Psychosocial Care For Cancer Patients Research Articles

Outpatient psychosocial screening in askin cancer center: acceptance, psychosocial distress and utilization of support : Aposthoc analysis in aquality management program

Psychosocial care of cancer patients is an important aspect throughout the entire course of oncological treatment. Since 2015, psychosocial screening has been implemented in the outpatient clinics of the Skin Cancer Center in Freiburg. We present here apost hoc analysis in the context of aquality management program. Acceptance, psychosocial distress and desire for counseling were evaluated. Exploratively, we investigated which patient and disease characteristics are related to increased subjective distress. In afull survey from 06/2015 to 12/2015, we evaluated acceptance, psychosocial distress by distress thermometer (DT), and desire for counseling. Of 753 patients, 345 (45.8%) participated in psychosocial screening and data from 310 (174men, 136women; 89.7% melanoma patients, mean time since initial diagnosis 4.7 ± 3.9years) could be analyzed. The mean burden on the DT was 2.97 ± 2.83 (median2, range 0-10). High distress (DT ≥ 5) was reported by 84patients (28.8%). Thirty-four patients (11%) indicated adesire for counseling, and 23patients took up the counseling offer. The patient group with high distress was younger, more often under ongoing or recently completed systemic therapy, and had more often adesire for counseling. In addition to assessing psychosocial distress with validated screening instruments, the survey of the subjective desire for care represents an important parameter for the identification of patients in need of care. Young patients and patients with ongoing systemic therapy should be the focus of attention.

Which type of fear of cancer progression contributes to the quality of life of Romanian cancer patients during the COVID-19 pandemic?

Fear of cancer progression (FoP) is one of the most frequently reported unmet needs invoked by the majority of cancer patients, which may significantly impair the quality of life (QoL) of patients. The major objective of the present cross-sectional study was to investigate the specificities of the relationship between different dimensions and intensity of FoP and different aspects of patients' QoL during the COVID-19 pandemic in Romania. A nationwide sample of 330 participants completed a survey, including measures of demographic characteristics, medical variables, QoL, and FoP. Multivariate General Linear and Hierarchical Regression Models were conducted in order to assess the relationship between variables. Our results indicate that less than a quarter of the sample experienced low, between 63 and 70% moderate, and 15% high levels of FoP. Our results also indicate that anxiety/worry related to the possibility of progression of the disease, and loss of independence produced significant differences with large effect sizes in all the dimensions of QoL. Our results indicate that besides affective reactions, the fear of cancer survivors to lose independence, not being able to attend to their own lives, seems to be a considerable threat, especially in the context of Romanian health system which has difficulties in offering qualitative psychosocial care for cancer patients. The idea that patients will have to rely on others and may not function well independently, not being able to attend to their own lives, seems to be a considerable threat, next to the experienced affective reactions per se.

The Relationship Between Social Support and Suicide Resilience in Chinese Cancer Patients: A Serial Multiple Mediation Model Through Self-care Self-efficacy and Meaning in Life.

A growing body of literature has shown a higher risk of suicide in cancer patients compared with the general population. Early detection of factors related to suicide resilience in cancer patients could prevent loss of life. The study aimed to investigate the serial-multiple mediation of self-care self-efficacy and meaning in life in the relationship between social support and suicide resilience among Chinese cancer patients. A cross-sectional investigation of 287 cancer patients using a battery of self-reported questionnaires was performed. For preliminary analyses, descriptive, univariate, and Pearson correlation analyses were performed. Mediation analyses were tested using a serial-multiple mediation model (PROCESS model 6). Mediation analysis indicated the indirect effects of social support on suicide resilience mediated solely by either self-care self-efficacy (point estimate = 0.20; 95% confidence interval [CI], 0.12-0.30), or by meaning in life (point estimate = 0.06; 95% CI, 0.01-0.12), or by the multiple mediation of self-care self-efficacy to meaning in life (point estimate = 0.03; 95% CI, 0.01-0.06). The findings demonstrated the crucial direct or indirect effects of social support, self-care self-efficacy, and meaning in life on facilitating cancer patients' suicide resilience. Oncology nurses, as 24-hour care providers for cancer patients, may interact with and be important sources for the psychosocial care of cancer patients at risk of suicide. Prevention and intervention efforts must be directed at assisting cancer patients, improving self-care self-efficacy, and finding meaning in life after a cancer diagnosis.

