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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
Linking Patients to Psychosocial Health Services
Several mechanisms used to link patients with psychosocial health services delivered by health and human service providers have empirical support, although the strength of this support varies. These mechanisms include structured referral arrangements and formal agreements with external providers, case management, and collocation and clinical integration of services. Use of care/system navigators is also being studied for its effectiveness in linking patients with needed services.
Although referral to other organizational or individual providers is a common mechanism for linking individuals with psychosocial health services (see the models in Table 4-1, examples in Chapter 5, and services delivered by referred organizations in Tables 3-2 and 3-3 in Chapter 3), there has been little study of the general effectiveness of such referrals. Most studies of referral have addressed referrals between physicians. These and one Australian study of referrals of cancer patients to psychosocial services indicate high rates of failure to connect individuals to the referred providers, frequent failure of the referred individuals to accept the referred services, and failure to track the outcomes of referrals (Bickell and Young, 2001; Curry et al., 2002; Grimshaw et al., 2006). These findings are consistent with the low ranking accorded referral by others studying practices aimed at achieving care coordination (Friedmann et al., 2000) and the finding of low success of referral by itself in linking cancer patients to needed psychosocial health services in one study of health maintenance organizations (HMOs) (Eakin and Strycker, 2001). And oncology nurses participating in focus groups pertaining to the implementation of survivorship care plans stated that they do not typically have formalized mechanisms for making referrals to social work services (IOM, 2007). On the other hand, the high utilization of services provided by such organizations as the American Cancer Society (which do not themselves provide medical services and thus depend in part on referrals for their clients) indicates that referrals can successfully link patients to needed services.
The few studies of how to make referrals more effective in linking patients with needed services have addressed referrals from primary to specialty care. The results of these studies indicate that using structured referral forms and educating referrers are most likely to improve the referral process (Grimshaw et al., 2006). Having formal agreements in place with those to whom referrals are made can also help (Friedmann et al., 2000). Tracking or following up on the actual receipt of referred services in cancer care is also recommended (Bickell and Young, 2001; Curry et al., 2002).
Referring patients to external providers is likely to continue to be a