Provision Of Psychosocial Care Research Articles

Patient experiences and needs in cancer care– results from a nationwide cross-sectional study in Germany

BackgroundPatient-centredness has become a central quality indicator for oncology care. Elements include shared decision-making, patient navigation and integration of psychosocial care, which impact patient-reported and clinical outcomes. Despite efforts to promote patient-centred care in Germany in recent decades, implementation remains fragmented. Further, research on patient experiences with cancer care and its determinants is limited. Therefore, this study examines which patient- and facility-specific factors are associated with patient-centred quality care delivery.MethodsA cross-sectional study was conducted among 1,121 cancer patients in acute treatment, rehabilitation, and aftercare for different cancer entities across Germany. A participatory developed questionnaire was used. Outcome measures were the quality of physician-patient interaction and provision of psychosocial care during acute care. Predictors comprised patient-specific characteristics and treatment facility-specific factors. Multiple linear regression and multivariate binary logistic regression analyses were performed. In addition, a content analysis of open-ended comments on the patients’ overall cancer care needs was applied.ResultsMultiple linear regression analysis showed recent diagnosis (β=−0.12, p = < 0.001), being male (β=−0.11, p = 0.003), and having a preference for passive decision-making (β=−0.10, p = 0.001) to be significantly associated with higher interaction quality, but not age, education and health insurance type. An overall low impact of patient characteristics on interaction quality was revealed (adj. R2 = 0.03). Binary logistic regression analysis demonstrated the availability of central contact persons (OR = 3.10, p < 0.001) followed by recent diagnosis (p < 0.001), having breast cancer (p < 0.001) and being female (OR = 1.68, p < 0.05) to significantly predict offering psycho-oncological counselling to patients in acute care facilities. The availability of peer support visiting services (OR = 7.17, p < 0.001) and central contact persons (OR = 1.87, p < 0.001) in the care facility, breast cancer diagnosis (p < 0.001) and a higher level of education (p < 0.05) significantly increased the odds of patients receiving information about peer support in the treatment facility. Despite relatively satisfactory quality of physician-patient interactions in cancer care (M = 3.5 (± 1.1)), many patients expressed that better patient-centred communication and coordinated, comprehensive cancer care are needed.ConclusionThe findings reflect effective developments and improvements in cancer care and suggest that patients’ social characteristics are less decisive for delivering patient-centred quality care than systemic factors surrounding the care facilities. They can serve to inform oncology care in Germany.

Development of a blueprint for sibling psychosocial services: A nationwide study.

Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers. Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N=27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis. Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint. The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.

Psychosocial support among adults living with metastatic breast cancer: Perspectives from providers across four New York-Presbyterian hospitals.

Key Points We conducted semi‐structured interviews with providers at four New York‐Presbyterian (NYP) hospitals: Weill Cornell Medicine (WCM), NYP‐Queens, NYP‐Brooklyn Methodist Hospital, and Columbia University Medical Center. Emergent themes identified factors that influenced healthcare delivery at the institutional, provider, and patient levels. Most frequently reported barriers included a lack of formal protocols for communicating and offering psychosocial resources to patients (institutional), lack of vital staff such as, social workers and patient navigators (institutional), time constraints (provider), and stigma regarding mental health care (patient). Most frequently cited facilitators to delivering psychosocial care included having a trained social worker on staff (institutional), awareness of psychosocial needs (provider), and engagement (patient). Our findings highlight opportunities to improve the provision of psychosocial care for adults with metastatic breast cancer (mBC) at multiple levels.

P4: Help-Seeking Factors Among Older Adults on the National Psychosocial Support Helpline on COVID-19 in India

The pandemic has halted the traditional way of life as we used to know it. Due to the highly contagious nature of the virus, physical distancing had become the primary norm for reducing the spread, inevitably leading to social isolation. The older adult population is vulnerable to environmental changes, making them very prone to stress during disasters. Comorbidities, lack of social support, loneliness and uncertainty can be common precipitating factors. The National Institute of Mental Health &amp; Neurosciences, with the Ministry of Health &amp; Family Welfare, commenced a helpline to provide psychosocial support and mental health services in thirteen languages to distressed persons across the Indian subcontinent. The study aims to explore the help-seeking factors due to which older adult callers have sought help from the helpline during the COVID-19 pandemic by analysing the call recordings and, as a secondary objective, to develop a checklist to assess the psychosocial issues of older adults to be used by telephone- based psychosocial care providers. The researcher would use a “Naturalised” conceptual framework of transcription, which would necessitate a literal interpretation of the call recordings. Recordings of the calls made will be transcribed. “Thematic analysis” shall be conducted to find psychosocial issues older adult callers face. Categories would be identified, refined, and specified for coding. A series of key-informant interviews would be conducted online with a group of mental health professionals (defined as per the Mental Health Care Act, 2017) associated with or working in geriatric mental health. The findings from the study would help look into the evolution of psychosocial needs of the older adult population during a pandemic and would also reflect the different aspects of telephone-based psychosocial support and mental health services and their need during disasters. The study’s outcome would reveal the needs of this at-risk populace and explore the issues and concerns unique to the COVID- 19 pandemic. The findings would also be a substructure for future studies that would probe into research areas analogues to pandemics and other biological disasters, telephone-based psychosocial support, and the older adult populace.

