patients requires only that oncology providers have a mechanism for identifying patients with psychosocial needs; knowledge of a few key organizations providing a wide array of psychosocial health services to individuals with many different types of cancer (e.g., NCI’s Cancer Information Service, ACS, CancerCare, the Lance Armstrong Foundation, and The Wellness Community); a way to support patients in accessing these resources by telephone or Internet; and a process for follow-up to ensure that patients accessed the services and that the services met their psychosocial health needs. Following is a discussion of how an organization with limited internal and local resources could address psychosocial needs following the model put forth in Chapter 4. This approach may not always be able to meet all psychosocial health needs; for example, some of the needed services, such as assistance with activities of daily living and chores, may not be available remotely. Nonetheless, this should not prevent providers from directing patients to remote resources that can meet as many of their needs as possible.

Implementation of the Use of Remote Resources

Clinical practices with limited resources can set the stage for effective patient–provider communication and delivery of psychosocial health services by communicating with patients about psychosocial health services at the outset of care. This could be accomplished, for example, through a short “Letter to My Patients” given to all patients at their first visit.11 This letter could inform patients about the importance of communicating effectively and the relevance of psychological and social issues to their health and health care. Box 5-1 contains a sample letter that oncology practices could adapt to their own characteristics—for example, the extent to which a practice uses a team approach to care.

Practices could then use one of the low-tech approaches discussed in Chapter 4 that require few personnel and other resources to help identify patients with psychosocial health needs. The National Comprehensive Cancer Network’s (NCCN’s) Distress Thermometer, for example is a one-page screening tool, publicly available at no cost, that can be self-administered in less than a minute. This tool could be duplicated using an office copy machine and presented by clinical or administrative staff to all patients each time they come in for a visit along with other routine paperwork, such as insurance forms. When completed, the screening tool could be attached to the patient’s chart and reviewed by the clinician together with the patient during the visit. To the extent that a clinician’s evaluation of psychological

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11This letter could also be used by clinical practices with greater internal and community resources.



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