This blog is the first in a 2-part series reporting on ACCC’s Call to Action: Delivery of Psychosocial Care in Oncology Summit.
When a patient hears “you have cancer,” every facet of their life—physical, mental, emotional, social, financial—changes in an instant. Access to appropriate psychosocial support can help support a patient during their treatment journey. The American College of Surgeons Commission on Cancer (ACS COC) mandates psychosocial distress screening, referral, and follow-up in cancer programs, however service delivery models vary and are largely dependent on the availability of staffing and funding. This inconsistency, sometimes even within a hospital or system and at no fault of the providers, can have a large impact on patients and their ability to receive not only screenings but psychosocial services needed throughout their treatment.
Ever-increasing in the post-COVID-19 healthcare landscape, the need for psychosocial care in oncology has transcended the needs of patients with cancer and their families, as supportive care to address emotional distress and burnout is also urgently needed for cancer care professionals. Due to similar limiting factors that patients face – staffing, funding, time to seek services, insurance coverage, etc., cancer care professionals are struggling to find appropriate, consistent access to psychosocial and mental health support. The cancer care team also faces the ever-present stigma of seeking mental health services. In a recent ACCC podcast, Cancer Care Team Mental Health: Normalizing Helpers Seeking Help, Drs Christine Cha and Tricia Wooden discuss this important topic.
To explore the current state of psychosocial care in oncology, the Association of Community Cancer Centers (ACCC), with its partners, the Association of Oncology Social Work (AOSW), the American Psychosocial Oncology Society (APOS) and with support from BeiGene—held a multistakeholder meeting, ACCC’s Call to Action: Delivery of Psychosocial Care in Oncology Summit, on March 8, 2023, in Washington, DC. With collaboration from key leadership representatives of advocacy organizations, academic medical centers, and community care programs, the summit developed several priorities and actions to address barriers to access and delivery of psychosocial care in oncology. The ensuing discourse focused on answering these questions:
Summit participants identified diversity, equity, inclusion, and access as key priorities in advancing psychosocial care. In the near future, advocacy for healthcare payment models that include psychosocial care and clinical social work will be critical to overcoming one of the most critical obstacles to patient access to mental health care: funding.
Participants also stressed the importance of acknowledging the ways (directly and indirectly) that structural racism, implicit bias, and other inequities continue to impact care in diverse and underserved communities. Crucial to confronting these barriers will be forming partnerships with communities and advocacy groups to improve outreach efforts, increase cultural humility and competence in patient care and communication, and identify funding to support specialty training and scholarships for people from diverse backgrounds interested in joining the oncology workforce.
Recent years have seen a significant increase in policy discussions around the social determinants of health: the sociological factors that influence health outcomes. Summit participants acknowledged that additional collaboration on research into these determinants would play a significant role in increasing the influence and effectiveness of psychosocial care. Efforts to increase access to transportation, internet access, and childcare were identified as necessary to overcome barriers to accessing care. Additionally, there has been increasing dialogue around the role of patient navigation services in ensuring patients have access to psychosocial services.
No discussion of healthcare access can disregard financial barriers. Understanding this, summit participants identified several financial barriers to accessing care including cost transparency, especially for indirect costs, and inconsistent insurance coverage from state-to-state. In addition, participants recommended an enhanced focus on measuring the health-related outcomes of psychosocial care, to demonstrate impact and advocate for enhanced funding.
It is important that cancer programs and practices utilize opportunities to advocate for policies that drive patient access to psychosocial care. This includes but is not limited to continued access and increases for mental health coverage and reimbursement, and access to mental health services delivered via telehealth.
Currently, psychosocial distress screenings within the oncology landscape are inconsistent in quality and effectiveness measures. These screenings are generally reactive, i.e., flagging symptoms and barriers patients have already experienced. Shifting toward a model focused on proactive support would streamline care delivering—allowing patients and providers to efficiently access vital resources at the right time.
Such a paradigm shift should come as part of a broader collective rethinking of the goals and methodology for psychosocial screening. As a result, summit participants supported the standardization of screening tools and policies. Further, consistent guidelines for responding to screenings could provide clarity to overworked and under-resourced providers and allow for enhanced uniformity of outcome. This standardization could lead to greater uniform data collection and reporting of both needs and outcomes, while demonstrating the value of psychosocial screenings and care.
This summit marks the start of a movement to create real change in psychosocial care delivery in oncology. ACCC, AOSW, APOS, BeiGene, and summit attendees are motivated to follow through with their two Calls to Action—to promote collaborative care and integrative models and to develop standards for a culture of care. ACCC looks forward to engaging additional stakeholders as progress is made to ensure patients and providers receive and provide the appropriate psychosocial care patients with cancer need, while addressing logistical and operational challenges with an effective model of collaborative care.
The ACCC Psychosocial Care in Oncology Summit education program is supported by BeiGene.
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