Adjustment and perceived needs of cancer survivors: a qualitative exploratory study in a Portuguese island region

Background: Cancer survivors from rural or isolated areas may experience psychosocial adjustment issues and needs following treatments. The adjustment and the perceived needs of cancer survivors in the Azores have not been investigated. Goals: To explore the adjustment to survivorship and perceived needs of cancer survivors from a Portuguese archipelago region.Methods: Cancer survivors from São Miguel Island (Azores archipelago) took part in this qualitative exploratory study. Three focus groups were carried out, which were transcribed, coded through thematic analysis, and analyzed using NVivo 12.Results: The sample comprised twenty-two cancer survivors. Five main themes emerged: 1) Current adjustment to diagnosis; 2) Barriers to current adjustment; 3) Promoters of current adjustment; 4) Post-diagnostic growth; and 5) Perceived needs and suggestions for improvement. The results revealed that the factors influencing cancer survivors´ adjustment and their perceived needs are similar to those of survivors from other rural or isolated regions. However, some differences were found, such as the perceived trauma related to the follow-up spaced-out period and the displacement to Portugal mainland to perform cancer therapy as a promoter of adjustment in survivorship. Beyond the financial and social concerns, the psychosocial support and continuity of care needs were also expressed by cancer survivors.Discussion: Assessing and monitoring survivors' needs during different stages of the disease could inform health and psychosocial care providers on how to better support cancer survivors from the Azores, preparing them for survivorship. A multidisciplinary approach which recognizes cancer survivors’ difficulties and unmet needs can promote optimal care delivery, improving their adjustment.

Challenges and Concerns in Assisting Indigenous People with Suicide Attempts.

There has been an alarming rise in suicide attempts among Indigenous people in Brazil, leading to national concerns about the provision of psychosocial care and professional support. In this study, we make an attempt to understand the perspectives of professionals in assisting Indigenous people from a specific group, the Inỹ, and identify the specific challenges of addressing issues through the mental health care system related specifically to suicide prevention. Using a qualitative approach with participant observation and semi-structured interviews, the research included Indigenous and their families assisted by three public institutions and the professionals that work in public psychosocial assistance. For this paper, we examined the tensions, conflicts, and challenges of the healthcare professionals at one of these institutions, a Psychosocial Care Center in the state of Goiás/Brazil. For data analysis, a sociocultural protocol was built to identify dialogical tensions between the different thematic fields of mental health care. The findings reveal that the theme of suicide was an important concern in the daily work with the community. Still, there were significant issues related to the assumptions, methodology, and meaning of care between the professionals and the community, on account of which the objective of the programme to address suicide attempts had not been effective or successful. The discussion of the results raises several critical questions about the possible contributions of dialogical cultural psychology in the context of Indigenous health. Also, it has important implications for the global issue of the wellbeing of Indigenous people.

The design and evaluation of a training program on culturally competent psychosocial care provision for men who have sex with men in Senegal.

Men who have sex with men (MSM) experience a high degree of discrimination and marginalization in Senegal. Homophobia is pervasive in Senegalese society at the cultural, religious, and political levels. Its effects are reflected in the disproportionately high levels of depression, anxiety, and substance abuse among men who have sex with men when compared to the general population. Given the widespread stigma and the lack of structural support, healthcare providers play a critical role in reconciling the physical and psychological needs of men who have sex with men. This led to the design of a training program that aimed to improve the capacity of healthcare providers to deliver MSM-competent psychosocial care. The training was delivered virtually to 37 Senegal-based nurses and physicians. The program was quantitatively and qualitatively evaluated using pre- and post-testing. The findings demonstrate a general post-training increase in knowledge acquisition (9. 23%, p-value = 0.0021) and a 6.39% reduction in homophobia, which was statistically significant (p = 0.0376); with male providers outperforming female providers, and physicians outperforming nurses. This demonstrates the effectiveness and applicability of the program to support the psychosocial needs of men who have sex with men, and its capacity for future and broader implementation among healthcare providers.

