Cancer Care for the Whole Patient Meeting Psychosocial Health Needs (2008) / Chapter Skim
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medical schools. Medical student's clerkship experiences and opinions reflect some satisfaction with current education and training in psychosocial health services (Yuen et al., 2006)
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does not explicitly cover psychosocial health services, but a "broad spectrum of cases reflecting common and important symptoms and diagnoses" (USMLE, 2006:9)
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. Program requirements for family medicine state that residents must become trained in meeting the psychosocial health needs of patients.
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can reasonably be expected to address psychosocial health services.13 For these clinicians, a greater issue is the extent to which psychiatrists are knowledgeable about and qualified to address the effects of acute or chronic illness on mental health. Accordingly, program requirements in psychiatry state that clinical education should give residents experience in "the diagnosis and management of mental disorders in patients with multiple comorbid medical disorders" (p.
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. Within such programs, topics related to psychosocial health services could be incorporated in such mechanisms as self-assessment modules, used to evaluate knowledge, and performance-inpractice modules, used for peer review.
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For example, NLNAC supports the Pew Health Professions Commission's 21 Competencies for the TwentyFirst Century as the bases for preparing practitioners to meet evolving health care needs,14 and recommends as guidance a set of core competencies, a number of which address psychosocial health services (see Box 7-5)
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. Accordingly, topics related to psychosocial health services are to be woven in throughout the nursing curriculum.15 More specifically, baccalaureate curricula are required to incorporates knowledge and skills identified in The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998)
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, Advanced Oncology Certified Nurse Practitioner (AOCNP) , and Advanced Oncology Certified Clinical Nurse Specialist (AOCNS)
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For example, a previous IOM report (IOM, 2006) documented that most schools of social work fail to provide students with basic knowledge of alcohol- and drug-use issues, and that a significant factor contributing to this PREPUBLICATION COPY: UNCORRECTED PROOFS
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provides a definition for oncology social workers' scope of practice, has established voluntary standards for practice, and serves as an educational resource. It defines oncology social work as providing "psychosocial services to patients, families, and significant others facing the impact of a potential or actual diagnosis of cancer," such as "stress and symptom management, care planning, case management, system navigation, education and advocacy" (AOSW, 2001:1)
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Psychologists can remain generalists or develop an area of expertise within these broad categories. Most relevant to the provision of psychosocial health services to medically ill patients and their families is the specialty of clinical health psychology, discussed in more detail below.
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Certification The American Board of Professional Psychology (ABPP) certifies psychologists in 13 specialty areas, including clinical health psychology, clinical neuropsychology, and rehabilitation psychology.
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Those seeking board certification in the area of clinical health psychology may specialize in any number of areas, including prevention, health promotion, public health, pain management, weight reduction, smoking cessation, and/or the psychological aspects of chronic illness. Board certification requires a degree from an APA-approved graduate program, plus licensure and two years of postdoctoral training or supervised experience in clinical health psychology.
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This situation serves as a barrier to the development and delivery of psychosocial services to medically ill patients in nonhospital community settings. A striking finding is that there appear to be no detailed competency sets or model curricula related to cancer care in use within this profession; there is merely a brief list of "core curricular areas" from a seminal 1983 health psychology conference.
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. EDUCATIONAL BARRIERS TO PSYCHOSOCIAL HEALTH CARE The above discussion indicates that there is likely inconsistency in the extent to which the educational curricula studied by predominantly medically focused health care providers address psychosocial health care (and conversely the extent to which the curricula studied by predominantly psychosocial health care providers address the effects of illness on psychosocial functioning)
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• Utilize informatics -- communicate, manage knowledge, mitigate error, and support decision making using information technology. The current weaknesses in health professions education in these five areas impede the delivery of psychosocial services to cancer patients in very concrete ways.
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. The inadequate delivery of psychosocial health care in oncology suggests that there also may be benefits to specifying the competencies necessary for providing psychosocial services to medically ill patients in general, and to cancer patients in particular.
