Characteristics and Outcomes of Psychology Referrals in a Palliative Care Department

Ann-Yi, Sujin; Bruera, Éduardo; Wu, Jimin; Liu, Diane D.; Agosta, Monica T.; Williams, Janet L.; Balankari, Vishidha Reddy; Carmack, Cindy L.

doi:10.1016/j.jpainsymman.2018.05.022

Cited by 25 publications

(23 citation statements)

References 31 publications

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“…In order to address these barriers, integrating psychosocial services into oncology care rather than it being presented as an optional and separate service may be essential. This is the current practice in palliative care at our institution, with high psychology service utilization in our inpatient and outpatient setting . Our intervention did not include psychoeducation to explain potential benefits of psychology services, which may impact acceptance, perception, and satisfaction of psychology services and should be considered in future studies.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were eligible if they were 18 years or older, proficient in English, had a diagnosis of advanced cancer defined as locally advanced, recurrent, or metastatic, and were of normal cognitive status as determined by the study recruiter based on the ability to understand the nature of the study and consent process. Our Supportive Care Center provides counseling onsite in the clinic, usually on the same day as the medical appointment, referred by medical staff to either three master's level counselors at no cost or three billable psychologists, depending on patient distress level . Patients who had previously received psychological counseling from one of our mental health providers and/or those suffering from severe symptom distress as assessed by nursing staff during the appointment such that it would significantly interfere with participation were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Introducing psychology services to advanced cancer patients: A randomized double‐blind trial

et al. 2019

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Context: Psychology services utilization in cancer patients remains low due to barriers such as patient/caregiver acceptance of counseling. Objective:We aimed to determine if the manner of introducing psychology services impacted patients' acceptance of services and to identify factors associated with acceptance and barriers to psychology utilization. Methods:In this double-blind randomized cross-over trial, cancer patients with no prior psychology services observed two video vignettes: (a) physician introducing counselor and psychology services to the patient (PI) and (b) counselor introducing psychology services alone (CI). A counterbalanced design was used to control for order effects. After viewing both videos, patients completed a survey regarding preference, attitudes, and barriers for psychology services. Patients and investigators were blinded to the purpose of the study and content and order of videos, respectively. We hypothesized that patients would prefer physician introduction of counselor. Results:One hundred patients participated: 40 (40%) expressed no difference, 34 (34%) preferred PI, and 26 (26%) preferred CI (P > .2). Younger patients (less than 40 years) either preferred PI (86%) or had no preference (14%, P = .01). Most reported awareness of available psychology services (N = 63), and half (N = 50) were offered psychology services by their physician. Only 40 (40%) and 43 (43%) patients felt psychology services would be helpful for them and their family/caregivers, respectively. Patients who perceived psychology as helpful for self or family had higher anxiety (P = .01 and P = .006, respectively). Conclusions:No significant difference was found in patient preference of introducing psychology services except in patients less than 40 years old who preferred PI.Psychological distress occurs in 25% to 35% of cancer patients. [1][2][3][4][5][6] Approximately 50% of patients who develop advanced cancer meet criteria for a psychiatric disorder, which includes adjustment disorders. 7 Furthermore, psychological distress may play a mediating effect between physical symptoms and suffering. 8 Psychological and adjustment issues have been shown to contribute as high as 64% of the variance in suffering. 9Psychological interventions can provide effective treatment options to reduce distress and improve adjustment and coping for cancer patients at all disease stages, 10-13 including those with advanced disease. 14,15 Unfortunately, despite significant distress rates and empirical support for psychosocial services, the availability and utilization continues to be low. In a study of women receiving cancer care at an urban medical center, only 12% of low-income women with breast or gynecologic cancer who met criteria for major depression were being treated with psychotropic medications, and only 5% were participating in either counseling or a support group. 16 Similarly, in a series of studies with lung cancer patients, there was a significantly lower proportion of psychology and mental health service use compar...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Introducing psychology services to advanced cancer patients: A randomized double‐blind trial

et al. 2019

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“…Thus, comprehensive palliative care integrates psychosocial treatment. Trained mental health providers can not only encourage expression of emotions but also, when indicated, use sophisticated evidenced‐based approaches, including cognitive behavioral therapy and acceptance and commitment therapy, to address clinically significant distress . An interdisciplinary team approach enhances patient care and supports the medical team in challenging cases with regard to patients and families so that neither physical symptoms nor emotional suffering is neglected …”

