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Pages 153-218

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From page 154... ... and the finding of low success of referral by itself in linking cancer patients to needed psychosocial health services in one study of health maintenance organizations (HMOs) (Eakin and Strycker, 2001) Read the entire page →
From page 155... ... , case management services that address psychosocial health needs typically include assessment of the patient's need for supportive services; individual care planning, referral, and connection of the patient with other necessary services and supports; ongoing monitoring of the patient's care plan; advocacy and education; and monitoring of the patient's symptoms. These activities can be performed by an appointed individual or a group. Read the entire page →
From page 156... ... . Results of other randomized trials in England and Australia, however, suggest that much remains to be learned about the effectiveness of the various activities of nurse case managers in cancer care (McLachlan et al., 2001) Read the entire page →
From page 157... ... Such programs in cancer care were developed initially to help low-income patients participate in screening for the detection of cancer and aid those with suspicious screening findings to gain access to diagnostic and treatment services. Initially, patient navigators tended to be local community residents without professional credentials, but more recently some have proposed that nurses, social workers, and other health workers play a navigator role. Read the entire page →
From page 158... ... search for information and systematic review (McDonald et al., 2007) of systematic reviews of the effectiveness of care coordination found over 40 definitions of care coordination and related terminology and 20 different coordination interventions,17 and developed the following working definition of care coordination: "Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) Read the entire page →
From page 159... ... This difficulty is exacerbated by the fact that care coordination as a psychosocial intervention must fulfill a dual function: coordination of psychosocial health services with biomedical services, and coordination of biomedical care provided by multiple clinicians. Consistent with the findings of the AHRQ evidence review, both types of care coordination are likely to be achievable in various ways, including the activities described in the preceding section that are effective in linking patients to needed psychosocial health services, such as case management and collocated, clinically integrated services. Read the entire page →
From page 160... ... In a comprehensive assessment of the literature and the U.K. experience with multidisciplinary teams in cancer care, however, Fleissig and colleagues (2006:935) Read the entire page →
From page 161... ... A RECOMMENDED STANDARD FOR CARE From the evidence presented above, the committee concludes that enough is now known to support the adoption of a standard of care for the delivery of psychosocial health services in cancer care. The committee recommends the following: PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 162... ... Multiple organizations could significantly influence adherence to this standard of care. NCI, as the nation's leader in cancer care, could include requirements for addressing psychosocial health needs in all of its protocols; standards for designating clinical or comprehensive cancer centers; and other programs, such as its Quality of Cancer Care Initiative. Read the entire page →
From page 163... ... consumer participation, decision support, and selfdetermination in care planning; and (3) mechanisms for linking biomedical and psychosocial health services, such as use of interdisciplinary teams and case management (Palmer and Somers, 2005) Read the entire page →
From page 164... ... Although most of the guidelines address how to care for individual symptoms, such as anxiety, or practical problems, such as financial or work-related concerns, the guidelines also recommend certain cross-cutting activities to be carried out in treatment settings. These activities include providing patients with information to support their decision making, screening all patients for clinically significant anxiety and depression, ensuring continuity of care through the designation of a person responsible for care coordination, and developing referral pathways and networks (National Breast Cancer Centre and National Cancer Control Initiative, 2003) Read the entire page →
From page 165... ... These models can inform strategies for delivering the broader array of psychosocial health services. Collaborative Care Model Although the term "collaborative care" is used to refer to a variety of types of interventions, one model of collaborative care developed by Katon and colleagues that has been tested in randomized controlled trials consists of a systematic approach to the structured involvement of mental health specialists in primary care. Read the entire page →
From page 166... ... . Project IMPACT Collaborative Care Model Another model of care for delivering psychosocial health services was developed by a national panel of experts for the Improving Mood─Promoting Access to Collaborative Treatment for Late-Life Depression (IMPACT) Read the entire page →
From page 167... ... A group-level, randomized controlled trial of the quality improvement interventions found increased rates of appropriate care, decreased symptoms of probable mental illness, and increased health-related quality of life in the intervention group compared with the group receiving usual care (RAND Corporation, 2007; Wells et al., 2000, 2004) Read the entire page →
From page 168... ... 1992. Randomised controlled trial of effects of coordinating care for terminally ill cancer patients. Read the entire page →
From page 169... ... 2003. Breast Cancer Patient Perception of the Helpfulness of a Prompt Sheet Versus a General Information Sheet During Outpatient Consultation: A Randomized, Controlled Trial. Read the entire page →
From page 170... ... 2003. The cancer care monitor: Psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients. Read the entire page →
From page 171... ... Cochrane Database of Systematic Reviews 3:CD004348. Read the entire page →
From page 172... ... 2003. Health professions education: A bridge to quality. Read the entire page →
From page 173... ... 2003a. Communication, quality of life and age: Results of a 5-year prospective study in breast cancer patients. Read the entire page →
