Cancer Care for the Whole Patient Meeting Psychosocial Health Needs (2008) / Chapter Skim
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Pages 51-80
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From page 51... ...
. Several studies have also shown that social support is associated with lower resting and PREPUBLICATION COPY: UNCORRECTED PROOFS
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From page 54... ...
.10 Findings from two randomized controlled trials of psychosocial interventions in breast cancer patients also found improvements in immune system functioning using a variety of measures of immune system competency (Andersen et al., 2004; McGregor et al., 2004)
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From page 55... ...
However, with respect to effects on the larger economy, the financial costs of failing to deliver psychosocial health services to individuals with cancer have not been studied. Studies that have attempted to quantify the impact of mental health problems on the cost of medical care have been based on the effect of depression and/or anxiety PREPUBLICATION COPY: UNCORRECTED PROOFS
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From page 56... ...
All components of the health care system that are involved in cancer care should explicitly incorporate attention to psychosocial needs into their policies, practices, and standards addressing clinical medical practice. These policies, practices, and standards should be aimed at ensuring the provision of psychosocial health services to all patients who need them.
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From page 57... ...
Adopting the terminology of psychosocial health services aims to define psychosocial services in a way that recognizes the legitimate and sometimes different purposes of psychosocial services across different health and human service sectors, while simultaneously setting an expectation for efficacy and effectiveness criteria in improving health or health care. Second, the committee's definition of psychosocial health services distinguishes between services directly needed by the patient (e.g., treatment for depression or financial assistance)
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From page 58... ...
2006. Application of the theory of planned behavior to understand intentions to engage in physical and psychosocial health behaviors after cancer diagnosis.
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From page 59... ...
Paper Commissioned by the Institute of Medicine Committee on Psychosocial Services to Cancer Patients and Families in Community Settings. Paper available from IOM.
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2004. The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients.
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From page 62... ...
2005. Ovarian cancer patients' psychological distress: The role of physical impairment, perceived unsupportive family and friend behaviors, perceived control, and self-esteem.
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From page 67... ...
Good evidence also underpins a number of interventions designed to help individuals adopt behaviors that can help them manage disease symptoms and improve their overall health. Other psychosocial health services, such as transportation to health care or financial assistance to purchase medications or supplies, while not the subject of effectiveness research, have wide acceptance as humane interventions to address related needs, and are long-standing components of such public programs as Medicaid and the Older Americans Act.
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From page 68... ...
• Supplement financial grants * The committee notes that, as discussed in Chapters 1 and 2, family members and friends and other informal sources of support are key providers of psychosocial health services.
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From page 69... ...
These more consistently needed provider- and system-level interventions to deliver effective psychosocial services are discussed in Chapters 4 and 5. EVIDENCE OF EFFECTIVENESS The effectiveness of some psychosocial health services has been substantiated through research.
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From page 70... ...
of lumping together divergent psychosocial health services and rendering an overarching judgment about their effectiveness. Reviews of the effectiveness of aggregate psychosocial services are problematic just as such reviews of the effectiveness of biomedical health care in the aggregate would be unhelpful (and unlikely)
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From page 71... ...
The effect of providing condition-specific information tailored to the individual patient's medical situation or condition has been the subject of many randomized controlled trials involving patients with cancer and other conditions, such as low back pain, diabetes, arthritis, and asthma. An analysis of systematic reviews of the effects of provision of health information found that, although the provision of information on the treatment and management of disease was not found to affect health status, written information improved knowledge and recall of health information, and the provision of verbal and written information together had a greater impact than the provision of either alone (Coulter and Ellins, 2006)
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From page 72... ...
One well-conducted randomized controlled trial (Goel et al., 2001) among surgical practices in Canada involving women with breast cancer who needed to decide between breast-conserving treatment and mastectomy found evidence of the effectiveness of such a multicomponent intervention, but only for women who were uncertain about what decision to make.
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From page 73... ...
. They are used most widely by patients with particular forms of cancer, the most common being prostate and breast (e.g., Us Too groups for prostate cancer and breast cancer support groups)
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From page 74... ...
. Better understanding of the effectiveness of peer support groups will require more randomized controlled trials in which the participants, content, and outcome variables are clearly delineated.
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From page 75... ...
, examining only well-designed controlled studies with clinically relevant outcome data, found support for incorporating tested interventions into clinical practice guidelines. The National Cancer Control Initiative in Australia similarly found strong evidence for interventions that used cognitive-behavorial, supportive, and psychoeducational approaches for the management of depression and anxiety (National Breast Cancer Centre and National Cancer Control Initiative, 2003)
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From page 76... ...
. A recent systematic review of telephone-based interventions for mental illness also found evidence of their effectiveness, but noted that the limited number of studies conducted, their small sample sizes, and lack of randomized controlled trial methodology prevent firm conclusions from being drawn.
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From page 77... ...
and antianxiety drugs (benzodiazepines) in adult cancer patients suggest that they reduce depressive symptoms, major depression, and anxiety in these patients, though fewer of the studies focused on anxiety (Pirl, 2004; National Breast Cancer Centre and National Cancer Control Initiative, 2003; Jacobsen et al., 2006; Williams and Dale, 2006;(Rodin et al., 2007)
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From page 78... ...
. One of the best-studied illness selfmanagement programs, found effective in randomized controlled trials, is the Chronic Disease Self-Management Program developed and offered by Stanford University School of Medicine (Stanford University School of Medicine, 2007)
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From page 79... ...
In randomized controlled trials, related interventions have been shown to improve mood and vigor among patients with malignant melanoma (Boesen et al., 2005) , reduce psychological distress after radiotherapy (Stiegelis et al., 2004)
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From page 80... ...
A limited number of randomized controlled trials have evaluated smoking cessation interventions in patients with cancer (Griebel et al., 1998; Gritz et al., 1993; Wewers et al., 1994; Browning et al., 2000; Sanderson Cox et al., 2002; Schnoll et al., 2003, 2005; Emmons et al., 2005)
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