Mental Health Care for Cancer Patients in Portugal – Implementation of a Psycho-Oncology Multidisciplinary Project

Psycho-oncology is an interdisciplinary field that addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers, and the psychological, behavioral, and social factors that may influence the disease process. It contributes to the clinical care of patients and families, to the training of staff in psychological management, and to the collaborative research that ranges from the behavioral issues in cancer prevention to the management of psychiatric disorders and the psychosocial problems during the continuum of the cancer illness, including end-of-life care.[1] There is scientific evidence of the benefits of providing psychosocial cancer care as part of standard care in reducing distress and psychosocial morbidity associated with cancer and in fostering a better quality of life during and after treatment, and eventually in increasing survival.[2] Because of the undeniably growing prevalence of cancer, its relationship with emotional distress and psychiatric comorbidity, and its impact on the quality of life of oncologic patients, their families, and health professionals, the need for mental health services for cancer patients is real and urgent. With this essay, the authors intend to present a brief narrative review of the scope and aims of psycho-oncology, clinical practice guidelines for the psychosocial care of cancer patients, and the authors' experience in the implementation of a multidisciplinary project of a psycho-oncology consultation in a central hospital, in Lisbon, Portugal.

The PACT Study: results of a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers

Abstract Background: The significant psychosocial morbidity experienced by cancer patients is often undetected and untreated. Despite international priority given to psychosocial care for cancer patients, implementation of psychosocial programs into routine cancer care is limited. We developed, implemented, and assessed the impact, acceptability, and cost of an integrated, patient-centered Psychosocial Assessment, Care and Treatment (PACT) model of care for cancer patients within a general hospital setting. Methods: A time series research design was implemented to test the PACT model of care, newly introduced in an Australian tertiary hospital. System-level impact on systematic distress screening and management was assessed through audit of the medical records of three cross-sectional samples of 141 patients, at baseline and at 12 and 24 months post-baseline. The impact of the model on patient experience and health care professionals’ (HCPs) knowledge and confidence was assessed via surveys. The acceptability of the intervention was assessed through HCP interviews at 24 months. The cost of the intervention was assessed by PACT staff recording the time spent on care provision, training, and intervention administration, and associated costs were calculated using staff payment rates adjusted for superannuation and leave. Results: Across the 24 months of implementation, formal distress screening increased from 0% at baseline to 29% of patients at 12 months and 31% of patients at 24 months, with an associated decrease in informal screening as formal screening increased. There was no notable change in distress management (ie, development of care plans) across the time period. Baseline patient experience was already high (mean score = 46.85/55) and did not change significantly over the course of the study. In both general and specific areas of addressing patient psychosocial concerns, HCP knowledge and confidence was moderate and remained largely unchanged over the course of the study. HCPs perceived the PACT model as highly beneficial and instrumental in bringing about significant changes to staff's knowledge, practices and awareness of psychosocial issues. The estimated total labor cost (including on-costs) was AUD$119,239 (over the 2 years); with a declining cost over the lifetime of the intervention reflecting the higher initial set-up costs. Conclusions: Although the PACT model was associated with an increase in distress screening, staff workloads, high turnover, and administrative barriers may have restricted the translation into distress management. Future research exploring effective avenues to engage staff at a management level and ensure that staff view distress management as a valuable component of their role may assist to embed strategies into the general hospital culture and lead to more sustainable changes.

Oncology social work intervention index (OSWii): An instrument to measure oncology social work interventions to advance research

Background/Purpose There is much interest in screening for and treating psychosocial distress in cancer patients; however, little is known about if and how psychosocial services are provided for patients demonstrating significant levels of distress. Oncology social workers (OSWs) are the primary providers of psychosocial care for cancer patients and their families, yet there is no widely-used and empirically-validated instrument that captures the range of interventions provided by OSWs. The purpose of this paper is to describe the development of the Oncology Social Work Intervention Index (OSWii), designed to measure interventions provided by OSWs, and the results of testing the instrument. Methods We conducted a content analysis of data collected by the Association of Oncology Social Work’s Project to Assure Quality Cancer Care (APAQCC). We analyzed 3,194 responses from an open-ended question that described social work interventions following a distress screen. Five investigators coded the data in an iterative process to enhance instrument validity. The resulting instrument measuring OSWii was piloted with 38 oncology social workers across 156 individual cases. Results OSWs who piloted the OSWii spent a majority of time (72%) engaging in clinical interventions. The user assessment revealed that data entry was rapid, the instrument was easy to use, and the content was relevant to the cancer treatment setting. Conclusions and Implications Using a standardized instrument that reflects OSWs’ clinical interventions is critical for researchers to examine the impact of psychosocial interventions on patient outcomes. This index may also advance the translation of scientific findings into patient-centered psychosocial cancer care. This pilot test suggests that the OSWii is both scalable and useful.

