Planning psychosocial care for cancer patients: if at first you don't succeed, shift your paradigm.

Concerned with our capacity to bridge the gap between patients' and families' psychosocial needs and the services provided, we developed a psychosocial intake and referral service. This paper will describe the lessons learned in trying to introduce an innovation whose time had not yet come and, after analyzing the outcome, to present a new approach to planning. The service was not approved and, on reflection, eight factors were identified as contributing to the failure of the service to reach fruition. In light of what we learned, we developed a new planning model that reflects planning as a circular, iterative process rather than as a linear process.

The impact of psychosocial need and needs resolution on quality of life in patients with brain tumors.

The diagnosis of cancer of the central nervous system (CNS) is often the diagnosis of an incurable, progressive disease with devastating effects on the physical, psychosocial, and cognitive functioning of patients. Because many of the treatment options are noncurative in nature, issues related to quality and quantity of life become paramount. The purpose of the authors' research was to explore the prevalence of psychosocial needs in this cancer population and to determine whether these needs and their resolution impact on quality of life (QOL). Telephone interviews were conducted with 75 patients in whom primary CNS cancer was diagnosed and who were able to pass the Mini-Mental Health Status Examination. Analysis of results indicated that the majority of patients (97.3%) had at least one concern; concerns over treatment side effects, controlling uncertainty, having a meaningful existence, self and body image, and family concerns were among the five most frequently cited need domains. Most patients (91.8%) received help. However, 75.3% reported needing additional help. The number of needs reported and the severity of fatigue most significantly impacted QOL. The study identified the needs and experiences of the patient with CNS cancer. Quality of life and needs assessment information can be used to screen patients for distress and to measure the outcome of medical and psychosocial care and ultimately to ease the burden of illness.

Identifying the psychosocial needs of individuals with cancer.

The diagnosis and treatment of cancer creates psychosocial needs that patients often find difficult to resolve. Because most need assessments do not reach beyond enumerating needs to examine barriers to needs resolution, existing social supports or patients' service preferences, we set out to develop a needs assessment inventory to meet these objectives. The first step was to identify need categories using a qualitative methodology. The aims of the research presented in this paper are to: (a) compare patients' and professional caregivers' identification of patients' psychosocial needs, (b) establish categories of psychosocial needs, and (c) verify the categories resulting from the analysis of the data. Twenty-seven need categories were identified. There was a lack of congruency between patients and hospital caregivers and between caregivers at the two cancer centres in the frequencies with which the need categories were cited. The incongruence underscores the importance of gathering information from more than one perspective.

Identifying the nonmedical concerns of patients with ocular melanoma.

1. The task of enhancing patients' quality of life begins with identifying their needs and concerns. This process requires a knowledge base of the needs, problems, and barriers patients face as they struggle with the physical, psychological, and social sequelae of cancer. 2. To enhance knowledge of the psychosocial consequences of ocular melanoma and to facilitate supportive care planning, a study was initiated to identify patients' needs arising from the symptom management and nonmedical concerns of these patients, barriers to resolving these needs, and patients' service preferences. 3. The results indicate that the expressed needs inventory and the scales measuring unexpressed needs represent a valid and reliable approach to needs assessment, and that this approach is able to identify the needs resulting from patients' symptom management and nonmedical concerns.

Improving ambulatory oncology nursing practice. An innovative educational approach.

To meet the educational needs of ambulatory oncology nurses, an innovative and flexible program was created at a major cancer institute in Canada. Utilizing adult learning principles, standards of nursing practice, and departmental goals, the Clinical Nurse Specialists and Clinical Teachers creatively approached the need for extensive education. Five site specific educational workshops were provided to the nursing staff utilizing a self-directed learning style to capture the varied experiences, educational background, and motivations of the staff. This paper highlights the necessary program elements, implementation of, and evaluation of the educational program.