Most Oncology Nurses Unfamiliar with IOM Report on Caring for the Whole Patient

NEW ORLEANS—A 2007 report by the Institute of Medicine (IOM) concluded that psychosocial issues created or exacerbated by cancer are “palpable, important, and potentially crippling” but can be effectively addressed by services and interventions. The report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, also acknowledged that appropriate psychosocial care is the “exception rather than the rule in cancer care today,” and a study by the Oncology Nursing Society (ONS) bore this out.

The ONS research, presented at the annual meeting of the American Psychosocial Oncology Society, found that almost two thirds of oncology nurses were unfamiliar with the IOM report and its recommendations (Table 1), according to Tracy Gosselin, RN, MSN, AOCN, director of oncology services at Duke University Hospital, Durham, North Carolina.

“Although nurses may assess patients’ needs, multiple barriers pertaining to individuals and institutions still exist related to communication, knowledge of IOM recommendations, and resources,” Gosselin said. “These barriers may impair their ability to provide the necessary psychosocial care to patients and their families.”

The web-based survey was developed by the ONS Psychosocial Project and the ONS Research Team. Questions were aligned with recommendations from the IOM report. The 34-item survey was pilot-tested on 76 ONS members, more than half of whom had a master’s degree in nursing and were advanced practice nurses.

The pool of candidates has since been expanded to 400 nurses, but the presentation was based on the 76 in the pilot study.

Seventy-one percent were aged 45 to 59 years, 97% worked with adults, 56% worked in the outpatient setting, 31% worked in the inpatient setting, and 74% worked in frontline patient care.

Regarding their knowledge of the IOM report, 64% were “not at all” or “not very” familiar with the report, whereas only 34% were “somewhat” or “very” familiar with it, she reported.

It is important to note that only 12% reported that someone in their work setting had communicated or taken action based on the IOM recommendations. Forty-two percent had not taken action, and 41% were unsure if any action had been taken.

The responsibility for the provision of psychosocial health services typically fell to a social worker (43%), followed by a nurse (17%), an advanced practice nurse (17%), a behavioral health professional (9%), a physician (3%), a pastor or spiritual care counselor (3%), or another individual (7%).

The nurses used a variety of methods for assessing and identifying the psychosocial issues and needs of their patients, but discussion with the patient was by far the most common (Table 2). Thirty-six percent said they applied evidence-based resources for psychosocial care to their practices.

“They used a variety of assessments, but the best evidence for this is from the NCCN [National Comprehensive Cancer Network], which developed the Distress Thermometer. This incorporates symptomatology, spirituality, economics, transportation, and other elements of stress and coping. Only 13% were using this,” Gosselin pointed out.

Perhaps some of the insufficiency in psychosocial service can be attributed to the multiple barriers faced by healthcare providers, including lack of time at work (49%), lack of patient and family access to providers (41%), lack of insurance coverage or high cost of services (41%), and lack of community resources (29%), she added.

“The key barriers were related to having time to assess and provide these services, to lack of insurance coverage, and to access to suitable providers,” she noted. “We know that the bulk of cancer patients are not treated in academic medical centers like ours. If you are a rural healthcare provider, do you have someone to refer these patients to? This is another important issue.”

Only 20% cited a lack of experience in assessment or screening tools for distress as a barrier to the delivery of psychosocial care.

These results were incorporated into a 3-year plan that has been submitted to the ONS, which includes recommendations for advocacy, education, and research related to the integration of evidence-based practices into psychosocial care delivery.