Factors Determining the Provision of Psychosocial Services for Oncological Patients and Their Loved Ones in Lithuania

It is acknowledged by various organizations, experts, and researchers around the world that meeting psychological and social needs is an important factor in cancer treatment. However, there is a shortage of psychosocial care supply for cancer patients and their family members in Lithuania. The aim of this study is to discern the causes of this insufficient supply. In order to find out the possible causes, Jon Elster’s action explanation framework was used. According to the framework, it is possible to deduce these factors: institutional constraints, economical (resources and labor supply) constraints, social preferences, and political preferences. Qualitative research (expert interviews) and secondary data analysis research methods were employed to gather the required data. A data analysis shows that the there are no institutional constraints for the provision of psychosocial care. However, there is a lack of public resources dedicated for the provision of psychosocial care. As a consequence, the main providers of psychosocial care for cancer patients and their family members are NGOs, which heavily depend on volunteer labor force. There is a contradiction in the point of view toward the professionalization of psychosocial care provision. It is the natural position of medical professionals that the provision of psychosocial care should be in the hands of professionals. On the other side, NGOs disagree with such a perspective. The need for psychosocial care is verbalized by experts and professionals; however, the general public prefers medical treatment. Thus, it is understandable why the public resources allocated to the provision of psychosocial care are so scarce. It is also evident that the political parties are not interested in psychosocial care, as it was shown by our analysis of their political programs.

Structured multi-disciplinary psychosocial care for cancer patients and the perceived quality of care from the patient perspective: a cluster-randomized trial.

We examined whether multi-disciplinary stepped psychosocial care for cancer patients improves quality of care from the patient perspective. In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for distress, consultation between doctor and patient, and the provision of psychosocial services. Quality of care was measured with the Quality of Care from the Patient Perspective questionnaire. The analysis employed mixed-effects multivariate regression, adjusting for age and gender. Thirteen wards were randomized, and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Patients who were highly distressed at baseline had 2.3 times the odds of saying they had had the possibility to converse in private with doctors and/or psychologists/social workers when they were in stepped care compared to standard care, 1.3 times the odds of reporting having experienced shared decision-making, 1.1 times the odds of experiencing their doctors as empathic and personal, and 0.6 times the odds of experiencing the care at the ward to be patient oriented. There was no evidence for an effect of stepped care on perceived quality of care in patients with moderate or low distress. Stepped care can improve some aspects of perceived quality of care in highly distressed patients. http://www.clinicaltrials.gov . NCT01859429.

What does an oncology social worker deal with in patient consultations? - An empirical study

ABSTRACTThe oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker’s (OSW’s) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the ‘carrying on as before’ or finding a ‘new normal’. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a ‘working alliance’ with their patients.

Update on distress management for cancer patients

Many cancer patients experience psychological suffering during their journey from diagnosis, through treatment, to survivorship or the end of life. Their psychological distress can become severe enough to interfere with their ability to cope with cancer. Conditions such as anxiety, depression, insomnia, and delirium often occur among cancer patients. Although distress is prevalent in cancer patients, it is often under-recognized and under-treated in the oncology setting. Psychological distress may have a negative effect on patients' quality of life. The prevention, early detection, and proper management of distress are important for improving patients' quality of life during and after cancer treatment. It is therefore necessary to develop a system for assessing and managing distress. The US National Comprehensive Cancer Network developed guidelines for distress management in 1999. Korean recommendations for distress management were released in 2009. The Korean government recently designated integrated supportive care centers for survivors at the National Cancer Center and regional cancer centers. The supportive care service is provided for cancer survivors who have completed first-line anti-cancer treatment. Psycho-oncology is one of the most important components of supportive care in cancer. Distress management yields many benefits for cancer patients, but the reality is that significantly distressed patients are often not properly referred for psychosocial care. All distressed patients should be properly referred for psychosocial care, and the psychosocial care of cancer patients should be integrated into routine cancer care practice.

