Exploring the role of psychosocial care in value-based oncology: Results from a survey of 3000 cancer patients and survivors.

PURPOSE: To explore the psychosocial needs of cancer patients and survivors across the United States and their implications for value-based oncology. DESIGN: A secondary analysis of findings from a cross-sectional national online survey. SAMPLE: Respondents were sampled and stratified by cancer type and geographic region to approximate the cancer-affected population of the United States. Breast, prostate, and colorectal were the most common cancers reported. Across surveys, the majority of respondents were female (57%), over 55 (60%), and white (70%) and had at least some college (36%). METHODS: Six online surveys were administered to cohorts of approximately 500 unique cancer patients and survivors. Survey topics included: (1) diagnosis, (2) treatment planning, (3) communication with providers, (4) insurance and financial concerns, (5) quality of life, side effects, and symptoms, and (6) survivorship and end-of-life. Descriptive analyses were used to explore psychosocial needs and experiences across three domains of patient-centered value in oncology. FINDINGS: Each survey received 500-527 responses. Respondents most commonly reported needing more information regarding their insurance coverage and out-of-pocket costs (65%), access to clinical trials (89%), and support organizations (45%). Forty-one percent were very or extremely distressed about cancer's impact on their ability to work and over 25% reported high-levels of cancer-related financial hardship. CONCLUSIONS: Patients and survivors reported significant unmet informational needs, financial hardship, distress, and symptoms or treatment side effects that interfered with daily life. Implications for Psychosocial Providers or Policy: Providers and payment reform advocates can improve value in oncology by ensuring access to comprehensive psychosocial care and informational support.

The Mount Sinai international enhancement of social work leadership program: The past and the future.

Developed in 1988, the Mount Sinai International Enhancement of Social Work Leadership Program brings 4-6 social workers from several countries each year to the Mount Sinai Hospital in New York City, where they meet with leaders from the hospital, community based organizations and graduate schools of social work, to enhance their leadership ability, strengthen management and research skills, and build upon global social work relationships. This article reviews the results of a survey conducted in 2016 to assess whether the visiting scholars met established learning objectives of the Program. Survey outcomes, presented in quantitative and qualitative terms, show positive results, and the scholars reported that the Program was extremely beneficial. The Program is viewed through the lens of two select adult learning theories: Social Learning Theory, which incorporates collaboration and learning from others, and Transformative Learning Theory, which is comprised of self-reflection and individualized learning. The inclusion of these theories in the implementation of the Program will be discussed. An analysis of the survey's outcomes, through pre- and post-Program participation and learning, facilitates assessment of potential programmatic adjustments to help evaluate long-term viability of the Program and potential duplication by other academic medical centers.

The characteristics of oncology social work in Australia: Implications for workforce planning in integrated cancer care.

AIMS: To describe the demographics, professional characteristics, self-reported professional development needs and research involvement of oncology social workers in Australia and to describe perceived barriers to provision of quality psychosocial care. METHODS: A cross-sectional online survey was administered to social workers working in the oncology field who were contacted through three professional organizations; the Australian Association of Social Workers, Oncology Social Work Australia and the Psycho-oncology Co-operative Research Group, the University of Sydney. A snowball recruitment method was adopted to maximize the sample size. RESULTS: Two thirds of respondents had over 10 years professional practice experience but with lesser experience in oncology settings. Twenty-eight percent had post-graduate qualifications. Professional development needs were reported as moderate or high by 68% of respondents. No association between professional needs and work setting was found. Years of experience in oncology practice and living in an urban area increased the likelihood of involvement in research. Barriers to psychosocial care included poor understandings of the social work role, time constraints and an inadequate number of social work positions. CONCLUSION: In this first Australian study of the social work oncology workforce, the results demonstrated active, well-qualified and experienced social workers providing frontline services to people with cancer and their caregivers in geographically diverse locations across Australia. Inadequate resources and a lack of integrated psychosocial care were identified as barriers to comprehensive cancer care. The need for Aboriginal and Torres Strait Islander social workers was identified as an urgent workforce priority.

Woman to woman: a peer to peer support program for women with gynecologic cancer.

Gynecologic cancer has significant emotional and psychosocial implications for patients and their families. This article describes the origin and implementation of a peer to peer support program providing emotional support and information to women in treatment for gynecologic cancer and their families, in collaboration with medical and social work staff in a large, urban medical center. A formative evaluation of the program is included which suggests program participants view the program as a helpful source of support throughout treatment.

Encouraging self-management in chronically ill patients with co-morbid symptoms of depression and anxiety: an emergency department study and response.

The complex interrelationship between depressive disorders and chronic disease has significant implications for both chronic disease management and the treatment of depression. In this article, the results of a mixed method, clinical data-mining (CDM) study ( Epstein, 2010 ) were combined with an original survey of Emergency Department staff, to design a program of intervention that targets patients with chronic illness, presenting to an Australian Acute-Care Hospital.

Maternal mental health: pathways of care for women experiencing mental health issues during pregnancy.

Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study ( Epstein, 2010 ) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported ( Buist et al., 2002 ), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy ( Vilder, 2006 ) and suggest the need for change to systems that work to support women's perinatal mental health.

Family predictors of psychosocial outcomes among Hong Kong Chinese cancer patients in palliative care: living and dying with the "support paradox".

A good death is universally desired. For Chinese patients, the family is believed to play a key role in making this possible. This study aims at exploring the relationship of family-related factors and psychosocial outcomes among Hong Kong Chinese cancer patients in palliative care. Clinical data mining was adopted as the research method. Nurses collected data from clinical interviews with incoming palliative care patients. A total of 935 patients from three years of deceased patient records was included. Stepwise regression analysis demonstrated that "caregivers" support and acceptance" predicted fewer psychosocial symptoms of patients, whereas "depressed family response to patient's illness" and "family anxiety" predicted a greater number of psychosocial symptoms of patients upon their admission to palliative care. The findings suggested two possible pathways toward enhancing the psychosocial experience of dying patients, that is, the 'family support pathway" and the "familial-altruistic pathway." Further reflections on the findings may suggest that these patients may be situated in a "support paradox, "in which they desire family support but also worry about the burden that support places on family members. Implications for practice were discussed in the cultural context.

Promoting harmony where there is commonly conflict: evidence-informed practice as an integrative strategy.

This article identifies dualisms in the continuing and sometimes acrimonious discourse concerning the relationship between social work practice and research. In so doing, it describes the epistemological assumptions of and differences between evidence-based practice, research-based practice, practice-based research, and reflective practice. In the spirit of the Hong Kong conference, the author extends McNeill's concept of "evidence-informed practice" to suggest a more inclusive and harmonious conception of practice-research integration. The article concludes by considering what such a model might look like.

Caregivers and professionals partnership caregiver resource center: assessing a hospital support program for family caregivers.

BACKGROUND: Given that 71% of caregivers nationally report that they are caring for someone with a long-term or chronic illness, providing support to families-from diagnosis to the bereavement phase--is essential. PURPOSE: This paper describes an exploratory assessment of a hospital-based support program for family caregivers, the Caregivers and Professionals Partnership (CAPP) Caregiver Resource Center. The goal of the program evaluation was to understand the challenges facing caregivers who used the Center, how social workers intervened and the results of their interventions. Authors suggest that caregivers benefit from social work interventions that focus both on the emotional impact of caregiving and the multiple resource issues caregivers face. METHODS: Social workers assisted more than half of participating caregivers with emotional coping issues as well as referrals to community resources. In approximately 75% of cases, social workers followed up with caregivers to engage them in services and ensure that they received ongoing support. FINDINGS: From the perspective of Resource Center social workers, their interventions enhanced caregivers' abilities to cope with their responsibilities. CONCLUSIONS: Supporting caregivers over time and following up to ensure that they access needed services are critical ways to help them cope with care of a loved one. Future research can focus on how to engage caregivers who are isolated or too overwhelmed to ask for help in order to increase their use of caregiver assistance programs.

Following in the footnotes of giants: citation analysis and its discontents.

Reflecting on his own personal history with bibliometrics, the author places it in the broader context of research with available information and data-mining. In so doing, he considers the utility of bibliometrics for raising new questions and its limitations for guiding decision-making.

Evaluating multidisciplinary child abuse and neglect teams: a research agenda.

A review of child welfare research literature reveals used to investigate and intervene in child abuse and neglect cases, the field does not know enough about their structural variations, implementation processes, or effectiveness. Moreover, although articles advocating multidisciplinary teams enumerate their apparent strengths, they lack attention to the teams' possible weaknesses. The article discusses implications for future evaluation studies.

Screening risks for intimate partner violence and primary care settings: implications for future abuse.

Most health care intervention models for intimate partner violence (IPV) are crisis driven and targeted to survivors of injury following episodes of physical violence. Knowledge about anticipatory and preventive approaches with women who are at risk for abuse is scarce, limiting professionals' ability to respond fully and effectively to this problem. This paper describes a retrospective, practice-based research study of social work interventions in two hospital-based primary care practices. A total of 431 female patients completed a self-administered questionnaire developed for the early detection of IPV risk factors during routine health care visits. The study showed surprisingly high rates of multiple risk markers in an urban primary care population whose medical presentations ordinarily would not raise provider suspicion about abuse. Findings confirmed the willingness of primary care populations to freely partake in routine screening and support the value of early identification and intervention with populations at risk. Practice implications are discussed.

A comparison of experts' perspectives on assertive community treatment and intensive case management.

This study compared experts' views on the critical ingredients of assertive community treatment and intensive case management. Twenty experts on assertive community treatment and 22 experts on intensive case management rated the importance of 40 elements common to each treatment approach. The assertive community treatment experts gave higher importance ratings than the intensive case management experts to 37 of the 40 items; for 21 of these items, the ratings were significantly higher. Differences in importance ratings were greatest for organizational and structural elements and smallest for treatment goals. The results of this study indicate that although intensive case management resembles assertive community treatment in most respects, assertive community treatment may be a more clearly articulated model overall.