Finally, the scope of work for this study included making recommendations for how to evaluate the impact of this report. The committee believes evaluation activities would be useful in promoting action on the preceding recommendations, and makes the following recommendation to that end.

Recommendation 10. Promoting uptake and monitoring progress. The National Cancer Institute/NIH should monitor progress toward improved delivery of psychosocial services in cancer care and report its findings on at least a biannual basis to oncology providers, consumer organizations, group purchasers and health plans, quality oversight organizations, and other stakeholders. These findings could be used to inform an evaluation of the impact of this report and each of its recommendations. Monitoring activities should make maximal use of existing data collection tools and activities.

Following are examples of the approaches that could be used for these monitoring efforts.

To determine the extent to which patients with cancer receive psychosocial services consistent with the standard of care and its implementation as set forth in recommendations 1 and 2, the Department of Health and Human Services (DHHS) could

• Conduct an annual, patient-level, process-of-care evaluation using a national sample and validated, reliable instruments, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) instruments.

• Add measures of the quality of psychosocial health care for patients (and families as feasible) to existing surveys, such as the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) and CAHPS.

• Conduct annual practice surveys to determine compliance with the standard of care.

• Monitor and document the emergence of performance reward initiatives (e.g., content on psychosocial care in requests for proposals [RFPs] and pay-for-performance initiatives that specifically include incentives for psychosocial care).

For recommendation 3 on patient and family education, DHHS could

• Routinely query patient education and advocacy organizations about their efforts to educate patients with cancer and their family caregivers about what to expect from, and how to request when



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