association is approved by the American Psychological Association to sponsor continuing education for psychologists. The Minnesota Psychological Association maintains responsibility for this program and its content. 

This program was cosponsored with: APA Committee on Rural Health; Illinois P.A.; National Association of County Behavioral Health & Developmental Disability Directors; National Association for Rural Mental Health; Hawaii P.A.; Minnesota Association for Marriage and Family Therapy; Southwest Virginia Psychology Doctoral Internship Consortium; Kansas P.A.; Indiana P.A.; Southern Illinois University



Shawna Ehlers, PhD Related seminars and products

Licensed Psychologist

Mayo Clinic, Consultant and Associate Professor

Dr. Ehlers is a Consultant and Associate Professor of Psychology within the Mayo Clinic College of Medicine and Science, holds Masters level privileges within the specialty of Translational Science, and is board-certified in Clinical Health Psychology with a specialty focus in oncology. Dr. Ehlers received her doctoral degree in psychology from the University of Iowa, with an emphasis in Health Psychology.  She completed her internship in Clinical and Health Psychology at the University of Florida.  Dr. Ehlers went on to complete her Postdoctoral Training in Transplant Psychology in the Center for Behavioral Health Research in Organ Transplantation and Donation.  She also completed a research fellowship in Psycho-Oncology with the Head and Neck Cancer Work Group at the University of Florida Health Science Center.  Dr. Ehlers is a licensed psychologist in Minnesota. Dr. Ehlers has consulted clinically on over 4,000 individual cancer patients, many from rural regions, and serves as a member of the Mayo Clinic Cancer Symptom Control/Survivorship Council and content expert for “Ask Mayo Expert”. With the exception of 2 years at the University of Minnesota (Psychology B.A., summa cum laude, 1996), Dr. Ehlers has lived in rural settings, including attending a 1-room K-8th grade school.

The speaker has indicated they do not have any conflicts of interest.

Elizabeth Kacel, Ph.D. Related seminars and products

Postdoctoral Fellow

Mayo Clinic, Postdoctoral Fellow

Dr. Kacel received her PhD from the University of Florida in 2019, with a focus on provision of psychological and integrated care for cancer patients and survivors. She completed her master’s degree in 2015; her thesis explored the associations between traumatic life stressors, anxiety, and depression in gynecologic oncology patients. She graduated cum laude from Northwestern University in 2010 with double majors in Psychology and American History.

The speaker has indicated they do not have any conflicts of interest.​