Family-centered pediatric psychosocial care in Qatar

Pediatric psychosocial care approaches are used to advocate for family and child strength and durability in health scenarios and to improve the overall well-being of children impacted by severe medical situations. This article focuses on family-focused care in pediatric psychosocial services in Qatar. Using secondary sources, this desk review advocates for a family-centered care approach to support hospitalized children, their families, and the healthcare provision team in pediatric psychosocial care. It argues that if improvements are made to four main areas including education and training, healthcare environment, financial support and advocacy, and future research and audits, Qatar’s pediatric psychosocial care program would more effectively cater to evidence-based child and family-friendly approaches. This article concludes by providing policy recommendations for Qatar’s pediatric psychosocial care provision.

Psychosocial Care Responses and Research After Terrorist Attacks

Introduction:The risk internationally of terrorist attacks and other mass trauma incites societies to strengthen the planning and implementation of psychosocial care. Prior findings have documented that psychosocial care responses, especially long-term follow-up, differ substantially between countries. With the aim to strengthen future psychosocial care responses and research, this presentation describes the models for psychosocial care and research activities following terrorist attacks in European countries.Method:Pre- and post-attack policy documents and reports addressing the psychosocial care responses to terrorist attacks were identified, and research on the mental health of affected individuals and psychosocial care provision was reviewed.Results:Although several aspects of the acute psychosocial care responses to terrorist attacks were similar across countries, there were substantial differences as to if and how long-term follow-up interventions were planned and implemented. There were also major differences in whether or not monitoring of and research on the psychosocial care responses were conducted, and existing research had important limitations.Conclusion:In order to strengthen the public health responses to future terrorist attacks and other mass casualty incidents, there is need for more standardized registration of affected individuals, as well as international models for monitoring their health and longitudinal research on the countries’ psychosocial care provision. During the presentation, it will be discussed how monitoring and research can be improved in this context.

Global Psycho-Oncology in Low-Middle Income Countries:Challenges and Opportunities.

This Special Issue of Psycho-Oncology is focused on challenges and opportunities in the provision of psychosocial care to patients in low- and middle-income countries (LMIC's). The aim is to highlight global disparities and inequity in the provision of evidence-based, culturally-sensitive and timely psychosocial care and to showcase the work of researchers and practitioners to address this gap. We hope that this Issue will help to advance the psychological and social dimensions of cancer care in all parts of the world. The focus of the papers is on research and clinical innovations in LMIC's that target the psychological, social and cultural dimensions of cancer and on interventions to improve or maintain the psychological well-being, social functioning and/or quality of life of those who are affected and of their families. These papers draw attention to guidelines, resource needs, clinical service evaluation, emerging research, and knowledge translation within LMIC's that advance knowledge and implementation in the field of psycho-oncology. Innovations and advances in psycho-oncology are emerging from LMIC's to enhance the care of patients with cancer and their families in these regions and in all parts of the world. A sustained global initiative is now needed to ensure that guidelines for such care are routinely included in global, national and local cancer control plans and that essential resources and attention are directed to implement them. This article is protected by copyright. All rights reserved.

Silver lining: a ray of hope through strength-based approach in the health care setting

The strength-based approach challenges the traditional deficit model applied in psychosocial care practice, which takes an all-encompassing perspective. Creating a comprehensive portrait of each person's life and working in a multidisciplinary team collectively analyses the full capabilities and circumstances of individuals or families. This paper employs case illustrations to demonstrate how psychosocial care providers can do assessments and interventions based on a strength-based approach to improve the quality of life of patients and their families. The study adopted cases from the case file and derived how strength-based approaches can be utilized for the patients referred for psychosocial assessment and designing psychosocial care plan in the tertiary care hospital. The case illustrations depict practice through strength-based approach. The assessments were conducted, plans were made, and interventions focused on the strengths in various domains. The result portrayed strength of each case on innate, acquired/learned, supportive strengths in personal, family, social and health domains of life. The analysis of the strengths of the patient allowed to develop a tailor-made intervention plan, and these interventions have resulted in empowerment and recovery. The strength-based approach is one of the approaches which came differently from the deficit models of psychosocial practice. In India, the practice of a strength-based approach for interventions in various fields is in its infancy. The legislations in India have provisions that support a strength-based approach.

