Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare project)

Abstract

Our findings demonstrate that evidence-based interventions to improve the psychosocial care of people with cancer can be implemented in a diverse range of oncology wards. This requires the involvement and motivation of the entire staff of the ward, support by an expert team, and promotion by policymakers.

Feasibility of implementing the ‘Screening for Distress and Referral Need’ process in 23 Dutch hospitals

“…This suggests that hospitals and healthcare providers view SDRN as a substantial improvement to oncology patient care. This success rate is high compared to most reports of distress screening guideline implementation [22, 23], but in line with two others, who also used a pre-developed, detailed implementation strategy [25, 26], although different from ours.…”

“…However, automatic adoption of guidelines in the clinic is not guaranteed [20, 21]. With regard to distress screening guidelines, healthcare professionals’ uptake and compliance to recommendations seems to be slow and problematic [22, 23], although progress has also been reported [24], particularly when a systematic implementation trajectory supported the implementation process [25, 26]. …”

Integrating Psychosocial Care into Routine Cancer Care

“…33 The other example is a project that evaluated the feasibility of a quality improvement strategy for integrating psychosocial care at 27 medical centers in Italy. 35 The strategy relied on context analysis and problem solving to facilitate implementation and involved 4 to 6 visits conducted in each center by the project team to assist clinic staff in identifying obstacles, finding solutions, and strengthening motivation to carry out recommended changes. Following an implementation period, the authors assessed adherence to each of the 6 recommendations and considered the objective to be met if the center's adherence percentage was at least 75%.…”

“…Following an implementation period, the authors assessed adherence to each of the 6 recommendations and considered the objective to be met if the center's adherence percentage was at least 75%. 35 Implementation was generally successful, as indicated by the relatively few centers with adherence rates that fell below this criterion for each of the following 6 recommendations: clinician participation in communication skills training (1 center), provision of a question prompt list to each patient (7 centers), assignment of a specialist nurse to each patient (2 centers), completion of at least 1 psychosocial distress screening for each patient (3 centers), completion of at least 1 social need screening for each patient (3 centers), and an offer to visit an information and support center for each patient (3 centers). 35 Although these results are promising, the participating medical centers were primarily leading centers of excellence, the sustainability of these outcomes was not assessed, and the evidence of improvement was limited to process indicators and not outcome indicators of quality (eg, patient psychological well-being).…”

“…2,33 Additional reports have provided more in-depth descriptions of efforts to implement distress screening and psychosocial referral and the acceptability and impact on processes of care in those efforts. [28][29][30][31][32]35 Work in this area would also benefit from published findings from rigorously designed, quality improvement projects designed to document the processes used to improve psychosocial care and the outcomes achieved, including the impact on patient quality of life. Such studies should also consider relevant conceptual frameworks such as the PRECEDE-PROCEED model, which focuses on identifying and influencing predisposing, enabling, and reinforcing factors for implementing changes.…”