WASHINGTON – Chalk up one for the little guy: Community cancer programs are better equipped for delivering psychosocial support services than are National Cancer Institute–designated Cancer Programs, investigators contend.
A survey conducted by oncology social workers in 60 large and small cancer programs across North America reveals that significantly more community cancer centers have comprehensive systems in place for screening, assessing, and managing the psychosocial needs of patients with cancer, said Dr. Brad Zebrack from the University of Michigan School of Social Work in Ann Arbor.
Dr. Brad Zebrack
“We still have work to do in terms of monitoring quality of care on a systemwide level. There’s still room [for improvement in] educating providers about the value and the importance of psychosocial care, and a lot of work to do in overcoming the observed racial disparities that we’re seeing in the provision of care,” he said at the at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.
Dr. Zebrack reported results of APAQCC (“A Project to Assure Quality Cancer Care”), a multisite study looking at institutional capacity to provide psychosocial services as a function of patient, provider, and institutional characteristics.
The investigators enlisted the help of oncology social workers at 60 accredited cancer programs, including comprehensive cancer center programs, community cancer programs (CCPs), NCI-designated cancer programs (NCIPs), and nondesignated academic medical center–based programs. The social workers administered the 10-item NCI Psychosocial Matrix to a convenience sample of providers at their centers.
The matrix assesses capacity to provide psychosocial services on a scale of 1-5, with 1 signaling that no systematic process is in place, and 5 indicating optimal implementation. The matrix includes 10 items concerning provider-patient communications, patient-needs assessments, care planning and coordination, provider training and education, evaluation of service delivery and patient outcomes, and quality improvement.
A total of 2,491 professionals responded. The sample comprised primary- or mid-level providers, nurses, psychosocial care providers, ancillary care providers, and administrators or managers not directly involved in patient care.
They found that respondents from NCIPs consistently reported significantly lower levels of capacity. For example, 36% of NCIPs reported having multiple mechanisms and multiple opportunities for communicating to cancer patients and their families the importance of psychosocial needs and care, and 47% reported that they communicated about psychosocial care by at least one mechanism at least one time. In contrast, the respective percentages for CCPs were 46% and 51%. In all, 17% of NCIPs had a failing grade on communication, compared with just 3% of CCPs.
CCPs were also better at identifying psychosocial health needs of cancer patients (37% reported the highest level of assessments, and 34% reported at least screening and assessment, compared with 20% and 29% for NCIPs).
Continuity of psychosocial care, measured as the capacity to conduct follow-up, reevaluation, and adjustment of a psychosocial treatment plan, was also highest at CCPs and lowest at NCIPs (30% vs. 18%).
In an analysis of capacity by provider type, the authors found that hospitals with a greater than 30% racial minority population had significantly lower capacity to communicate the importance of psychosocial care (P less than .05). In an analysis by program type, NCIPs were also worse at communicating these ideas than other program types (P less than .05).
Their findings suggest that assessing institutional capacity, monitoring changes in services, and tracking patient outcomes will be required for improvement of the delivery of psychosocial services in cancer programs of all types, Dr. Zebrack said.
The study is supported by the Association of Oncology Social Work with an educational grant from Takeda Oncology. The authors reported having no conflicts of interest.