Section: Introductionmentioning

confidence: 99%

Enhancing palliative care patient access to psychological counseling through outreach telehealth services

et al. 2019

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Context: Palliative care encompasses an interdisciplinary team, including mental health care professionals, to address psychological distress of cancer patients. Objectives:To present the implementation of an outreach counseling program via videoconferencing or telephone to patients receiving care in an outpatient palliative care clinic and to compare patients using this service to those who only received psychological counseling in our outpatient clinic. Methods:We conducted a retrospective chart review of cancer patients seen for psychology counseling services in an outpatient supportive care center between June 2015 and March 2017. Results:We reviewed 2072 unique patients (52% of the total patients seen at the outpatient Supportive Care Center), who had 4567 total counseling encounters across outreach and outpatient settings. A total of 452 (22%) patients participated in a combination of outpatient and outreach counseling services. Patients who participated in outreach services had significantly more encounters (311 [69%] had two to five sessions) compared with those who had outpatient services only (1137 [70%] had one session only) (P < .001). Outreach patients also had shorter times between the initial and follow-up encounters (median 14 days) compared with those who had outpatient services only (median 30 days) (P < .0001). Conclusions:Outreach telehealth counseling services was found to enhance palliative care patient access to psychological counseling. These services represent an additional modality for providing continuous psychological care. KEYWORDS cancer, counseling, oncology, outpatient palliative care, palliative care medicine, palliative care psychology, psychological distress in palliative care, psycho-oncology, supportive care, telemental health

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“…Palliative care is a holistic approach of care, which can be integrated early in the disease trajectory, alongside active, curative treatment, [1] and aims to alleviate physical and non-physical symptoms of patients and their families [2][3][4][5][6][7]. Though physical symptoms may be more easily identified by healthcare professionals, patients and carers, non-physical symptoms can equally disrupt the patient and family's quality of life and cause suffering [8]. In a recent rapid systematic review of randomised controlled trials looking at effectiveness of psychological interventions to improve quality of life in people with long term conditions, authors found that all 6 included studies significantly improved at least one quality of life outcome immediately post-intervention and were maintained at 12-months follow-up in one out of two studies for each of the short-(0-3 months), medium-(3-12 months), and long-term (≥ 12 months) [9].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent rapid systematic review of randomised controlled trials looking at effectiveness of psychological interventions to improve quality of life in people with long term conditions, authors found that all 6 included studies significantly improved at least one quality of life outcome immediately post-intervention and were maintained at 12-months follow-up in one out of two studies for each of the short-(0-3 months), medium-(3-12 months), and long-term (≥ 12 months) [9]. In another study, Ann-Yi S and colleagues report that 24% of palliative care in-patients and 19% of palliative care out patients in a major cancer centre benefited from psychology services [8]. Also, psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients [10].…”

Section: Introductionmentioning

confidence: 99%

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of a patient reported outcome measure – a multi-centre study

Antunes

Rodrigues

Higginson

et al. 2019

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Background: patients with palliative needs often experience high symptom burden which causes suffering to themselves and their families. Depression and psychological distress should not be considered a “normal event” in advanced disease patients and should be screened, diagnosed, acted on and followed-up. Evidence shows that psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients. A holistic, but short measure should be used for physical and non-physical needs assessment. The Integrated Palliative care Outcome Scale is one such measure. This work aims to determine palliative needs of patients and explore screening accuracy of two items pertaining to psychological needs. Methods: multi-centred observational study using convenience sampling. Data were collected in 9 Portuguese centres. Inclusion criteria: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness. Exclusion criteria: patient in distress, cognitively impaired. Descriptive statistics used for demographics. Receiving Operator Characteristics curves and Area Under the Curve for anxiety and depression discriminant properties against the Hospital Anxiety and Depression Scale. Results: 1703 individuals were screened between July 1st, 2015 and February 2016. A total of 135 (7.9%) were included. Main reason for exclusion was being healthy (75.2%). The primary care centre screened most individuals, as they have the highest rates of daily patients and the majority are healthy. Mean age is 66.8 years (SD 12.7), 58 (43%) are female. Most patients had a cancer diagnosis 109 (80.7%). Items scoring highest (=4) were: family or friends anxious or worried (36.3%); feeling anxious or worried about illness (13.3%); feeling depressed (9.6%). Using a cut-off score of 2/3, Area Under the Curve for depression and anxiety items were above 70%. Conclusions: main palliative needs were psychological, family related and spiritual. This suggests that clinical teams may better manage physical issues and there is room for improvement regarding non-physical needs. Using the Integrated Palliative care Outcome Scale systematically could aid clinical teams screening patients for distressing needs and track their progress in assisting patients and families with those issues. Trial Registration: Not applicable. This was not an intervention study.

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Characteristics and Outcomes of Psychology Referrals in a Palliative Care Department

Abstract: Palliative care psychology services successfully integrated into an interdisciplinary palliative care department and rapidly grew in both inpatient and outpatient settings.

Cited by 25 publications

References 31 publications

Introducing psychology services to advanced cancer patients: A randomized double‐blind trial

Introducing psychology services to advanced cancer patients: A randomized double‐blind trial

Enhancing palliative care patient access to psychological counseling through outreach telehealth services

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of a patient reported outcome measure – a multi-centre study

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