Academic journal article Health and Social Work

Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

Academic journal article Health and Social Work

Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

Article excerpt

A holistic approach to the evaluation and management of cancer patients has become well recognized in clinical oncology as an essential feature of patient-centered care (National Comprehensive Cancer Network, 2003). A comprehensive and multidisciplinary care plan, which supplements conventional cancer care with an added emphasis on the psychological, behavioral, and social aspects of illness, has been shown to positively affect a patient's overall wellness and quality of life (Institute of Medicine of the National Academies, 2010). This is especially important because of the prevalence of psychosocial distress in this population, affecting 30 percent to 43 percent of oncology patients in the ambulatory setting (Zabora, BrintzenhofeSzoc, Curbow, Hooker, & Piantadosi, 2001). Psychosocial distress is defined as "a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social, and/or spiritual nature" (National Comprehensive Cancer Network, 2009). Although psychosocial interventions, including those aimed at reducing distress, have been shown to improve quality of life in adult oncology patients (Rehse & Pukrop, 2003), cancer patients continue to underuse psychosocial services, with only a 14 percent acceptance rate (McDowell, Occhipinti, Ferguson, & Chambers, 2011). This underuse is attributable to a number of factors, including a lack of awareness that services are available, insufficient empowerment to seek out services, fear of associated stigmas, uncertainty regarding whether such resources would be helpful, and logistics such as time and transportation constraints (Eakin & Strycker, 2001; Holland, 2002).

In an analysis of sociodemographic, psychological, and illness-related factors in cancer patients, it has been demonstrated that female gender is an independent predictor of the need for psychosocial support (Ernstmann et al., 2009). In addition to the distress associated with cancer diagnosis and treatment, women with gynecologic malignancies face issues related to reduced reproductive ability and altered sexual function, which may threaten their sense of self and feelings of womanhood (Gilbert, Ussher, & Perz, 2011). This highlights the particular importance of developing methods to increase the awareness and use of psychosocial services by gynecologic oncology patients. Despite physicians' best efforts to provide supportive care, the assessment and management of psychosocial issues in gynecologic oncology patients remains inadequate (Chase, Monk, Wenzel, & Tewari, 2008).

In light of research indicating multiple patient--and provider-specific factors that may pose barriers to the evaluation and management of psychosocial well-being in cancer patients (Schofield, Carey, Bonevski, & Sanson-Fisher, 2006), various studies have explored methods to increase the rates of psychosocial service use. Approaches that have been studied include routine distress screening of all cancer patients, with referral for psychosocial services on detection of distress (Clark, Rochon, Brethwaite, & Edmiston, 2011; Lee, Katona, De Bono, & Lewis, 2010); education of health care staff in recognizing the signs and symptoms of distress, with subsequent implementation of formal distress screening and psychosocial service referral (Grassi et al., 2011); and offering a brief psychosocial intervention to all new oncology patients, independent of distress screening (Powell et al., 2008). It is notable that the majority of studies to date use some form of distress screening as a means of increasing psychosocial service usage. In addition, although several studies have evaluated the efficacy of interventions implemented by nurses and physicians, to our knowledge none have assessed a social worker-mediated approach (Preyde & Synnott, 2009). In this article, we report the results of a program featuring the introduction of psychosocial services to new gynecologic oncology outpatients by an oncology-trained licensed clinical social worker, independent of distress screening, and the effect of this program on the rate of referral for psychosocial services. …

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