Meeting Psychosocial Needs of Women with Breast Cancer (2004) / Chapter Skim
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6 Delivering Psychosocial Services
6 Delivering Psychosocial Services
Pages 133-164
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From page 133... ...
THE EVOLUTION OF BREAST CANCER CARE AND ITS IMPLICATIONS FOR THE PROVISION OF PSYCHOSOCIAL SERVICES Quality of life following a diagnosis of breast cancer is influencecI by how anti when the disease is cliagnosecI, the treatment, anti the manner in which care is cleliverecI. Breast cancer diagnosis, treatment, anti care clelivery have evolvecI greatly in the past 25 years, altering the composition of the population of women living with breast cancer, the health status of survivors of the disease, anti how care is cleliverecI.
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From page 134... ...
Women treated for breast cancer in the 1960s would have typically been treated surgically with mastectomy in the hospital, with cancer care managed by a surgeon. In contrast, a woman with breast cancer today is likely to encounter a surgeon, radiation oncologist, ancI meclical oncologist cluring her initial breast cancer treatment.
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From page 135... ...
Younger cohorts of women, in contrast, have benefited from a wicler range of options, but may be concerned about a broacler set of late effects relatecI to their treatment. Among the late effects of contemporary breast cancer treatments are cognitive deficits, early menopause, heart conditions, anti sexual dysfunction.
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From page 136... ...
THE STRUCTURE AND DELIVERY OF PSYCHOSOCIAL SERVICES TO WOMEN WITH BREAST CANCER Patterns of Breast Cancer Care Assessing how well psychosocial services are being cleliverecI clepencis on knowing where women with breast cancer seek care anti who provides that care. There are very few descriptions of cancer-relatecI health care clelivery, but according to national population-basecI surveys, each year an estimated 4.8 million ambulatory care visits are macle anti 150,000 hospitalizations occur for breast cancer care (Table 6-11.
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From page 137... ...
was recorded as the first, second, or third diagnosis associated with the visit. The sample size for breast cancer-related visits to physician offices was 904 and the sample size for visits to hospital outpatient departments was 1,169.
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From page 138... ...
Progress visit 14.3 19.5 Breast cancer care 13.2 18 1 General medical exam/breast exam 8.8 9 2 Post-operative visit 8.2 4.4 Chemotherapy 7.3 10.6 Medical counseling 3.7 Radiation therapy 2.5 Other 48.1 32.0 Time spent with doctorb Less than 15 minutes 20. 3 27.0 15 to 29 minutes 54.9 17.9 30 minutes and longer 24.7 55.1 Saw RN, PA, NP during visit Yes 37.7 59.6 No 62.3 40.4 Services provided during visit Mental health and psychotherapy 4.8 5.3 Breast self exam instruction 50.0 34 5 Diet counseling/education 15.7 7 6 Exercise counseling/education 13.3 4.7 aAnalyses of the National Ambulatory Medical Care Survey (NAMCS)
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From page 139... ...
Because the physical ancI the psychological impacts of the disease ancI treatment are often inter-relatecI, having psychosocial services available within the breast care setting allows for the flow of patient-centerecI information to be shared among the center practitioners. For example, if a woman suciclenly clevelops lympheclema of her arm, she will neecI a variety of physical interventions to aciciress the problem, anti she will neecI someone to assist her with the psychological distress that often accompanies this experience.
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From page 140... ...
While much of the surgical care provided to women may be absent in the estimates above, it is likely that pre- ancI post-surgical consultations take place in ambulatory settings for which ciata are available ancI where psychosocial issues wouicI most likely be aciciressecI. PSYCHOSOCIAL SERVICE USE While evidence suggests that roughly 20 to 40 percent of women with breast cancer will exhibit psychosocial distress (see Chapter 3)
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From page 141... ...
. NOTE: 1,850 of 613,719 sample hospital discharges were for women whose primary diagnosis was breast cancer (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM]
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From page 142... ...
The National Coalition for Cancer Survivorship (NCCS) , an advocacy organization, as a part of its published "Imperatives for Quality Cancer Care" stressed the importance of meeting the psychosocial needs of cancer survivors.
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From page 143... ...
More than a quarter (27 percent) of women with a history of breast cancer hacI received psychosocial services following their diagnosis (Hewitt et al., 1999)
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From page 144... ...
concluctecI at a regional breast care center in upstate New York anti contactecI within 3 years of their breast cancer diagnosis, relatively few hacI used formal psychosocial services. Only 15 percent of women hacI talkecI to a professional counselor (e.g., psychologist)
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From page 145... ...
