How Oncology Nurses Can Identify and Manage Trauma Responses in Patients

Oncology nurses play a pivotal role in identifying emotional distress and connecting patients with vital psychosocial support. Kelly Dyckman, LCSW, a clinical social worker with Haven for Healing Psychotherapy in Shrewsbury, New Jersey, who provides counseling at Mary’s Place by the Sea in Ocean Grove, New Jersey, highlights how nurse-led collaboration can reshape the patient care journey.

Dyckman, who also facilitates a metastatic cancer support group at Mary’s Place by the Sea, emphasized that a nurse’s everyday observations can directly influence how a person considers and connects with counseling services.

Understanding Trauma Cues: The Four Fs

In oncology settings, emotional distress and medical trauma often manifest as physiological and behavioral trauma cues in treatment areas, doctor's offices, and other clinical settings. According to Dyckman, trauma responses frequently present as fight, flight, freeze, or fawn. Recognizing these behaviors as forms of communication rather than deliberate defiance is critical for oncology nursing staff.

• Fawn: This response is marked by extreme compliance. Dyckman described this as "the patient who is absolutely like A+, gold star, “‘I'm going to do everything that you say. I'm going to never ask any questions. I'm going to say yes. I'm going to say yes.’" This pleasing behavior often masks underlying anxiety and a felt need to please the provider and ensure compliance.
• Fight: Irritability, a lack of trust in providers, and difficulties navigating the care system can signal a fight response driven by a lack of confidence in what is happening.
• Flight: Patients exhibiting flight may struggle with consistency, miss appointments, or fail to follow through on treatment details.
• Freeze: A freeze response occurs when a provider feels they are "talking at the patient and the patient's not really hearing them, getting it, connecting with them."

"To suggest that somebody's just being difficult, I don't know what that does for the patient," Dyckman stated. She warned that labeling patients as difficult "makes the patient's life that much harder and the provider's lives that much more difficult in working together."

Nurses must recognize the humanity beneath these actions, leaning into the understanding that "behavior [is] a form of communication, especially when we're talking about a health crisis."

Collaborative Strategies for the Care Team

To ease these trauma responses, Dyckman advocates for immediate, integrated care. First, nurses should not wait for formal referral moments. If a nurse detects distress or anxiety during a routine check-in, they should name it immediately and suggest counseling in the same conversation, using phrasing like: "I do want to let you know that this is something a social worker could sit with you and talk about."

Second, care coordination relies on deep trust and shared patient details. For instance, a nurse sharing a patient’s hobbies with a counselor allows for a more personalized, less repetitive introduction, removing the burden of the patient always being the one to hold all of the information all of the time.

Lastly, informal introductions in clinic hallways can dismantle barriers, easing patients into supportive therapy. By practicing these collaborative techniques, oncology nurses help patients build enduring coping mechanisms, such as five-senses grounding, to safely navigate their medical journeys.