Psycho-oncology care in breast cancer centres: a nationwide survey.

OBJECTIVE: To describe psycho-oncological care structures and processes in German breast cancer centres from the perspective of the centre administration. METHODS: The findings are based on a postal survey of a representative random sample of surgical sites of certified breast cancer centres in Germany. Data were collected in 2013 and 2014. The questionnaire included questions about infrastructure, patient information standards, psycho-oncological services and aspects of organisational culture. Data analyses included frequencies, means and bivariate relationships. RESULTS: The return rate was 88.3% (53 hospital sites). Psycho-oncological care is provided by permanent employees in 87%. The average number of full-time-equivalent employees (FTE) is 1.23. Most breast cancer centres engage the occupational group of psycho-oncologists for psycho-oncological care (90%), followed by the medical service (80%) and breast care nurses (78%) (multiple answers were possible). The correlation coefficient between FTEs and surgical treatments per year is not significant (r=0.292, p=0.051). Hospitals are screening every inpatient for the need of psycho-oncological support in 76% of all sites. Frequently used screening instruments are distress thermometer (19%), clinical interview (13%) and basic psycho-oncological documentation (11%). CONCLUSION: Our data provide insights into the self-reported structural and procedural quality of psycho-oncological care in German breast cancer centres. Further research should examine patient and caregiver perspective on the psycho-oncological services provided by breast cancer centres.

An inventory of psychosocial oncological interventions in The Netherlands: identifying availability, gaps, and overlap in care provision.

Purpose: While a wide range of psychosocial oncological (PO) interventions has been developed, a systematic overview of interventions to inform patients, care providers, as well as researchers, policy makers and health insurers, is lacking. The aims of this paper were (1) to describe the attainment of this overview, which may be used in other jurisdictions and for other health conditions and (2) to reflect on what determines developments in this field.Methods: Dutch researchers and care providers were invited to describe PO-interventions they apply in research or clinical practice. Selection criteria for what constituted a PO-intervention were determined. The input was organized in 12 predefined categories (e.g. physical functioning, genetics).Findings: Sixty-six PO-interventions were included in the overview. Two major categories were psychosocial functioning (24%) and physical functioning and recovery (24%). Interventions are mostly directed at adults (65%) and not aimed at a specific type of cancer (61%). Nearly 25% of the interventions lacked scientific underpinning.Conclusions: This paper provides an overview of Dutch PO-interventions and input on what drives their development. The categorizing method can be used in other jurisdictions and for other health care conditions. A next step would be to investigate the effectiveness and evidence of PO-interventions.Implications for Psychosocial Providers and Policy: The open access overview of interventions provides referral information for care providers. By identifying possible gaps and overlap, the overview looks at possible drivers behind developments in this field which will be of interest to policy makers.

Observational non-randomised controlled evaluation of the effectiveness of cancer counselling centres: a study protocol.

INTRODUCTION: In recent years, medical treatment for cancer has improved, thereby increasing the life expectancy of patients with cancer. Hence, the focus in healthcare shifted towards analysing treatments that offer to decrease distress and improve the quality of life of patients with cancer. The psychological burden of patients with cancer originates from all kinds of psychosocial challenges related to diagnosis and treatment. Cancer counselling centres (CCounCs) try to address these concerns. However, the current literature lacks research on the effectiveness of CCounCs. This study aims to assess the effectiveness of CCounCs with regard to distress and other relevant psychosocial variables (quality of life, anxietyand so on). METHODS AND ANALYSIS: This prospective observational study with a non-randomised control group has three measurement points: before the first counselling session (baseline, t0) and at 2 weeks and 3 months after baseline (t1, t2). Patients and their relatives who seek counselling between December 2018 and November 2020 and have sufficient German language skills will be included. The control group will be recruited at clinics and oncological outpatient centres in Hamburg. Propensity scoring will be applied to adjust for differences between the control and intervention groups at baseline. Sociodemographic data, medical data and counselling concerns are measured at baseline. Distress (distress thermometer), quality of life (Short Form-8 Health Survey, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-Core 30), anxiety (Generalized AnxietyDisorder-7), depression (Patient HealthQuestionnaire-9) and further psychosocial variables are assessed at all time points. With a total of 787 participants, differences between the intervention and control groups of a small effect size (f=0.10) can be detected with a power of 80%. ETHICS AND DISSEMINATION: The study was registered prior to data collection with the German Registration of Clinical Trials in September 2018. Ethical approval was received by the local psychological ethical committee of the Center for Psychosocial Medicine at the University Medical Centre Hamburg-Eppendorf in August 2018. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00015516; Pre-results.

