Wcmics service Development Project Funding 2006/07 Part 1 – Hospital / Health Services Final Report May-December 2007 Project Coordinator: dr Lauren williams project managers: marg d’arcy, professor Bruce mann and katy weare report written



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The Breast Service Psychosocial Model of Care Project


WCMICS Service Development Project Funding 2006/07

Part 1 – Hospital / Health Services

Final Report

May-December 2007

Project Coordinator: dr Lauren williams

project managers: marg d’arcy, professor Bruce mann and katy weare

report written by: Dr lauren williams. december 14, 2007


Contents

The Breast Service Psychosocial Model of Care Project 1

Contents 2

Tables 3

Acknowledgements 4

Project Overview 5

Background 5

Purpose 5

Project Objectives 6

Literature Review 7

Psychosocial concerns 7

Risk factors associated with psychosocial distress 8

Psychosocial care 8

Staff Consultations 12

1. Assessing Psychosocial Concerns: Use of the Supportive Care Tool 13

2. Delivering effective Psychosocial Care: Referrals and Staff Training Needs 14

2.1 Referrals 14

2.2 Staff Education 14

3. Psychosocial needs of women experiencing breast cancer 14

4. Other 15

Summary 15

Consumer Perceptions: Patient Interviews and Focus Groups 16

Method 16

Participants 16

Materials 16

Procedure 16

Results and Discussion 17

The Breast Service 17

Supportive Professionals 17

Sensitivity and communication from medical staff 18

Settings 18

Tangible Support 19

Psychosocial and psychological concerns 19

Psychosocial Well-being 20

Optimism, resilience and distraction 20

Faith in medical staff 21

Assessing psychosocial distress: The SCT 21

Psychosocial support: Professional, community, family, peer and individual 22

Professional psychosocial support 22

Community, family and peer psychosocial support 22

“I’m not a group person”: Individual supports 23

Suggestions for alternative supports 23

Summary 24

Action, recommendations and future directions 24

The Breast Service Recommended Pathway for Psychosocial Support 27

References 29

Expenditure Report 31



Tables


Table 1: Overview of psychosocial issues experienced by women diagnosed with breast cancer 10

Table 2: Psychosocial risk factors associated with psychological distress and barriers to support uptake 11

Table 4 Summary of patient demographics 16

Table 5 Mode of participation 17

Table 6: Summary of main themes 24

Table 7: Staff consultations results 25

Table 8 Issues with the SCT identified by staff and patients 26

Table 8: The Breast Service Psychosocial Model of Care 28

Acknowledgements


This project has been generously funded by Western & Central Melbourne Integrated Cancer Service.

Both the RWH and the RMH are part of the Western & Central Melbourne Integrated Cancer Service (WCMICS). Integrated Cancer Services are funded by the Victorian Department of Human Services to implement the Victorian Government's Cancer Services Framework across Victoria. The WCMICS extends from central Melbourne to Werribee working through its seven public constituent hospitals including the Royal Women’s and Royal Melbourne Hospitals. WCMICS also has broader involvement with private hospital services, GP services, community based health and palliative care services and community, consumer and carer support and self-help groups. The objectives of WCMICS are to:

Meet the needs of people with cancer living within its geographic area, as well as in other metropolitan and regional ICS who use WCMICS services; and,

Enhance integration and coordination of cancer services within its area, including the development of clear and formal communication processes, referral patterns and relationships between its primary, secondary and tertiary services as well as with other ICS services.

The Psychosocial Model of Care Project team would like to thank WCMICS for its support in enabling the opportunity to improve the quality of psychosocial care to women with breast cancer.

The Psychosocial Model of Care Project team would also like to thank the following individuals and organisations.


  • Staff from Royal Women’s Hospital and Royal Melbourne Hospital who participated in the ‘staff consultations’ phase of the project.

  • Women attending The Breast Service who generously donated their time and thoughts in the focus groups and interviews.

  • BreaCan for their information and support.

  • Michelle Fleming, WCMICS, for her support.

