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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
Review of Existing Definitions
“Psychosocial support” is identified by multiple parties as an essential component of quality cancer care (American Psychosocial Oncology Society, undated; National Breast Cancer Centre and National Cancer Control Initiative, 2003; IOM and NRC, 2004; President’s Cancer Panel, 2004; Association of Community Cancer Centers, 2006). However, there does not appear to be a commonly shared definition or listing of the various types of psychosocial services or a conceptual framework underpinning various definitions.
Psychosocial services literally could be interpreted as referring to all psychological (mental health, emotional issues) services, as well as all services needed to address adverse social conditions. However, several expert bodies explicitly identify several other dimensions of psychosocial needs/services. The Association of Community Cancer Centers (2006:25), for example, defines psychosocial oncology care (which it also refers to as “psychosocial distress management services”) as services “to address the psychological, emotional, spiritual, social, and practical aspects that patients and their families have as a consequence of cancer and its treatment [emphasis added].” The Institute of Medicine (IOM) report ImprovingPalliative Care for Cancer (IOM and NRC, 2001) also identifies spiritual, religious, and existential distress separately from psychosocial distress. Are spiritual, religious, and existential concerns mutually exclusive and conceptually different? Are “psychological” and “emotional” concerns? Should they and “practical concerns” be included separately as components of a definition of psychosocial services?
The IOM report Meeting Psychosocial Needs of Women with BreastCancer (IOM and NRC, 2004:70–71) presents “brief descriptions of the full range of psychosocial services [emphasis added].” However, it then discusses only “basic social and emotional support,” which “focuses on adjustment to diagnosis, apprehension regarding treatment, and existential concerns,” and psychoeducational approaches; cognitive and behavioral interventions, such as guided imagery, biofeedback, progressive muscle relaxation, and meditation; psychotherapeutic interventions, such as group therapy and counseling; pharmacological interventions; and complementary therapies, such as yoga and massage. It contains no discussion of social services addressing such practical concerns as transportation, child care, financial problems, work, or educational problems.
Australia’s Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer define a psychosocial intervention as “treatment that is intended to address psychological, social, and some spiritual needs [emphasis added]” but does not clarify which spiritual issues are and are not to