The role of parents in the care for adolescents suffering from emotional and behavioral problems.

Parents play an important role in the psychosocial care of their children. Previous research has primarily examined their role in care entry, whereas evidence on their role in other stages of the care process is scarce and lacking particularly in regard to the perspective of care providers. Our aim was therefore to examine how psychosocial care providers perceive the role of parents in the process of psychosocial care for adolescents. We used data from 25 semi-structured interviews with psychosocial care providers on the roles of parents in the care process. We analyzed data using consensual qualitative research and thematic analysis. Four main themes were identified: (1) parents as a source of adolescents' problems; (2) parents trying to escape from responsibility for adolescents with problems; (3) parents as an active part of the care for adolescents; and (4) parents as a barrier to effective care. Psychosocial care providers should specifically address the role of the parents in psychosocial care to improve outcomes. Specific interventions are needed to support the involvement of parents in care, as their role is important. Moreover, professionals can be better trained in working with multi-problem families also to resolve some of the negative perceptions of these parents.

Inconsistent, uncoordinated, and reactive: The current state of sibling psychosocial care.

Although providing sibling psychosocial services is a standard of care in pediatric oncology, initial survey research suggests that this standard is rarely achieved and siblings' support needs remain unmet. Which sibling psychosocial services are available and how centers provide such services is unknown. To identify targetable services gaps, this qualitative study characterizes current sibling psychosocial care practices at select pediatric cancer centers across the United States. Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N=27) working across the United States in pediatric oncology centers of varied sizes. Interviews queried providers regarding sibling-focused parent psychoeducation, psychosocial screening, comprehensive assessment, and psychosocial support offerings. Interview data were analyzed using Applied Thematic Analysis. Across cancer centers, sibling care practices did not align with consensus-based recommendations. The nature and availability of sibling-focused psychoeducation, screening, assessment, and support were variable between and within centers. Siblings themselves were largely absent from sibling psychosocial care, and care was rarely sibling-specific. The flow of information about siblings was discontinuous and uncoordinated across the care continuum, resulting in psychosocial care provided reactively, typically in response to parental concerns. Sibling psychosocial care provision falls short of established care recommendations, leaving sibling psychosocial needs unmet. Findings highlight the need for tools and strategies to facilitate the implementation of sibling psychosocial care across the care continuum, to support siblings' psychosocial functioning across the life course.

Regional evolution of psychosocial services in Australia before and after the implementation of the National Disability Insurance Scheme.

This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme - a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level.

Feasibility and acceptability of psychosocial care for unsuccessful fertility treatment.

Many people undergo fertility treatment to have biological children, but around four in ten patients complete all treatment cycles without having the children they desire. This triggers intense grief from which patients report taking on average 2years to recover. Fertility guidelines and regulators stress the need to support patients through this process, but there is a scarcity of evaluated interventions to this end and evidence about when and how to offer care is lacking. This study explored patients' and healthcare professionals' (HCPs) experiences of and views about provision of psychosocial care (to patients facing unsuccessful fertility treatment, i.e., care provided by a mental health professional to address the emotional, cognitive, behavioural, relational and social needs that patients have at this stage of treatment). Five qualitative online focus groups were conducted with Portuguese participants: three with patients waiting to initiate or undergoing their last cycle of in vitro fertilization/intracytoplasmic sperm injectionor having completed it within the last 2months without achieving a pregnancy and two with HCPs working at fertility clinics. Focus groups were recorded and transcribed verbatim, and data were analysed with Framework Analysis. Thirteen patients and nine HCPs participated. Analysis resulted in 1293 codes, systematically organized into 13 categories, 4 themes and 1 metatheme. The latter showed high consensus about the need for psychosocial care for unsuccessful treatment, but perceived challenges in its implementation. Themes reflected (1) consensual demand for psychosocial care at all stages of treatment but particularly at the end, (2) high perceived acceptability of integrating preventive care initiated during treatment with early psychosocial care only for those patients who experience unsuccessful treatment, (3) perceived challenges of implementing psychosocial care for unsuccessful treatment at clinics and (4) suggestions to promote its acceptability and feasibility. Patients and HCPs perceive that clinics should improve care provision across the whole treatment pathway and in particular for unsuccessful fertility treatment. Suggestions were made to inform future research focusing on the development and evaluation of psychosocial interventions to this end. Patients and HCPs participated in the focus groups. Two HCPs also revised the manuscript.

