If the patient is receiving psychosocial care but no referral date can be identified, record the date of the first account of receipt of psychosocial care as the date of referral. Clinical practice guidelines for the psychosocial care of adults with cancer. My items 0 Login. Browse registry Where do I start? Search archive. Print page. Show technical. Login options Log in.
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Ingrid Barrera et al. International Review of Psychiatry Volume 26, - Issue 1. Published online: 25 Feb William S. Specifically, the reports recommend that patients completing primary treatment be provided with a Survivorship Care Plan.
Clinical practice guidelines for the psychosocial care of adults with cancer | Cancer Australia
Several other components that feature prominently in the plan can be viewed as falling within the domain of psychosocial care. Patients should also receive recommendations for healthy behaviors that include advice about diet, exercise, sunscreen use, and smoking cessation. Subsequent to the completion of these reports, the IOM convened a workshop devoted to advancing the implementation of Survivorship Care Plans. The proceedings of this workshop provide additional details about the content of Survivorship Care Plans and the processes for developing and using them in routine clinical practice.
As patients near the end of their primary treatment, a psychosocial evaluation should be conducted to identify those issues that would need to be addressed in this aspect of the Survivorship Care Plan.
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The evaluation would likely be conducted concurrent with a medical evaluation designed to identify other issues that would need to be addressed in the plan. In both cases, the goal is to generate a plan personalized to the patient's specific disease and treatment characteristics and identified needs. Key components of the psychosocial evaluation would include an assessment of the patient's psychological distress as well as other symptoms common in cancer survivors that may respond to psychosocial interventions eg, pain and fatigue.
The assessment should also address major areas of functioning including role, social, and family functioning and identify any practical problems eg, finances, child care, and transportation that would complicate the patient's ability to receive recommended survivorship care. In addition, an assessment of current health habits eg, dietary behavior and physical activity and substance use eg, tobacco and alcohol would be necessary to formulate recommendations for lifestyle modification. Finally, the assessment should evaluate patients' current levels of knowledge about their disease and its treatment and their desire for additional information about these topics and about specific aspects of survivorship.
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer
For example, the Distress Thermometer, a measure that has been studied extensively with patients in various phases of cancer treatment, 21 would appear to have potential as an initial screen for psychological distress at the end of treatment. Methods for assessing patients' and their caregivers' unmet psychosocial and supportive care needs is one such area. A systematic review of needs assessment measures for cancer patients and their families identified no instruments targeting survivorship. The results of the evaluation performed should subsequently inform the specific recommendations that comprise the psychosocial component of the Survivorship Care Plan.
The evaluation should also identify personalized information to be delivered to the patient to enhance their knowledge and understanding of the issues or problems they are currently facing or may likely face as a consequence of their disease and the specific treatments they received. For example, women treated with chemotherapy for early stage breast cancer who are experiencing fatigue at the end of treatment might be alerted to the possibility that their fatigue may persist for months or years based on evidence from longitudinal research. Similarly, survivors who would benefit from changes in their diet or physical activity should be guided to programs shown to be efficacious in achieving goals consistent with American Cancer Society guidelines for nutrition and physical activity after cancer treatment.
In the likely absence of such evidence, it may be necessary to rely on RCTs or lower level evidence from research conducted with patients undergoing primary cancer treatment or patients with other health conditions. With regard to the psychosocial aspects of Survivorship Care Plans, there is a need for studies that evaluate whether procedures such as those depicted in Figure 1 yield the expected improvements in patient knowledge and quality of life.
Data element attributes
Studies are also needed to identify if survivorship care planning is effective in promoting adoption of a healthier lifestyle. In addition to determining whether survivorship care planning yields the desired outcomes, these studies could identify optimal ways to conduct a psychosocial evaluation at the end of treatment and to link patients to the resources and services that could benefit them. Cost is an important factor to consider in identifying optimal approaches to organizing and delivering survivorship care.
Given the many barriers to providing psychosocial care, creation of an evidence base that could guide clinical practice should be viewed as an essential step in promoting the psychosocial component of survivorship care planning. The IOM report on adult cancer survivors 1 was preceded by a report on pediatric cancer survivors. The product of this effort was first released to the public in and has been updated periodically. Research evidence was used primarily to derive risk categories based on a review of studies that have examined associations between treatment exposure and late effects.
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- Person with cancer—date of referral to psychosocial services, DDMMYYYY.
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Consensus was used primarily to derive recommendations about how to screen for late effects and how often to screen. Intervention recommendations are based on research evidence or, in its absence, on a consensus of clinical experts. An example will serve to illustrate how the guidelines are organized. Based largely on a review of research evidence, the guidelines indicate that psychosocial disorders eg, social withdrawal and educational problems and mental health disorders eg, depression and anxiety are potential late effects of any cancer experience ie, regardless of specific treatment exposure.
Based largely on consensus, the guidelines recommend that survivors undergo a psychosocial assessment on a yearly basis that would include screening for psychosocial and mental health disorders. Also based largely on consensus, the guidelines recommend consideration of psychological consultation, social work consultation, and psychotropic medication as intervention strategies. Citations are provided to reviews and original research publications relevant to these guideline recommendations.
Second, the work involved in systematically reviewing the evidence see Table 1 would yield valuable information about the strength of research findings in this area and is likely to identify important gaps in knowledge. In addition, there has been relatively little research examining integrated models of psychosocial care delivery in oncology settings. Notable exceptions include 2 studies 35 , 36 that showed that the collaborative care approach to managing depression, found to be effective in primary care settings, 37 can be successfully adapted for oncology settings.
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