Barriers and facilitators to community-based psycho-oncology services: A qualitative study of health professionals' attitudes to the feasibility and acceptability of a shared care model.

OBJECTIVE: Psychological therapies combined with medication are effective treatments for depression and anxiety in patients with cancer. However, the psycho-oncology workforce is insufficient to meet patient need and is hard to access outside of the major cities. To bridge this gap, innovative models of care are required. Implementation of a new model of care requires attention to the facilitators and barriers. The aim of this study was to explore stakeholders' attitudes to the feasibility and acceptability of a community-based, shared care model for the treatment of depression and anxiety. METHODS: Semi-structured interviews were conducted with community-based clinical psychologists (n = 10), general practitioners (n = 6), and hospital-based psychologists working in psycho-oncology (n = 9). Framework analysis was conducted to identify key themes. RESULTS: All stakeholders perceived the model as feasible and acceptable. Potential barriers/facilitators to implementation were summarised under six key themes: (a) initiative, ownership, and autonomy; (b) resources; (c) pathway establishment; (d) support; (e) skill acquisition; and (f) patient engagement. Facilitators included quality communication between health professionals across primary and tertiary care and appropriate education and support for community-based clinicians. CONCLUSIONS: This in-depth exploration of Australian health professionals' perceptions of the feasibility and acceptability of a community-based model of psycho-oncology care revealed that most clinicians were willing to adopt the proposed changes into practice. An RCT of a shared care intervention for depressed patients with cancer is needed.

Outcome comparison of integrated psycho-oncological care versus unstructured care-Results of a non-randomised open-label two-arm trial.

OBJECTIVE: To compare patients' experiences with a systematic, integrated psycho-oncological care (IC) model to experiences with "care as usual" (CAU). METHODS: To improve patients' knowledge about psychosocial support options and to facilitate use, an IC model was developed by psycho-oncologists and a health insurance company and implemented in one German cancer care facility. Using a parallel, non-randomised design, these patients' experiences were compared to CAU patients. In 2015, both patient groups received questionnaires 6-12 months post-inpatient treatment. Main outcomes were awareness, use and opinion of psycho-oncological care (PC) and anxiety level (Generalized Anxiety Disorder Scale (GAD-7)). RESULTS: 228 patients (IC = 90; CAU = 138) participated (response rate 24%). More IC patients felt adequately informed about PC (63% vs. 46%, ORadj : 2.5 (CI: 1.3-4.8); p = 0.008). More IC patients recalled being offered various support options and had had at least one PC discussion (44% vs. 33%, ORadj of IC patient saying "yes" instead of "No, didn't want to" compared to a CAU patient: 0.4 (CI: 0.2-0.8); p = 0.01). More IC patients rated their care as good/excellent (49% vs. 38%, ORadj : 1.8 (CI: 0.7-4.1; p = 0.2)). Anxiety levels were similar (GAD-7 score>=10: IC 34% vs. CAU 28%; p = 0.4). CONCLUSION: Structured psycho-oncological care had some positive results on the outcomes, but anxiety levels did not differ.

A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability.

OBJECTIVE: ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post-treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. METHODS: Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi-structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. RESULTS: Participants were 13 males and one female with, on average, 14 years psycho-oncology experience. Nine over-arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention); context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways); and facilitation of implementation (intervention/service fit, intervention/patient fit, and training, support, and provided resources). CONCLUSIONS: ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base; a receptive context; good fit between the intervention, therapist orientation, and patient need; and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho-oncology interventions in routine care.

[The early recognition of mental morbidities during psycho-oncologic treatment]. / A pszichés morbiditások korai felismerése a pszichoonkológiai ellátás során.

