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Institute of Medicine Says Psychosocial CarePossible in Any Oncology Practice in U.S.
By Caroline McNeil
A
ll cancer care providers shouldensure that patients receive neededpsychosocial services, according toa new standard of care proposed by theInstitute of Medicine (IOM). Perhapsmost surprising: The IOM concludesthat the resources already exist for every provider, large or small, to meet thisstandard. The IOM’s proposed standard calls onclinicians to provide screening for psycho-social needs, link patients with services,coordinate and monitor the care received,and follow up (
see
sidebar). “We believethat it is possible for every provider to meetthis standard in some way,” said Ruth McCorkle, R.N., Ph.D., of Yale University School of Nursing in New Haven, Conn., amember of the committee.Lack of resources has been cited as abarrier to including psychosocial services inmost cancer care. But the IOM challengesthis rationale. “One of the things thatstruck us in doing this was the very widerange of services that are already available,”said Nancy Adler, Ph.D., chair of the IOMpanel and vice chair of the psychiatry department at the University of California,San Francisco. “What we saw as the biggestlack is how to hook patients up with theseservices,” she said. The IOM defines psychosocial servicesbroadly, including not only those thataddress emotional problems, such asdepression, that can accompany a major ill-ness but also “life challenges” that preventgood health care. Examples include theinability to pay for care, lack of transporta-tion to medical appointments, and diffi-culty with daily activities such as bathingor preparing meals. The report lists morethan 100 national groups that offer free orlow-cost psychosocial services ranging frominformation and education to financialassistance, counseling, and emotional andlogistical support.“At first, [providing psychosocialservices] looked like a large hill toclimb—time, expense, the need tocreate a program,” said panel memberLee Schwartzberg, M.D., medical directorof the West Clinic in Memphis. “But infact you don’t have to create a program. We were happily surprised to find this.” The report does not speak only to clini-cians. It also includes recommendations foradvocacy groups, federal agencies, insurancecompanies and other payers, and nationalpolicy and professional groups. But providersget the most ink. “We focused on what hap-pens when patients are being seen,” Adlersaid. “That’s where it has to happen.”
Practical Details
The report offers detailed discussions of ways to integrate psychosocial services intoany clinic, including descriptions of the pro-cesses and resources at the practice level. Inaddition to the lists of national organiza-tions, there is detailed information on reim-bursement mechanisms and psychosocialscreening tools. Case studies feature com-munity practices of different sizes thatalready meet the proposed standard of care. The committee decided to go into suchdetail because many providers do notaddress psychosocial issues, despite evi-dence that psychosocial interventions canbe of benefit. For instance, a survey of the18 large cancer centers that belong to theNational Comprehensive Cancer Network found that only three offered psychosocialscreening, despite network guidelines rec-ommending screening. In another survey,33% of members of the American Society of Clinical Oncology said that they donot routinely screen cancer patients fordistress.One barrier is simply lack of awarenessthat psychosocial issues are truly integralto cancer care and can be addressed as partof routine care. “It’s a question of prioritiz-ing,” Schwartzberg said. “A lot of practicesmay pay attention to psychosocial issues onan ad hoc basis. It would be more efficientto do it in a more systematic way.” The IOM identified three different mod-els for providing psychosocial interventionssystematically, depending on a clinic’s sizeand resources. The most comprehensive
Most oncology practices can provide their patients withpsychosocial care, according to a recent report from theInstitute of Medicine.
“One of the things that struck us in doing this was the very wide range of services that are already available. What we saw as the biggest lack is how tohook patients up withthese services.”
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