12. Quality Assurance – Psycho-oncology

Currently, the designation „Psycho-oncology“ is not yet regulated by law. In accordance with the principle of interdisciplinarity, various professional groups can be active in psycho-oncology. First and foremost, these include psychologists, physicians, social workers/social pedagogues and other health and social science professions.

Depending on the field of activity within psycho-oncology, the service providers must be qualified to perform the required tasks with regard to psycho-oncological diagnosis, counseling, and treatment in a quality-assured manner in accordance with current scientific knowledge.

Those working in psycho-oncology should be able to recognize specific psychosocial and psychological burdens in patients and, if a comorbid mental illness is suspected, to initiate specific assessment and treatment in consultation with an appropriate medical specialist/psychotherapist.

The basic qualification required for specific psycho-oncological work should be a degree in medicine, psychology or other subjects such as social work or education. In addition to the basic qualification, there should be specific psycho-oncological advanced training and continuing education certified by the German Cancer Society. 

The respective advanced training and continuing education requirements depend on the basic qualification and the type of psycho-oncological activities. For specific psycho-oncological activities such as the diagnosis and psychotherapeutic treatment of comorbid mental illnesses, a medical qualification (physician or psychology with psychotherapy) is required.

The advanced training and continuing education requirements for psychological/psycho-oncological activities in palliative care facilities are regulated in the S3 Guideline on Palliative Care (AWMF register number: 128-001OL) as well as in the "General Recommendations for the Establishment of Positions in Psychology in Hospice and Palliative Care“ from the DGP, Psychology Section.

Targeted training measures to promote communicative competence are a prerequisite for teaching basic communication skills to physicians and nurses working in oncology. These should be offered as part of the advanced training and continuing education. In addition, the competencies for conducting conversations with cancer patients and their relatives should be continuously improved and further developed [1186], [3].

For creative arts therapists working in psycho-oncology (music, dance, art therapists, etc.), a corresponding bachelor's or master's degree or in-service training that meets the quality standards of the respective trade and professional associations of the Bundesarbeitsgemeinschaft Künstlerischer Therapien (BAG-KT) is a prerequisite.

For palliative care facilities, there is no empirically based information on the required number of positions. Based on clinical experience, the General Recommendations of the Psychology Section of the German Society for Palliative Medicine recommend 0.05 psychology staff per bed for palliative stations and at least 0.5 psychology staff per bed for palliative medical services (inpatient or outpatient) [121]. In order to promote accessibility, cooperation, and therapeutic constancy, it is recommended that the corresponding staff members be integrated into a psycho-oncological team.

According to the S3 Guideline Palliative Medicine (AWMF Register Number: 128-001OL), depending on the respective hospital setting, it is possible to expand the palliative services by including creative arts therapists (e.g. art therapists, music therapists).

The psycho-oncological services in the respective facilities should be tailored to the specific distress situations and needs of the cancer patients and reflect the current state of scientific knowledge. The services must be clearly recognizable for patients with appropriate opening and consultation times (by telephone and in-person) as well as the named contact persons. For psychiatric emergencies, a corresponding emergency plan must be laid down in writing in all facilities. Information about the services offered should be provided through appropriate media such as flyers, websites, etc. In this context, care should be taken to ensure that the information is conveyed in a patient-friendly and easy-to-understand manner.

The processes of psycho-oncological diagnostics and interventions are documented in a quality manual in the quality management system of each facility.

The networking of psycho-oncological tasks is to be defined not only with regard to facility-internal processes but also with regard to external networking and collaboration.

For the internal networking of psycho-oncological specialists, an interdisciplinary exchange takes place in the respective facilities (hospital, rehabilitation clinic, outpatient facilities) through regular organizational meetings, case discussions or ward conferences. In case or ward meetings, in addition to the medical, nursing and psycho-oncological specialists, all those involved in the treatment of the patients, such as physiotherapists, social counselors or chaplains, should be included as needed. The objective is the mutual exchange of information, coordination and planning of psycho-oncological diagnostics, counseling and treatment. If psycho-oncological services are provided by external specialists in inpatient facilities, appropriate forms of information exchange and cooperation in the above sense should be established. In the certified centers, psycho-oncological specialists should take part on the tumor boards on an as-needed basis. 

The networking of inpatient and outpatient psycho-oncological services is an important task of psycho-oncological practice with regard to the provision of further psycho-oncological support and the continuity of care. Important cooperation and networking partners include the psycho-oncological services of the clinics, the outpatient psychosocial counseling centers, oncological specialized practices, established medical and psychological psychotherapists, and rehabilitation clinics. In addition, there should be close networking and cooperation with self-help organizations. All cooperation agreements should be documented in writing. 

Psycho-oncological services are to be recorded using documentation specific to the respective facility (hospital, rehabilitation clinic, outpatient facility). The documentation should contain a systematic baseline and progress documentation of the core features of the psycho-oncological interventions and should be maintained regularly. In this context, the data protection guidelines of the respective facilities must be observed with regard to the collection, storage and transmission of these data. The core features are:

• Indication for psycho-oncological care including psychosocial distress scores from screening
• Patient preference with regard to further offerings
• Type of diagnostics
• Type of intervention
• Duration and number of contacts
• Information on the outcome of counseling and treatment
• Type of end or further referral

A networking of the psychosocial data with the medical data must be ensured. It should be possible to provide statistical evaluations with corresponding key values on the psycho-oncological services at defined intervals (at least once a year).

Regular external supervision of psycho-oncological practices is an essential component of quality assurance in all areas of psycho-oncological care and must be provided in all facilities. It serves to optimize treatment, relieve and support psycho-oncology professionals, and prevent burnout. The frequency of supervision depends on the needs of the specialist staff in the respective institutions.

External supervision shall be supplemented by intervision; this cannot, however, replace external supervision.