disorder, or mood disorder) to ensure an adequate effect size. Studies also are needed that compare one drug with another and with the drug plus a psychosocial intervention.

More multisite research on services targeting children is needed as well. Because cancer in children is rare, most research involves small samples, limiting the conclusions that can be drawn (Patenaude and Kupst, 2005).

Research testing the effects of the receipt of psychosocial health services on physiological and clinical outcomes also could help build the conceptual framework underpinning those services, and point to new interventions and ways to target services and interventions to those who are most vulnerable (Patenaude and Kupst, 2005; Thacker et al., 2007). Such research should address, for example, the links between certain types of stress and immune system functioning and the effects of psychosocial supports on health, such as through changes in endocrine and immunological functioning and mediating physiological pathways.

Health Services Research

Health services research could help identify better ways of implementing some of the interventions necessary for the delivery of psychosocial health services. This research could be accomplished through the large-scale demonstration program recommended in Chapter 5 that would test various approaches to the effective provision of psychosocial health care in accordance with the standard of care set forth in this report. Health services research could also address how to implement components of the model described in Chapter 4 more efficiently and effectively, focusing in particular on methods for improving the patient–provider partnership, the development of better screening and needs assessment tools, comprehensive illness and wellness management interventions, approaches for effectively linking patients with services and coordinating care, and reimbursement arrangements that would support these interventions.

Methods for Improving the Patient–Provider Partnership

As discussed in Chapters 3 and 4, tools and approaches are needed to improve communication between patients and providers and to support patient decision making in the face of a large volume of complex information. Research is needed to develop such tools and approaches for populations at greatest risk (e.g., older adults; those of lower socioeconomic status; and those with comorbid conditions, including psychosocial distress and decreased cognition).

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