Academic journal article Cognitie, Creier, Comportament

Clinical Practice Guide in Psycho-Oncology

Academic journal article Cognitie, Creier, Comportament

Clinical Practice Guide in Psycho-Oncology

Article excerpt


Patient care in the oncological system undergoes a major paradigm shift from disease management to a patient-centered approach, increasingly more attention being paid to psychosocial issues such as cancer distress, quality of life, patients' rights and empowerment, co-morbidities and survival. Negative phenomena in the life of cancer patients amplify each other, generating overlapping effects with a strong psychosocial impact on the quality of life. The World Health Organization defines quality of life as the individuals' perception of their position in life in the context of culture and value systems in which they live and in relation to their goals, expectations, standards and concerns(WHOQOL, 1995). For cancer patients improving quality of life is as important as survival or the prolongation of life. Most psycho-oncology studies view quality of life as an independent prognostic factor of disease progression and survival odds (Di Maio & Perrone, 2003).

Psycho-oncological care is part of an integrative evidence-based approach addressing the psychosocial needs of the cancer patient. "Cancer care for the whole patient" is an interdisciplinary approach including psycho-oncological interventions that is being centered on elements of strict particularity for each single case. Such typology actually gives the measure of therapeutic effectiveness (Bultz & Carlson, 2005)

As part of interdisciplinary medicine, psycho-oncology demands communication and co-operation between medical and non-medical professionals, aiming to derive increased patient satisfaction by promoting patient empowerment and greater participation, responsibility indecision-making regarding the treatment and compliance to the therapeutic program.

There is growing evidence that a multidisciplinary approach improves the level of care provided to the oncology patient, exerting beneficial effects on the professionals of the multidisciplinary team as well. Among the benefits of a multidisciplinary approach to cancer patient care one can mention improvements made by development of a treatment plan in line with the patient's needs and implementation of evidence-based best practices, increased survival rate, better chances to receive care in line with clinical guidelines, including psychosocial support, increased access to information - particularly regarding psychosocial support, increased satisfaction regarding the level of care and, finally, professional development and improved emotional wellbeing on behalf of the professionals involved in the multidisciplinary team (Sainsbury, Haward, Round, Ricler, & Johnston, 1995; Gabel, Hilton, & Nathanson, 1997; Richardson, Thursfield, & Giles, 2000; Changet al., 2001; Hawardet al., 2003).

This guide is addressed to psychosocial specialists working with cancer patients. It aims to provide an easy to use guide in a simply to adopt form for every specialist.

At the moment there are a number of intervention protocols, particularly in the cognitive-behavioral paradigm, but one of the problems encountered in their implementation is due to their format (evaluation and psychological intervention meetings structured over a longer period of time) as such model is not readily appropriate in some medical interventions, more so in an oncological context (considering all the aspects implied by a crisis situation, i.e. preoperative or postoperative psycho-oncological intervention).

In designing and adapting this guide we considered the resources currently available in the Romanian medical system, recommendations of the psychooncology literature - psychosocial care standards recommended by the International Society of Psycho-Oncology (IPOS) in particular -, and our clinical experience in oncology.

We tried to conceive this guide in a manner designed to be useful for specialists with various levels of experience.

The first part of the guide refers to the definition and rationale of psychosocial care in oncology, the second addresses the communication process engaged with the cancer patient, while part three covers screening, psychosocial assessment and practical psycho-oncological interventions during each step of the curative oncological treatment, while part four provides final recommendations on psychosocial care. …

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