From page 174... ... 2000. A randomized clinical trial of a specialized home care intervention on survival among elderly post-surgical cancer patients. Read the entire page →
From page 175... ... 1996. A randomized controlled trial of the cost-effectiveness of a district coordinating service for terminally ill cancer patients. Read the entire page →
From page 176... ... Cochrane Database of Systematic Reviews(2) Read the entire page →
From page 177... ... 2004. Five-year impact of quality improvement for depression: Results of a group-level randomized controlled trial. Read the entire page →
From page 178... ... Cochrane Database of Systematic Reviews 1. Read the entire page →
From page 179... ... 1. As stated in Chapter 4, the committee believes that the delivery of psychosocial health services should occur from diagnosis through all stages of the illness, and therefore, the standard for delivering psychosocial health care articulated in Chapter 4 should guide the activities of all clinicians delivering cancer care. Read the entire page →
From page 180... ... also has responsibility for securing appropriate psychosocial health services. However, the committee does not distinguish this as a separate approach to implementing the model because coordination of care requires effective linkages among all parties involved, and because at present and for the foreseeable future, the committee believes that the PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 181... ... Examples The Rebecca and John Moores Cancer Center, University of California, San Diego The Moores Cancer Center's Science of Caring program provides comprehensive psychosocial health care integrated with biomedical treatment for all patients with cancer seen in its outpatient clinic. At each outpatient's initial visit, patient and family meet with a social worker who provides printed information about the psychosocial health services offered on site and an orientation to these services. Read the entire page →
From page 182... ... Full-time, on-site social workers also provide case management and refer patients to a wide variety of psychosocial health services available on-site (e.g., support groups, educational seminars, psychotherapy, stress management) and from providers in the community. Read the entire page →
From page 183... ... . For some psychosocial health problems, patients receive the needed services directly on site; for others, they are referred to resources in the community by clinic nurses and social workers on an ad hoc basis. Read the entire page →
From page 184... ... Approach 2: Provision of Psychosocial Health Services Using Local Resources Examples Kansas City Cancer Center7 (KCCC) is a full-service medical and radiation oncology practice that includes 29 medical oncologists, 8 radiation oncologists, and 11 oncology nurse practitioners (NPs) Read the entire page →
From page 185... ... , a relocated oncologist and Tahoe Forest Hospital created a solo physician ambulatory oncology practice that routinely incorporates attention to psychosocial health needs as part of oncology care. The solo oncologist uses hospital personnel to help address psychosocial needs of patients. Read the entire page →
From page 186... ... It does, however, require that organizations making referrals to other providers do so effectively, and that the referring organization have strong follow-up procedures in place. Approach 3: Use of Remote Providers of Psychosocial Health Services When a clinical practice has few staff, limited resources, and/or is located where there are few or no psychosocial health care resources, such as in rural or remote areas, the only way to provide psychosocial health services on a frequent and timely basis may be to link patients with remote providers through telephone or Internet access. Read the entire page →
From page 187... ... Following is a discussion of how an organization with limited internal and local resources could address psychosocial needs following the model put forth in Chapter 4. This approach may not always be able to meet all psychosocial health needs; for example, some of the needed services, such as assistance with activities of daily living and chores, may not be available remotely. Read the entire page →
From page 188... ... We want to give you the best health care possible! All practices should be able to provide at least some of the psychosocial health services needed by patients -- for example, information about the patient's diagnosis and treatment options, emotional support, and help in managing some of the symptoms of the illness and side effects of treatment. Read the entire page →
From page 189... ... Service in English and Spanish Questions can also be sent via e-mail to: cancergovstaff@mail.nih.gov A "live" help service is available to answer general questions about cancer and provide help in navigating the NCI website at https://cissecure@nci.nih.gov/livehelp/welcome.asp# The American Cancer Society By telephone 24 hours a day, every day: 1-800-ACS-2345 and 1-866-228-4327 (TTY for the hearing impaired) (both toll free) Read the entire page →
From page 190... ... Virtual communities providing emotional support, information, and sometimes other psychosocial health services also are now commonplace. Their services are available to many cancer patients as a result of such Internetbased initiatives as those of PlanetCancer (http://www.planetcancer.org/html/index.php) Read the entire page →
From page 193... ... All cancer care providers should ensure that every cancer patient within their practice receives care that meets the standard for psychosocial health care. The National Cancer Institute should help cancer care providers implement the standard of care by maintaining an up-to-date directory of psychosocial services available at no cost to individuals / families with cancer. Read the entire page →
From page 194... ... Thus a large scale, systematic program demonstrating and evaluating the effects of the implementation of the standard of psychosocial health care at various oncology sites (e.g., comprehensive cancer centers attached to medical centers, freestanding oncology practices, and smaller oncology practices located outside of urban areas) would provide useful information about different ways to implement the standard as a whole and its individual components more efficiently in oncology practices and the impact of doing so. Read the entire page →
