Aims and Background:
Integrated psychosocial cancer care aims to improve 1) identification of psychosocial needs; 2) support for self-management of illness; 3) aligning patients more effectively to services); 4) coordination of care and systematic follow-up. This paper will briefly overview evidence regarding barriers to achieving these goals and examples from Australian health service-related psycho-oncology research.
Multicomponent intervention studies will be outlined that aimed to improve detection of psychosocial needs, coordination of care, building skills among “front-line” cancer clinicians, and improving patient access to self-management resources. Evaluation included service uptake and implementation using health service audit and activity data. Clinician perspectives on implementation were investigated using qualitative methods.
While barriers to implementation included a range of organisational and system factors, clinicians identify a range of clinical practice improvements and system gains from program implementation encompassing distress screening, clinician support and skill development in psychosocial care, coordination of care and attitudinal change. Conduct of such multifaceted health service research highlighted key challenges to implementation research in psycho-oncology.
Innovative models of integrated care and methods of implementation research in health services are necessary to address these gaps and barriers. Improved psychosocial outcomes requires health service research that attends to key patient, clinician and health system factors. Applicability to diverse geographic and socioeconomic settings of patient care is also necessary to overcome the well-recognised disparities in cancer care and outcomes.
Funding: Cancer Institute NSW, beyondblue