Self-forgiveness is associated with reduced psychological distress in cancer patients and unmatched caregivers: Hope and self-blame as mediating mechanisms

ABSTRACTThis study examined the association between self-forgiveness and psychological distress and tested whether self-blame and hope mediated these associations equally for both patients and caregivers. Participants were 38 patients and 44 unmatched caregivers receiving care at a national cancer hospital. Participants completed measures of self-forgiveness, self-blame, hope, and psychological distress. Self-forgiveness was inversely associated with self-blame and psychological distress and positively associated with hope. Self-forgiveness was indirectly associated with psychological distress through hope but not self-blame and more strongly for caregivers than patients. Group differences between patients and caregivers in associations are intriguing and may have implications for improved psychosocial care of cancer patients and support of caregivers.

Psychosocial burden and desire for support in outpatients with skin cancer.

An important basis for adequate psycho-oncological and psychosocial care of cancer patients is the regular assessment of their psychosocial distress and thus their need for care. For this purpose, there are numerous questionnaires available. The objective of the present study was to assess whether distressed patients require professional support and which screening instrument outpatients with skin cancer prefer. In a cross-sectional survey, we asked outpatients with skin cancer to fill out three questionnaires assessing psychosocial stress, and to indicate which one they considered most adequate. Patients were offered the following three instruments: Hornheide Questionnaire (27 items), Hornheide Screening Instrument (7 items), and the Distress Thermometer. In addition, we inquired about the patients' desire for support. (1) Comparing subjective distress and patients' declared desire for support revealed a marked divergence. While one-third of the 137 patients were identified as being in need of care, only 11.5% of the sample requested such support. (2) 63.7% of patients chose the long version of the Hornheide Questionnaire. In addition to their psychosocial burden, patients' desire for support should be assessed. Moreover, apart from screening tools, other ways to provide access to psychosocial care should be considered.

Effectiveness of a psycho‐oncology training program for oncology nurses: a randomized controlled trial

Oncology nurses are expected to play an important role in psychosocial care for cancer patients. The aim of this study was to examine whether a novel training program aimed at enhancing oncology nurses' ability to assess and manage common psychological problems in cancer patients would improve participants' self-reported confidence, knowledge, and attitudes regarding care of patients with common psychological problems (trial register: UMIN000008559). Oncology nurses were assigned randomly to either the intervention group (N = 50) or the waiting list control group (N = 46). The intervention group received a 16-h program, the content of which focused on four psychological issues: normal reactions, clinically significant distress, suicidal thoughts, and delirium. Each session included a role-play exercise, group work, and didactic lecture regarding assessment and management of each problem. Primary outcomes were changes in self-reported confidence, knowledge, and attitudes toward the common psychological problems between pre-intervention and 3months post-intervention. Secondary outcomes were job-related stress and burnout. Intervention acceptability to participants was also assessed. In the intervention group, confidence and knowledge but not attitudes were significantly improved relative to the control group. No significant intervention effects were found for job- related stress and burnout. A high percentage (98%) of participants considered the program useful in clinical practice. This psycho-oncology training program improved oncology nurses' confidence and knowledge regarding care for patients with psychological problems. Copyright © 2015 John Wiley & Sons, Ltd.

Screening for Psychosocial Distress: A National Survey of Oncology Social Workers

Oncology social workers are the primary providers of psychosocial care for cancer patients, thus they are well positioned to implement and oversee psychosocial distress screening. A national survey of members of the Association of Oncology Social Work was conducted to examine screening knowledge, attitudes, behaviors, and perceived competency. The findings indicated that most participants screened for psychosocial distress using a standardized instrument and identified institutional and individual barriers to implementing screening. Analyses revealed that social workers who perceived patient benefits from screening and were knowledgeable about guidelines were significantly more likely to implement screening procedures and use a standardized instrument.