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basic health professions education curricula used at academic institutions; 2) continuing education programs and licensing requirements by health professional societies; and 3)
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f. Recognize the importance of survivorship in a long-term cancer care plan at the conclusion of active treatment.
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Faculty development programs that attend to both numbers and expertise are needed to ensure the application of the competencies across health professions schools. Effective Teaching Practices Competency identification and curriculum development provide a foundation for training and education.
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, and Bristol-Meyers Squibb Foundation uses interactive strategies to train social workers and other mental health professionals to provide "cancer-sensitive" counseling to individuals with cancer. ICAN's 8 hour face-to-face, interactive, experiential training program comprises discussion and knowledge- and skillbuilding activities encompassing clinicians' monitoring of their own attitudinal and emotional responses to cancer; psychosocial issues relevant to cancer patients, including stress management, coping, quality-of-life concerns, grief, and hope; and ongoing case consultation support.
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However, health professions education and training shape clinicians before they enter the workforce and are key determinants of clinicians' attitudes, knowledge, and skills. Continuing education and maintenance-of-competency initiatives also help as new knowledge and care methods develop.
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– Drafting and implementing a plan for developing the skills of faculty and other trainers in teaching psychosocial health care using evidence-based teaching strategies. – Strengthening the emphasis on psychosocial health care in educational accreditation standards and professional licensing and PREPUBLICATION COPY: UNCORRECTED PROOFS
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Educational accrediting organizations, licensing bodies, and professional societies should examine their standards and licensing and certification criteria with an eye to identifying competencies in delivering psychosocial health care and developing them as fully as possible in accordance with a model that integrates biomedical and psychosocial care.
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2006a. Program requirements for graduate medical education in family medicine.
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2005. Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews.
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2003. Health professions education: A bridge to quality.
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Journal of Continuing Education in the Health Professions 21(2)
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A TAXONOMY AND NOMENCLATURE FOR PSYCHOSOCIAL HEALTH SERVICES The committee reiterates the importance of the recommendation made in Chapter 3 for the development of a standardized, transdisciplinary taxonomy and nomenclature for psychosocial health services: Recommendation: Standardized nomenclature. To facilitate research on and quality measurement of psychosocial interventions, the National Institutes of Health (NIH)
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Identification of Effective Interventions For some psychosocial health problems faced by cancer patients, research has not yet identified efficacious remedies. For example, as discussed in Chapter 3, research does not well inform clinicians about how to address effectively continued tobacco use among cancer patients, cognitive impairment among adults treated for cancer, and difficulties with school reentry for children treated for cancer.
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. Effectiveness research on psychosocial health services has most often addressed women with breast cancer at the middle to upper middle socioeconomic levels without regard to the amount of psychosocial stress they are experiencing.
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PCM 2.0 focuses on role functioning and overall quality of life. Other types of psychosocial health needs not addressed by these instruments include, for example, social isolation/social support, difficulties in navigating the health system, and poor literacy.
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If a clinician cares for an individual with more than one chronic condition, which screening tool or tools should be used? Is there a minimum set of domains that should be included in all screening tools for psychosocial health needs?
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Because most oncology patients receive their cancer care in outpatient settings, research comparing the effectiveness and cost of using different mechanisms to link patients to psychosocial services and coordinate their care could help inform and redesign oncology practices. Such research also could evaluate the use of 1 For example, physical, psychological, medical interactions, sexual, coping information, activities of daily living, interpersonal communication, availability and continuity of care, physician competence, support networks, spiritual, childcare, family needs, pain/symptom control, home services, having purpose, etc.
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These tools and strategies should include: – Approaches for improving patient–provider communication and providing decision support to cancer patients. – Screening instruments that can be used to identify individuals with any of a comprehensive array of psychosocial health problems.
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Promoting Uptake and Monitoring Progress. The National Cancer Institute/NIH should monitor progress toward improved delivery of psychosocial services in cancer care and report its findings on at least a biannual basis to oncology providers, consumer organizations, group purchasers and health plans, quality oversight organizations, and other stakeholders.
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