covered, and the items included in similarly named domains (see Table 4-3). Reviewers also found a lack of evidence for the instruments’ sensitivity to change over time, failure to examine their required reading levels, and failure to address the period after initial treatment for cancer. Despite these deficiencies and the need for further research (see Chapter 8), results of the two systematic reviews that examined the use of needs assessment instruments when processes for follow-up on identified needs were implemented, as well as the reasonableness of needs assessment as a means of identifying individuals who need psychosocial health services, argue for the usefulness of the process as a prelude to the planning and provision of such services. This conclusion also is supported by the models for delivering psychosocial health services contained in Table 4-1.
Once psychosocial health needs have been identified, a plan should be developed that will assist the patient in managing his or her illness and maintaining the highest possible level of functioning and well-being. Nearly all of the models for delivering psychosocial health services reviewed by the committee (Table 4-1) identify care planning as a component of the intervention. This inclusion of planning may originate from (1) the long-standing practice of developing treatment or care plans as a part of routine medical, nursing, and other health care; (2) the logic of developing a plan for action before action is taken; and/or (3) the identification of care planning in some research as an essential to improving health care. Although care planning in itself has not been the subject of much health services research, some research identifies it as one ingredient in effective interventions to improve health care outcomes in adults with chronic illnesses (Chen et al., 2000; Stuck et al., 2002). Written plans developed jointly with the patient and containing clear goals are characteristic of care coordination initiatives that achieve reductions in hospital care and medical costs (Chen et al., 2000). Moreover, research has shown that people vary in their expression of the need for psychosocial support and in the types of support they prefer.
For these reasons, the committee believes that planning for the delivery of psychosocial health services is a logical step in meeting the need for such services. Advance planning is likely to facilitate the identification and implementation of interventions best suited to each patient’s individual situation and to conserve resources not useful to the patient. Such planning for psychosocial health services should address mechanisms needed to effectively (1) link the patient with the needed services, (2) support the patient in managing his or her illness and its consequences, and (3) coordinate psychosocial and biomedical health care.