The Validity of the Distress Thermometer in Greek Colon Cancer Patients

Background : Although screening for distress is a crucial part of psycho-social care for cancer patients, there has not been a validation study for this purpose in Greece. The purpose of this study was to evaluate for the first time the psychometric properties of the Greek translation of the Distress Thermometer (DT) and Problem List (PL) in Greek colorectal cancer patients (CRC).Methods : Participants were 84 CRC inpatients of the 1st Surgical Propedeutic Department of the Aristotle University of Thessaloniki with a mean age of 70.8 ± 9.5 years. Participants completed the DT, PL and the Hospital Anxiety and Depression Scale (HADS).Results : The Cronbach’s alpha coefficient in the DT was 0.795. Patients’ mean score in the DT was 5.7 ± 2.74, while the mean number of the reported problems in the PL was 18.85 ± 5.50 and the mean total score of the HADS was 15.61 ± 6.95. ROC-analysis supported that a cut-off score of 7 gives the optimal sensitivity and specificity for the DT. Conclusion : The index sample has manifested high levels of distress, which correspond to high need for support and improvement of the patient-provider relationship. This is probably a difficult task, since the Greek healthcare system has minimal experience of providing psycho-oncology care. The present study has indicated that the DT can be reliably used in the Greek clinical setting. Future studies, along with state provision, are essential in order to offer Greek cancer patients state-of-the-art and comprehensive care.

Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation.

The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind-body process. A gap exists between research evidence and implementation into clinical practice. The patients' search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems.

Beyond the distress screening debacle: rethinking and rebuilding psychosocial care for cancer patients

Beyond the distress screening debacle: rethinking and rebuilding psychosocial care for cancer patients

Biologic, psychological, and social health needs in cancer care: how far have we come?

In 2007, the U.S. Institute of Medicine delivered a report titled Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs1, in which gaps in the provision of psychosocial care for cancer patients were identified.[...]

Intervening to Improve Psychological Outcomes after Cancer: What Is Known and Where Next?

Cancer is a leading cause of burden of disease in Australia. The diagnosis of cancer is a major life stress with heightened psychological distress common and unmet psychological supportive care needs highly prevalent. There is a clinical imperative to provide accessible evidence‐based psychosocial therapies to patients and their families in order to reduce distress and optimise psychological outcomes.A range of theoretical approaches have been proposed to guide psychological interventions in the context of cancer, including theories of stress and coping and social cognitive theories of adjustment. In addition, there is a well‐established body of evidence demonstrating that psychosocial interventions improve psychological outcomes after cancer, and clinical practice guidelines for intervention to reduce distress in people affected by cancer have been developed based on this evidence. However, despite relevant theoretical models, empirical evidence, and the availability of guidelines, evidence‐based psychosocial care for cancer patients is the exception rather than the norm.The answer to this problem may lie in research translation. A model for research translation is overviewed in this article with barriers to research translation discussed and a case study presented. Finally, recommendations for how health psychology can contribute to psycho‐oncology research and practice are proposed.

Knowledge, attitudes, and practice behaviors (KAPb) of nurses and the effectiveness of a training program in psychosocial cancer care

Psychosocial distress in oncology patients may significantly interfere with their health outcomes and quality of life. Nurses work closely with their patients and are in the best position to screen for distress and provide timely intervention. It is thus important for nurses working in oncology settings to be equipped and prepared to address distressing psychosocial issues. The present study aims to investigate the impact of a training program in psychosocial care on nurses' knowledge, attitudes, and clinical practice behaviors. A total of 180 nurses working in medical oncology and radiation oncology departments at the National University Cancer Institute Singapore underwent a training program in psychosocial care as part of their continuing nursing education curriculum. One hundred fifty four of these nurses completed a self-designed questionnaire on nurses' knowledge, attitudes, and practice behaviors (KAPb) at all four time points: baseline, post-training, and at 6 and 12 weeks post-training, respectively. The self-designed KAPb questionnaire proved adequate for this study. Positive gains on applied knowledge and practice behaviors were sustained over a 12-week period. There were no changes in theoretical knowledge. A decreasing trend in attitudes was noted, although this was specific to the participants' attitudes toward the importance of emotional concerns as compared to physical concerns in cancer treatment. Enrolled nurses seemed to have higher starting levels of theoretical knowledge than their registered counterparts were. There were no other differences on demographic variables in relation to the efficacy of the training program. The training program was successful in improving the applied knowledge and practice behaviors of nurses in providing psychosocial care for cancer patients. However, further refinement to the program, with particular attention to nurses' existing training and years of clinical nursing experience, would enhance staff empowerment and care improvement.