Note: This report is best read in conjunction with the Royal Women’s Hospital and Royal Melbourne Hospital Current Breast Care Service Profile and Model of Care. (2007).

Project Overview

Background

Recently, the Royal Women’s Hospital and Royal Melbourne Hospital breast services merged to create The Breast Service in an attempt to create a centre of excellence for breast services in Victoria. In the near future (June 2008) the Royal Women’s Hospital will relocate next door to the Royal Melbourne Hospital which will enhance the ability to effectively implement coordinated and integrated psychosocial care within a single service across two sites. Currently, a large proportion of the psychosocial care coordination is managed by Breast Care Nurses. Other health professionals also play a vital role in assessing and managing the psychosocial needs of women diagnosed with breast cancer. The referral pathway to other health professionals and support services, has been found to be inconsistent which has been shown1 to lead to some women receiving too much or too little support. Another component of the timely and effective delivery of psychosocial care is appropriate staff education on service availability, communication skills and referral procedures. In this case it is important to acknowledge the information requirements for clinical staff to enhance their ability to detect indicators of distress and/or anxiety to make appropriate referrals. Input from consumers can inform the current psychosocial model of care so that service provision more accurately meets their needs. Moreover, validation of consumer identified timelines of psychosocial care needs is also required to adequately inform the project and enhance project outcomes. This is enhanced by the need to further understand barriers to consumer referral uptake and multidisciplinary liaison of consumer behaviours. Finally, the evidence-based foundation for psychosocial care is essential in building a psychosocial model of care that satisfies both staff and patients.

Purpose


The aim of the psychosocial model of care2 project was to develop, implement and evaluate a multidisciplinary model of psychosocial care. It has been consistently identified that women diagnosed with breast cancer will experience psychosocial distress at various stages along the disease trajectory. Based on the supportive care model, the psychosocial model of care project will illustrate that the variety and level of intervention required at each stage of the disease is specific to the individual. An assessment of psychosocial distress is applicable to all women diagnosed with breast cancer, and includes both rural and urban women and those from different socio-economic, culturally and linguistically diverse backgrounds. Consequently, psychosocial care has been identified as a key area where The Breast Service can improve its quality of care. The commencement of the multidisciplinary psychosocial team and implementation of a psychosocial screening tool for use within The Breast Service has enhanced coordination of and access to clinicians with expertise to address patients psychosocial needs. Given that The Breast Service is still in its infancy, the current project will enable further investigation of the changes made to The Breast Service from both a consumer and health professional perspective. The purpose of the Psychosocial Model of Care Project is to evaluate and validate, and where applicable alter The Breast Service’s current multidisciplinary psychosocial care model.

Project Objectives

The objectives of the Psychosocial Model of Care Project were to:

Provide a brief literature review of the psychosocial issues faced by women diagnosed with breast cancer, the risk factors associated with psychosocial distress, the support services and programs developed to assist women with breast cancer and the NHMRC clinical practice guidelines for the psychosocial care of adults with cancer.

Provide an accurate reflection of the current psychosocial model of care from relevant stakeholders. Relevant stakeholders include:


  • Medical staff and breast care nurses

  • Social Work

  • Pastoral Care

  • Psychology

  • Psychiatry

  • BreaCan

  • Psychosocial Working Group3

Provide an updated and accurate reflection from consumers regarding:

  • Their psychosocial needs.

  • The level of psychosocial support they received from The Breast Service.

  • How the psychosocial support assisted them with coping with breast cancer.

  • Whether women felt comfortable discussing their psychosocial needs with members from The Breast Service.

  • Whether there was any psychosocial support they would have liked to receive and did not, including issues or barriers to support service uptake.

  • Their opinions on the structure and delivery of the current psychosocial model of care from The Breast Service. This includes feedback on the delivery of the psychosocial assessment tool (applicability and timeliness).

Evaluation of the use of the Supportive Care Tool (SCT) (psychosocial screening tool), a review of referrals, service usage and documentation procedures.

Clear identification of issues based on consumer and health professionals reports and patient file audit.

Recommendations and/or revisions to the current psychosocial model of care including suggested prioritisation of findings.


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