From page 195... ... , and the Agency for Healthcare Research and Quality (AHRQ) should, individually or collectively, conduct a large-scale demonstration and evaluation of various approaches to the efficient provision of psychosocial health care in accordance with the standard of care. Read the entire page →
From page 196... ... 2007. Patient-centered communication in cancer care: Promoting healing and reducing suffering. Read the entire page →
From page 197... ... 2006. How underserved breast cancer patients use and benefit from ehealth programs: Implications for closing the digital divide. Read the entire page →
From page 199... ... To overcome these obstacles, the committee recommends that group purchasers of health care coverage, health plans, and quality oversight organizations take a number of actions to fully support the interventions necessary to deliver effective psychosocial health services. The National Cancer Institute, Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services also should spearhead the development and use of performance measures to improve the delivery of these services. Read the entire page →
From page 200... ... . Other policies, however, do not reflect existing evidence on the need for and methods of delivering psychosocial health care. Read the entire page →
From page 201... ... : - Research Symposium on Consumer–Provider Communication in 2002 - Synthesis of literature on physicians' communication behaviors in cancer care and generally PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 202... ... health and codes varies by state behavior assessment PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 205... ... Policy support for the provider side of the patient–provider partnership is illustrated by the efforts of the Veterans Health Administration, whose Employee Education System provides mandatory and optional classes on such topics as clinician–patient communication to enhance health outcomes, communication to affect behavior change, and disclosure of unanticipated outcomes and medical errors. Other initiatives to improve patient–provider communication by organizations such as Kaiser Permanente, Geisinger Health System, the American Academy of Orthopedic Surgeons, Affinity Health System, and Washington State University are chronicled by the Institute for Healthcare Communication (2005) Read the entire page →
From page 206... ... used by physicians and certain other clinicians (e.g., physician assistants, nurse practitioners, and nurse midwives) to report the services and procedures PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 208... ... . Although the extent to which private insurers and state Medicaid programs reimburse for these codes is not comprehensively tracked, in early 2007 an American Psychological Association list serve contained anecdotal reports of denial of reimbursement for these services by Medicaid, and coverage by private-sector health plans is not yet uniform.8 8 Personal communication. Read the entire page →
From page 209... ... Policies Addressing Care Planning, Linking of Patients to Psychosocial Services, Care Coordination, and Follow-up Current Support in Fee-for-Service Reimbursement Addressing patients' identified psychosocial needs by planning, linking patients to service providers, coordinating psychosocial with biomedical care, and following up on the receipt and effectiveness of services is provided for to some extent in existing FFS reimbursement policy. Although perhaps not always recognized (Adiga et al., 2006) Read the entire page →
From page 211... ... All patients with psychosocial health care needs require some degree of planning, linking, coordination, and follow-up, and this 11 Conversely, if tomorrow all physicians identified attention to patients' psychosocial health needs as integral to the provision of medical care and put in place mechanisms to address these needs, the practice expenses associated with doing so could be captured in the data sources Medicare uses to estimate practice expenses, and could lead to an increase in payment rates. However, since Medicare payments are based on the value of each service "relative" to another, when relative values (and payments) Read the entire page →
From page 212... ... Medicare in particular is implementing several care coordination demonstration projects to inform efforts to develop better support for planning, linking, coordinating, and following up on the delivery of necessary psychosocial health services (see Box 6-1) Read the entire page →
From page 213... ... This 3-year demonstration, begun in 2005, is designed to test approaches to helping Medicare beneficiaries with complex medical needs achieve better health outcomes through improved care coordination. In addition to providing traditional FFS Medicare benefits, participating health care organizations offer a variety of additional services to coordinate care, including home visits, in-home monitoring devices, electronic medical records, self-care and caregiver support, education and outreach, tracking and reminders of individuals' preventive care needs, 24-hour nurse telephone lines, behavioral health care management, and transportation services. Read the entire page →
From page 214... ... . SUPPORTS FOR AND CONSTRAINTS ON SERVICE AVAILABILITY In addition to the policy support for interventions aimed at delivering psychosocial services described above, policies need to support the availability and accessibility of the various services patients require. Read the entire page →
From page 216... ... services, Health and Behavior (H/B) provider purchased Disease Interventions, and additional services from Control and managed care plans Prevention initiatives PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 217... ... insurance "personal under certain care" benefit circumstances and state specific waivers of federal law Can be Some Area Some Legal Services purchased Agencies on availability (e.g., regarding Aging (e.g., Cancer the Americans Legal with Disabilities Resource Act, the Family Center) ; some and Medical in defined Leave Act, geographic wills, power of PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 218... ... Limited Can be Some Area Day-to-day Financial availability purchased Agencies on financial Planning, Aging management Counseling, and assistance Management of available, Day-to-Day depending Activities (e.g., on bill paying) individual's informal supports PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →

From page 154...

... and the finding of low success of referral by itself in linking cancer patients to needed psychosocial health services in one study of health maintenance organizations (HMOs) (Eakin and Strycker, 2001)