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Meeting Psychosocial Health Needs. 2 Common Psychosocial Problems •Lack of info, knowledge, skills to manage illness •Anxiety, depression, other emotional distress

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Published by , 2017-05-03 01:10:03

Meeting Psychosocial Health Needs - The Academies

Meeting Psychosocial Health Needs. 2 Common Psychosocial Problems •Lack of info, knowledge, skills to manage illness •Anxiety, depression, other emotional distress

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


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