Psychosocial Situation and Patient Satisfaction among Clients of Cancer Counselling Centers in Saxony

Abstract

Outpatient psychosocial counselling (OPC) centers for those affected by cancer fulfill 2 main purposes: (a) to offer low-threshold psychological, social and legal counselling, and (b) to refer clients to other services. Here we report findings from a user-based assessment of OPC in the state of Saxony, Germany. This study was funded in part by the Saxon State Ministry of Social Affairs and Consumer Protection. We used a paper-based questionnaire to survey 213 clients of OPC in Saxony at 2 points (t1: up to one week after first contact, t2: 4 months after t1). All participants were cancer patients. The survey assessed utilization of services, depressive symptoms (PHQ-9), anxiety (GAD-7), quality of life (SF-8) as well as clients' satisfaction with the counselling service (ZUF-8). The majority of clients (81%) were referred to the OPC from a hospital or rehabilitation center. 46% of patients only had one contact. 78% of counselling sessions treated matters of social law. Patients suffered from 13 problems on average, the most common being fatigue and exhaustion, worries, anxiety, uncertainty about the future, and pain. Half the patients (49%) reported moderate to severe anxiety and 68% showed elevated levels of depressive symptoms. Psychosocial distress did not change significantly over time (GAD-7: p=0.580, PHQ-9: p=0.101). Patients' quality of life was low overall (cut-off<50). At t2, quality of life had particularly increased in physical aspects, but overall quality of life remained lower than in the general population (all subscales: p<0.05). We identified younger age and lower income as risk factors for higher psychosocial distress and lower quality of life. Patients were very satisfied with the counselling they received, 9% reported to be dissatisfied. Our results show that psychosocial distress remains high over a longer period of time at least for some patients. This illustrates the persisting need for long-term support regarding physical, mental and social impairments as a consequence of cancer and its treatments. It also shows the challenging demands which OPC centers are faced with. As a consequence, psychosocial support in the outpatient setting needs to be extended and developed further.