Incorporating psychosocial care into routine oncological care: Insights into challenges and strategies from certified cancer centers' audit data.

Provision of psychosocial care is obligatory in cancer centers certified in accordance with the criteria of the German Cancer Society, but the extent to which it is utilized differs greatly between centers. Anomalous utilization percentages are discussed during certification audits. This analysis aims to describe (1) how certified centers explain psychosocial care utilization percentages during audits and (2) the measures they then plan for improving psychosocial care utilization. The aim of the analysis is to help understand patterns of psychosocial care utilization in oncology and reduce potential disparities by describing the challenges that cancer centers face and their strategies for integrating psychosocial care into routine oncological care. The content of free-text comments regarding psychosocial utilization percentages by certified centers during certification audits in 2019 was analyzed. In total, 178 comments were analyzed from 116 prostate, colorectal, and breast cancer centers in Germany, Switzerland, Austria, Italy, and Luxembourg. The explanations for utilization percentages most often mentioned involved patients' levels of interest and need, outpatient care, staff shortages, inclusion of psychosocial care in other processes in the center, documentation issues, and factors regarding different legal regulations in countries outside Germany. The measures most often planned for improving psychosocial care utilization involved adjusting work processes, increasing staff resources, optimizing documentation, and establishing quality-assurance groups/task forces. This exploratory analysis shows that the challenges and strategies involved in incorporating psychosocial care into routine oncological care are diverse. Further research should identify process-level strategies that can promote the integration of psychosocial care.

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

BackgroundThe international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium.MethodsWe identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016.ResultsIn Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks.ConclusionsPsychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries’ psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents.

Validating the Factor Structure of the Psychosocial Assessment Tool Using Internet-Based Data.

The Psychosocial Assessment Tool (PAT) is a well-validated, brief screener of family psychosocial risk. Since 2014 a web-based version of the PAT (WebPAT) has been available for use by clinicians and researchers, but the psychometric properties have not been examined. The objective of this article was to examine the factor structure and internal consistency of the WebPAT, which was administered to caregivers of youth with cancer. The WebPAT was administered to 1,252 caregivers of youth with cancer across 29 institutions. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WebPAT. Internal consistencies of the total and subscale scores were examined via the Kuder-Richardson 20 coefficient. The distribution of total PAT score across the three risk categories of the Pediatric Psychosocial Preventative Health Model (PPPHM) was also examined. The CFA supported the original seven-factor structure of the PAT (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs). Internal consistencies were strong for the total PAT score and four subscales (Social Support, Child Problems, Sibling Problems, and Family Problems). The distribution of total PAT scores across PPPHM risk categories was consistent with prior research. The WebPAT is a psychometrically sound screener of psychosocial risk in families of youth with cancer. Healthcare providers can use the WebPAT to assess families' psychosocial risk and guide the provision of psychosocial care. Future research should evaluate the implementation of the PAT and identify barriers and facilitators to implementation.

Psychosocial care providers' perspectives: Barriers to implementing services for siblings of children with cancer.

Siblings of children with cancer are at increased risk for poor long-term psychosocial outcomes. The standard of psychosocial care in pediatric oncology calling for sibling support is not routinely implemented, often leaving siblings with unmet psychosocial needs. Barriers to implementing the sibling standard may exist at multiple levels. This study addresses research gaps regarding multilevel barriers to supporting siblings at the health care system, oncology center, and family levels. Qualitative interviews were conducted with psychosocial care providers (N=27; 18 psychologists, five social workers, three psychiatrists, and one child life specialist) employed at oncology centers within hospitals across the United States, varying in extent of sibling programming and center size. Interviews included questions about providers' roles, oncology center characteristics, existing psychosocial sibling services, barriers to providing systematic sibling assessment, and ideas about how to overcome barriers. Data were analyzed using applied thematic analysis. Qualitative analysis revealed (a) barriers to providing sibling services occur at multiple levels (health care system, oncology center, family); (b) barriers at multiple levels frequently interact with one another; and (c) interacting barriers maintain a cycle: barriers to providing services contribute to limited provision of services, low service provision leads to limited utilization of existing services and underprioritization of siblings, and together this leads to siblings being off the radar, which further limits sibling service provision. Addressing health care system and oncology center barriers to implementing sibling assessment and support may be important potential targets for interventions to help ensure that siblings receive needed psychosocial assessment and support.

Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers.

This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.