Quantifying the psychosocial needs of cancer patients and associated provider workload to build PSO services into the funding model for systemic treatment in Ontario.

Abstract

18 Background: As part of a broader set of provincial health funding reforms, Cancer Care Ontario (CCO) developed a new funding model for systemic treatment. A decision was made to build dedicated funding for psychosocial oncology (PSO) services into the model. The objective of this work was to estimate the psychosocial needs of cancer patients and the associated PSO provider workload to inform the incorporation of these services into the model. Methods: PSO clinicians formed advisory groups for six disciplines: social work, psychology, nutrition, physiotherapy, occupational therapy, and speech language pathology. For each cancer type, treatment intent, and phase of the cancer journey, advisors were asked to estimate: 1) proportion of patients who need services, 2) length of an average visit, and 3) average number of visits needed to address patient needs. Groups utilized online surveys to generate estimates to serve as a starting point for discussion. Evidence was used to inform the advisory groups’ consensus when available. Results: Each group produced recommendations based on estimated patient needs and associated workload. For example, the dietitian group recommended that prior to beginning systemic treatment, 50% of lung cancer patients receive a first consult visit (~75 minutes), followed by 1-2 follow up visits (~30 minutes each). Direct activities for these visits included nutrition assessment, weight loss management, and managing symptoms such as dysphagia. Indirect activities included documentation, chart review, and making referrals. Conclusions: This was an initial attempt to measure PSO workload based on patient needs, and the consensus process used could be leveraged by other jurisdictions. This work allowed the identification of specific funding for PSO services for patients who undergo systemic treatment in Ontario. Limitations included a lack of rigorous evidence and the complex nature of the funding model. Further efforts are underway to refine the recommendations and to leverage this work for quality improvement purposes.