Unfortunately there have been no positive changes in the main indicators of cancer incidence in Hungarian population since the turn of the millennium. The main goal of psycho-oncologic treatment is to provide the highest possible quality of life to the patient. The prevalence of mental disorders in cancer patients is high and it is accompanied by a rather small number of qualified staff. Thus, the remedy might be the identification of high-risk patients, i.e. the systematic psycho-oncologic screening. Hungary is still lacking a unified screening method that involves all oncologic treatment-providing units. Compiling the Hungarian standards for the Distress Thermometer and the Problem List is the first step of a complex program for creating a general psycho-oncologic screening. Such a comprehensive program might improve oncologic patient-care and, eventually, the quality and prospect of the lives of patients.

[Areas and challenges of oncopsychological rehabilitation]. / Az onkopszichológiai rehabilitáció területei és kihívásai.

Patients with cancer present a number of different difficulties that adversely affect their health care and recovery (e.g. poor communication with physicians, lack of knowledge about their illness and its management, financial problems). Furthermore, mental health problems, such as distress, depression and anxiety, are common amongst patients with cancer. These mental health problems are additional contributors to functional impairment in carrying out family, work, and other social roles, poor adherence to medical treatments, and adverse medical outcomes. Oncopsychosocial rehabilitation aims to optimize the possibilities of medical health care through psychological interventions by helping cancer patients and their families and/or health care workers with the management of the psychological and social aspects of the illness. Oncopsychosocial rehabilitation includes all psychosocial interventions that are designed to positively influence patient psychosocial adaptation and adjustment to diagnosis, treatment, and survivorship. Oncopsychological rehabilitation could also manage cancer related distress and other psychosocial problems with specific types of treatments or interventions including prevention, relaxation techniques, structured psychoeducational interventions including sexual information and/or preparation for surgery, and various methods of psychotherapy.

2016 President's Plenary International Psycho-Oncology Society: challenges and opportunities for growing and developing psychosocial oncology programmes worldwide.

Consistent with the International Psycho-Oncology Society's (IPOS) vision and goals, we are committed to improving quality cancer care and cancer policies through psychosocial care globally. As part of IPOS's mission, upon entering "Official Relations" for a second term with the World Health Organization (WHO), IPOS has dedicated much attention to reaching out to countries, which lack formalized psychosocial care programmes. One of IPOS's strategies to accomplish this goal has been to bring psycho-oncology training programmes to low- and middle-income countries and regions. To this end, the IPOS Board approved a new position on the Board of Directors for a member from a low- to middle-income country (LMIC). The IPOS 2016 President's Plenary focused on challenges and opportunities that exist in growing and developing psychosocial oncology programmes worldwide. The plenary presentations highlight how IPOS and WHO have aligned their goals to help LMICs support cancer patients as an essential element of cancer and palliative care. IPOS country representatives are strongly supported in liaising with national health authorities and with WHO Country Representatives in LMICs. The plenary speakers discussed the role IPOS Federation has taken in building a global network of psychosocial leaders and the impact this had in assisting LMICs in meeting IPOS's psychosocial care objectives. The plenary highlighted the challenges of expanding psychosocial reach into these countries. One significant question remains: Can psychosocial guidelines be adapted to LMICs and regions?

Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture.

In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work, and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment, or end-of-life distress. These observations are usually based on clinical acumen not on metrics. In psychosocial oncology, by committing to the science of caring and relying on the use of standardized tools to screen for distress, the multidisciplinary cancer care team assess, communicate, and intervene on what is measured. That is, health care providers can begin to address the patients' identified concerns. Branding distress as the 6th vital sign and incorporating screening for distress into standard cancer practice can be an effective strategy to challenging the resistance in implementation of psychosocial oncology in cancer care institutions. Accreditation agencies are endorsing the need to assess patient distress and better manage symptoms of distress as part of routine and standardized patient care. While many international organizations and societies support the importance of screening, implementing screening for distress still has a long way to go to be operationalized in many cancer care programs. Screening for distress when implemented does, however, create an opportunity for psychosocial oncology to extend its reach into cancer care programs and institutions.

2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue-challenges and opportunities.

The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the "Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right" was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward.