Advising the Nation. Improvin
Cancer Care for the W
Meeting Psychosocial Hea
ng Health.
Whole Patient:
alth Needs
Common Psych
• Lack of info, knowled
illness
• Anxiety, depression,
distress
• Impaired work, schoo
• Financial problems
• Lack of transportation
resources
• Lack of social suppor
hosocial Problems
dge, skills to manage
, other emotional
ol, other roles
n, other logistical
rts
2
A Problem with C
• 28% of patients repo
attention to other tha
• 33% of ASCO memb
screening for distress
• Only 3 of 18 member
Comprehensive Can
screen all patients fo
Care for Cancer
ort doctor doesn’t pay
an medical care;
bers report no
s
rs of National
ncer Network routinely
or distress
3
Patients also rep
providers
• consider psychoso
quality cancer car
• understand psych
know about resou
Presid
port health care
s do not:
ocial care integral to
re.
hosocial needs,
urces, or refer.
dent’s Cancer Panel 2003,2004
4
Why should
providers conce
with patients’
proble
health care
ern themselves
psychosocial
ems ?
Unmet psycho
• Increase death and disease
– Social isolation comparable to
– 66% higher risk of dying withi
with breast cancer (Kroenke, 20
• Prevent good health care; e
– 8 percent of families having a
did not receive care because
• Reduce patient adherence t
depression:
– Impairs thinking; e.g. memory
– Weakens motivation
– Promotes poor coping; e.g., s
unhealthy eating
osocial needs:
e burden; e.g.
o smoking & cholesterol
in 6 yrs in socially isolated women
006)
e.g.,
a member with cancer delayed or
of cost.
to treatment; e.g.,
y
smoking, medication misuse,
6
Other Adverse E
• Depression
– 20-25 % experiencing m
depression.
• Onset / progression of
– heart disease
• Imbalance in neuro-end
functions and compone
– Cell growth and replicat
– Tumor metabolism and
Effects of Stress
major stressful events develop
other diseases; e.g.,
docrine & immune system
ents; affecting e.g.,
tion
evasion of body’s defenses
7
Can somethin
address psycho
ng be done to
osocial stress ?
8
Psychosocial Needs and Forma
Psychosocial Need • Provisio
effects o
Information about and help
illness, treatments, this info
health, services
• Peer sup
Help coping with • Counsel
emotions • Pharma
symptom
Help managing • Compre
illness care pro
al Services to Address Them (1/2)
Health Services
on of info; e.g., on illness, treatments,
on health, and psychosocial services,
ping pts/families understand and use
o
pport programs
ling/psychotherapy
acological management of mental
ms
ehensive illness self-management/self-
ograms
9
Assistance changing • Behavioral
behaviors to minimize – Provid
impact of disease behavi
– Brief c
Material and logistical – Patient
resources, e.g.,
• Provision o
transportation
Help managing • Family / ca
disruptions in work, • Assistance
school, and family life • Legal prote
Financial advice / and Medic
assistance • Cognitive
• Financial p
• Insurance (
• Eligibility
SSDI
• Supplemen
l/health promotion interventions; e.g.,
der assessment/monitoring of health
iors (e.g., smoking, exercise)
counseling
t education
of resources
aregiver education
e with ADLs, IADLs, chores
ections / services, e.g., under ADA / Family
cal Leave Act
testing / educational assistance
planning / counseling / daily management
(e.g., health, disability) counseling
assessment /counseling for benefits; e.g.,
ntal financial grants 10
How to make su
need services
ure patients who
s receive them
Model Interven
Crit
• RWJ Building Health Systems
for People with Chronic
Illnesses (Palmer and Somers, 2005)
• Chronic Care Model (ICIC, 2007)
• Clinical Practice Guidelines for
Distress Management (NCCN,
2007)
• Clinical Practice Guidelines for
the Psychosocial Care of Adults
with Cancer (Australia, 2003)
• Improving Supportive and
Palliative Care for Adults with
Cancer (NICE, 2004)
ntions Meeting
teria
• Collaborative Care of
Depression in Primary Care
(Katon, 2003)
• Three Component Model
(3CM™)
• Project IMPACT Collaborative
Care Model (Unutzer et al., 2002)
• Partners in Care (Wells et al.,
2004)
• Promoting Excellence in End-
of-Life Care Program (Byock et
al., 2006)
12
Common Compo
Interve
• Process to Identify Pa
• Care Planning
• Mechanisms to Link P
• Support for Illness Sel
• Mechanisms for Coord
• Follow-up on Care De
onents of Effective
entions
atients with Needs
Patients to Services
lf-Management
dinating Care
elivery
13
Model for the delivery of psy
Effective Pa
Comm
Patient/Family Patient–
Partn
Identification of P
Development and Im
Suppo
Link patient / •Provide
family with •Identify
needed address
services •Provide
support
•Help pts
illness/ h
Follow-up an
ychosocial health services.
atient–Provider
munication
–Provider Provider T eam
nership
Psychosocial Needs
mplementation of a Plan T o:
ort patients:
e information Coordinate care
strategies to
needs
e emotional
s manage
health
nd Re-evaluation 14
Psychosocial h
Psychosocial health se
and social services and
enable patients, their fa
providers to optimize bi
and to manage the psy
and social aspects of ill
consequences so as to
health services
ervices are psychological
d interventions that
amilies, and health care
iomedical health care
ychological/behavioral
lness and its
o promote better health.
15
Enough is now k
a standard of car
of psychosocial h
cance
known to support
re for the delivery
health services in
er care.
Recommendation 1: T
All parties establishing or using standard
adopt the following as a standard:
All cancer care should ensure th
psychosocial health services
– Facilitating effective communi
providers.
– Identifying each patient’s psyc
– Designing and implementing a
• Links the patient with need
• Coordinates biomedical an
• Engages and supports pat
health.
– Systematically following up on
The standard of care.
ds for the quality of cancer care should
he provision of appropriate
by:
ication between patients and care
chosocial health needs.
a plan that:
ded psychosocial services.
nd psychosocial care.
tients in managing their illness and
n, reevaluating, and adjusting plans.
17
Implications fo
Provi
Ruth McCorkle RN, PhD
Florence S. Wald Profe
Director, Center for Exc
Care
Yale University School
Lee Schwartzberg MD
Medical Director, The W
or Cancer Care
iders
D
essor of Nursing and
cellence in Chronic Illness
of Nursing
West Clinic
18
Recommendation 2: H
All cancer care provid
that every cancer p
practice receives ca
standard for psycho
…
Health care providers.
ders should ensure
patient within their
are that meets the
osocial health care.
19
Commitment
leade
Work re
from practice
ership
edesign
20
Different approache
the standa
1. Collocating and inte
and biomedical hea
2. Using local resource
3. Using remote provid
4. Combining approac
es for implementing
ard of care
egrating psychosocial
alth care
es
ders
ches
21
Clinical Practice T
Standard
1. Pt-Provider
communication
2. ID needs
3. Link with providers
4. Support illness self
management
5. Coordinate care
6. Follow-up
T ools/Approaches
Some T ools / Approaches
Routine patient visits
Patient letter
Patient self-screening
Health behavior
assessment /
intervention
Refer to free, community/
remote services
Repeat screening,
monitoring by phone,
involving patients,
22
“The inability to sol
problems perma
preclude attempts
as possible—a sta
cancer even whe
outcome is n
lve all psychosocial
anently should not
to remedy as many
ance akin to treating
en the successful
not assured.”
Implications f
Organiz
Diane Blum
Executive Director,
for Advocacy
zations
m MSW,
, CancerCare
24
Patient
• Well functioning pati
partnership, charact
communication
• Knowledge about ps
services which will a
participating in care
• Support in communi
these services
Needs
ient-provider
terized by good
sychosocial health
assist the patient in
icating about / using
25