A frequently reported reason for refusal of services was "not now" inclicating that the offer of psychosocial services neecis to be repeated (Curry et al., 20021. Relatively few long-term survivors of breast cancer continue to receive psychosocial support, according to a large cohort stucly of women concluctecI in Los Angeles anti Washington DC.
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From page 146... ...
The Delivery of Psychosocial Services Psychosocial services can be cleliverecI by primary care ancI cancer care providers, specialty providers such as mental health professionals (psychologists ancI psychiatrists) , acivancecI practice nurses, social workers, community-basecI programs, ancI increasingly by telephone or online computer services (see Chapter 4 for a description of psychosocial proviclers)
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From page 147... ...
A mocle! that is infrequently usecI, but which hoicis promise for making psychosocial services more accessible to patients seen in private physicians' offices is "collaborative practice," which involves a psychologist in private practice regularly rotating to private oncology, primary care, ancI other practices (e.g., obstetrics/gynecology)
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From page 148... ...
Relatively few inclivicluals with cancer are seen within the 47 NCI-clesignatecI comprehensive cancer centers, but these institutions are where many of the research, education, anti training programs are locatecI, making them important moclels of care. This section of the report describes the availability of psychosocial services within hospitals that provide cancer care.
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From page 149... ...
counseling' discharge planning, hospice care, nutritional care, oncology nursing, palb control, pastoral care, patient education, pharmacy, rehabilitation~upport, social work, specials physicians)
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From page 150... ...
eA support group sponsored by ACS for men who are prostate cancer survivors. fUS TOO provides information, local support groups, counseling and educational meetings to assist people with prostate cancer as they make decisions about their treatment and continued quality of life.
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From page 151... ...
At least some level of supportive care was available in the reporting sites, for example, social workers were available in 99 percent of programs, psychologists were available in 91 percent of programs, ancI the ACS Reach to Recovery was available in 90 percent of programs. Association of Community Cancer Centers Stanciarcis (ACCC)
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From page 152... ...
A Psychosocial services include, but are not ilmited to.
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From page 153... ...
E Institutions, through their multidisciplinary committees, should undertake the educational efforts to inform staff and patients of the fact that psychosocial services are pad of the total care provided and Inform t of the procedures to obtain care.
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From page 154... ...
Psychosocial services for cancer patients have become more constrained clue to increasing financial pressures in the health-care setting. Social work departments have contracted as hospital resources have climinishecI, anti in many clinical settings these services only exist through philanthropic support.
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From page 155... ...
Among the services these programs offer are peer support, incliviclual counseling by telephone, information on nutrition anti exercise, anti assistance with appearance, for example, wigs ancI breast prostheses. This section of the report highlights programs represented at the October 2002 NCPB workshop, those offered by the American Cancer Society, the Weliness Community, anti a few programs that focus on the neecis of Hispanic ancI African American women with breast cancer.
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From page 156... ...
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From page 157... ...
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From page 158... ...
All programs are facilitatecI by health care professionals, inclucling social workers, psychotherapists, nurses, anti psychologists, anti all programs anti training curricula are uniform throughout the country. Its newest program, The Virtual Weliness Community, inclucles online support groups, WeEcasts, mincI/bocly exercises, anti information (see Figure 6-21.
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From page 159... ...
This section of the report describes three such programs: Cancer Care, The Association of Cancer Online Resources (ACOR) , anti CHESS (Comprehensive Health Enhancement Support System)
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From page 160... ...
, referrals to other resources, clirect financial assistance, anti teleconference programs which allow people to listen via telephone to experts in oncology or relatecI fielcis discuss state-of-the-art treatment options, provide coping strategies for sicle effects, make recommenciations on communicating with one's healthcare team, anti offer advice on how best to maintain quality of life while living with cancer. Cancer Care is also involvecI in professional education anti training offering seminars, workshops, anti teleconferences in all fielcis of oncology care.
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From page 161... ...
WiclespreacI use of mammography has, for example, lecI to women being cliagnosecI at younger ages, which likely has increased the neecI for psychosocial services because younger people, in general, report higher rates of mental problems, anti their mental health service use tencis to be high. There have been ciramatic shifts in the site of breast cancer care, from the hospital to outpatient settings, making access to psychosocial support services more clifficult because psychologists, social workers, ancI nurses, the mainstays of psychosocial care, are usually basecI in hospitals.
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From page 162... ...
Psychosocial service use seems to clecline into the survivorship period, with some studies suggesting that between 10 ancI 15 percent of long-term breast cancer survivors use psychosocial services. REFERENCES American Cancer Society.
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From page 163... ...
1995. Psychosocial Services in Cancer Care: A Survey of Comprehensive Cancer Centers.
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From page 164... ...
2002. Survivorship resources for post-treatment cancer survivors.
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