care that meets the standard for psychosocial care. These organizations should also continue their work on strengthening the patient side of the patient–provider partnership. The goals should be to enable patients to participate actively in their care by providing tools and training in how to obtain information, make decisions, solve problems, and communicate more effectively with their health care providers.

Finally, the organizational, financial, and size differences among cancer care practices may influence the strategies providers use to implement the standard of care. For example, the economics of collocation and care coordination is affected by the volume of cases. Local resources also influence the way in which care is organized.

The committee concluded that evidence is sufficient to establish a standard for the delivery of psychosocial health care to patients with cancer. At the same time, as discussed in Chapter 4, much of the research underpinning this recommendation comes from populations with diseases other than cancer, and evidence in support of the individual components of the model is of variable strength. Thus a large-scale, systematic program demonstrating and evaluating the effects of the implementation of the standard of psychosocial health care at various oncology sites (e.g., comprehensive cancer centers attached to medical centers, freestanding oncology practices, and smaller oncology practices located outside of urban areas) would provide useful information about different ways to implement the standard as a whole and its individual components more efficiently in oncology practices and the impact of doing so. Demonstrating the model of care in general medical practices would provide additional valuable information. Patients with cancer may not constitute the majority of the patients of such practices, and a demonstration could address how these practices could implement the standard of psychosocial care. For example, would such a practice adopt the standard only for patients with cancer, for patients with other complex conditions as well, or for all patients? Such a demonstration program would allow the model to be honed over time and generate additional examples of how it can be implemented efficiently and effectively.

Moreover, measuring such outcomes as reductions in unmet needs and levels of distress, adherence to treatments, and cost-effectiveness would make it possible to compare different approaches to implementing the standard. A demonstration also could document effects of and approaches for successful implementation of the standard among vulnerable groups, such as those with low socioeconomic status, ethnic minorities, those with low health literacy, older adults, and the socially isolated. In addition, such a demonstration could examine different models of reimbursement, reveal additional ways of implementing the standard in resource-rich and non-resource-rich environments, and test the feasibility and soundness of perfor-



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