A diagnosis of cancer or another serious illness can challenge a person’s spiritual as well as physical and psychological well-being. During illness and recovery, patients and their families may explore ways to address these difficulties by seeking pastoral counselors—ministers who integrate religious resources with insights from the behavioral sciences—to assist them with coping. The American Association of Pastoral Counselors (AAPC) accredits pastoral counselor training programs and credentials individuals in the discipline. To become a certified pastoral counselor, a candidate must possess a bachelor’s, master’s, or doctoral degree in divinity; become ordained or recognized by identified faith groups; maintain an active relationship to a local religious community; complete a supervised self-reflective pastoral experience; spend 3 years in ministry; and complete an AAPC-approved Training Program in Pastoral Counseling. Pastoral counselors are then able to work with a state license (AAPC, 2005).
The above discussion indicates that there is likely inconsistency in the extent to which the educational curricula studied by predominantly medically focused health care providers address psychosocial health care (and conversely the extent to which the curricula studied by predominantly psychosocial health care providers address the effects of illness on psychosocial functioning). Confounding the ability to understand and redress this inconsistency are the limited information systems available to collect data on how educational standards are translated into hours or methods of instruction, the content of such instruction, or the resulting skills of the workforce. Therefore, it is not possible to know with any certainty the characteristics of the education these health care providers receive on psychosocial issues, or the actual competency in assessing and addressing psychosocial needs they develop as a result of their education.
As discussed in Chapters 1 and 4, however, there is compelling evidence that the psychosocial needs of patients are not being adequately identified (Passik et al., 1998; McDonald et al., 1999; Fallowfield et al., 2001; Keller et al., 2004; President’s Cancer Panel, 2004; Maly et al., 2005; Merckaert et al., 2005; USA Today et al., 2006; IOM, 2007). Also as discussed previously, a range of interrelated factors—including how work in clinical practices is designed and how incentives from payers and oversight organizations operate—can impede the health care workforce’s identification of psychosocial needs and delivery of psychosocial services. Yet limitations of the content and methods of professional education and training play a role as well. In addition to a possible underemphasis on psychosocial issues in