surgeons; radiologists; and other specialists, such as hematologists and urologists (see Table 5-1).1 As stated in Chapter 4, the committee believes that the delivery of psychosocial health services should occur from diagnosis through all stages of the illness, and therefore, the standard for delivering psychosocial health care articulated in Chapter 4 should guide the activities of all clinicians delivering cancer care. Nonetheless, as adult and pediatric oncologists are recognized specialists in the delivery of cancer care, they should lead the way in implementing this standard of care. This chapter focuses on how they can do so.

APPROACHES TO THE DELIVERY OF PSYCHOSOCIAL HEALTH SERVICES

As of 2005, an estimated 12,000 oncologists practiced in the United States in a variety of practice settings and arrangements, including teaching hospitals (33 percent), group practices (46 percent), solo practices (9 percent), and other arrangements. The majority of oncologists (56 percent) worked with nurse practitioners and physician assistants who provided patient education and counseling, pain and symptom management, followup care for patients in remission, and other activities as part of patient care (AAMC Center for Workforce Studies, 2007).

Oncology practices can take two general approaches to the delivery of psychosocial health services in accordance with the model and standard for care set forth in Chapter 4: (1) providing the needed services and interventions directly themselves by offering collocated, integrated psychosocial and biomedical health care, or (2) establishing effective linkages and coordination of care with other providers.2 This chapter describes and provides real-life examples of both approaches. Also described is a third approach, a potential variation on the second that involves the use of remote providers of psychosocial health services and can be employed in communities that lack substantial psychosocial health care resources.

Many organizations blend these approaches, collocating some psychosocial health services on site while coordinating and supplementing

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1The committee located no data describing how cancer care differs across these different settings of care.

2The committee recognizes that there are cases in which another party (e.g., another health care provider treating a serious comorbid condition or a designated intermediary, such as a disease management entity) also has responsibility for securing appropriate psychosocial health services. However, the committee does not distinguish this as a separate approach to implementing the model because coordination of care requires effective linkages among all parties involved, and because at present and for the foreseeable future, the committee believes that the dangers of too little attention to psychosocial problems outweigh the dangers of duplicative attention to those problems.



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