4. Requirements for Psycho-oncological Care Settings – Psycho-oncology

The term palliative care covers inpatient and outpatient care services for cancer patients with incurable cancer and their relatives. This includes inpatient hospices, palliative care units as well as various forms of outpatient hospice work, palliative networks and specialized outpatient palliative care (SAPV). Palliative care focuses in particular on improving the quality of life of patients and their relatives with regard to physical as well as psychosocial and spiritual aspects during the last phase of life.

For palliative care units and palliative care services, the recommendations of the "Extended S3 Guideline Palliative Care for Patients with Non-curable Cancer" (AWMF Register Number: 128-001OL) apply. There, the overlap between the actions in palliative care and other support services, such as independent psycho-oncology services, are emphasized and close cooperation and mutual support are recommended.

Psychosocial professionals in palliative care are part of the core team. In hospitals, psycho-oncologists can be part of the psycho-oncology service as well as part of the palliative team and/or palliative services.

 

Due to the shortening of the length of inpatient stays, outpatient psycho-oncological care has an important task which can be ensured by various service providers:

• psycho-oncological support within the framework of psychosomatic primary care by general practitioners and specialists.
• practicing specialists for: psychiatry and psychotherapy, psychosomatic medicine and psychotherapy, neurology and neurological medicine as well as specialists working primarily in somatic medicine with the additional field of psychotherapy.
• practicing psychological psychotherapists
• psychosocial cancer counseling centers
• psycho-oncological outpatient clinics of hospitals / certified centers
• psycho-oncological care within the framework of outpatient rehabilitation
• psycho-oncological care within the framework of specialized oncological practices
• psycho-oncological support services in SAPV and inpatient hospices as well as in palliative outpatient clinics or day-clinic palliative medical care ("Extended S3 Guideline on Palliative Medicine for Patients with Non-curable Cancer" AWMF Register Number: 128-001OL).

General practitioners and specialists working primarily in somatic medicine offer basic psychosomatic care for cancer patients in the form of psychosomatic primary care. The aim is the early diagnostic clarification of the somatic, psychological and psychosocial aspects of the disease in the context of a comprehensive biopsychosocial diagnosis as well as a low-threshold psychosomatic treatment option with a time-defined scope.

Outpatient psycho-oncological care in the context of psychotherapeutic treatment of cancer patients within the health insurance scheme is mainly offered by psychological psychotherapists, followed by specialists in psychosomatic medicine and psychotherapy as well as specialists in psychiatry and psychotherapy [5]. After a comprehensive diagnosis – also within the framework of a psychotherapeutic consultation – a psychotherapeutic treatment or a guideline psychotherapy can be offered depending upon indication. Psychopharmacological treatment can also be provided by specialists for psychosomatic medicine and psychotherapy as well as specialists in psychiatry and psychotherapy, if indicated. In addition to the aforementioned specialists, specialists working primarily in somatic medicine with the additional title „Psychotherapy“ can also be involved in the psychotherapeutic care of cancer patients. 

Psychosocial cancer counseling centers serve as a contact point for psychosocial distress in connection with cancer and the resulting medical treatment [123]. The focus of counseling can be social problems, being overwhelmed by everyday life and questions about possible social benefits, as well as psychological distress and crises. The target groups are cancer patients and their family, especially partners and children, but also people close to them in their social environment. Advice is given to people of all ages and in all phases of the disease, including long-term survivors. Outreach counseling can be offered to immobile patients. In addition to continuous quality assurance, the central principles are the low-threshold nature of the counseling services, the fact that they are free of charge, the availability of services at short notice, as well as the complete absence of formal access restrictions (e.g., verification of eligibility requirements).

The services provided by cancer counseling centers are fundamentally aimed at helping patients overcome psychological and social problems and crises, filling information deficits, and strengthening patient competence and individual psychological coping skills. Early psychosocial counseling can have a preventive effect on the development of mental disorders. Other important goals are:

• the development of social/social welfare assistance and care services as well as referral to further care services, such as self-help groups, specialists, psychotherapists, palliative care facilities, or government offices (guidance function),
• support in taking advantage of medical rehabilitation measures and subsequently maintaining the rehab success,
• advice on professional reintegration and securing social participation,
• reducing psychological distress caused by the effects and long-term consequences of medical treatments,
• promoting the use of social resources and communication with the medical treatment team,
• relieving the burden on family members.

The range of services required for this includes providing information, psychosocial counseling with a psychological focus (see Chapter 9.7), psychosocial counseling with a focus on social aspects (see Chapter 9.7), psychoeducation, psycho-oncological crisis intervention, as well as couple and family counseling.

Psychotherapeutic services and medical counseling that goes beyond basic information are not part of the range of services provided by cancer counseling centers. If necessary, those seeking advice are referred to psychotherapists or specialists.

The multidisciplinary team that provides the above-mentioned services usually consists of psychologists, social workers/pedagogues, administrative staff or assistants and other professional groups, depending on the structure of the services offered.

In hospitals as well as certified centers, psycho-oncological outpatient clinic offer psycho-oncological and psychotherapeutic counseling, treatment and support for patients and their families. 

Furthermore, psycho-oncological support services are also available in some specialized oncology practices.

 

Self-help organizations offer cancer patients non-professional psychosocial support. They thus have an important function in the interplay of psychosocial care services, since from the patient's point of view, psychosocial distress is not usually sufficiently addressed in discussions with medical practitioners and many patients have little knowledge about the content and effectiveness of psychosocial support. The situation is made worse by the fact that patients often downplay their distress for fear of being stigmatized or psychiatrized.

The members of the cancer self-help/support groups and the voluntary staff of the cancer self-help organizations, who have themselves endured the disease, can provide confidence to others by being a conversation partner in terms of exchanging experiences and informational sessions, and thus contribute to overcoming fears and leading a self-determined life.

The cancer self-help organizations qualify their staff affected by cancer through seminars and provide information (including brochures), especially on everyday life with the disease, therapies, and possible side-effects of therapy.

Patient-oriented information about psycho-oncological support services at an early stage during the course of treatment can initiate individually tailored psycho-oncological care based on individual needs (see Chapter 5).

Appropriate and standardized instruments or suitable assessment procedures should be used to determine needs (see Chapter 7). Due to shorter lengths of inpatient hospital stays, the respective psycho-oncological services, in addition to their direct care functions, also have the task of providing information and referrals for further psycho-oncological services. In order to be able to ensure these tasks, a good regional as well as interregional networking of the psycho-oncological services in the inpatient as well as outpatient setting is necessary.

The continuity of psycho-oncological care as well as the optimization of the interfaces between the care sectors must be ensured by making referrals and passing on information to the patient. For this purpose, a good regional as well as interregional network of psycho-oncological services in the inpatient as well as outpatient sector must be established. On the regional level, psycho-oncological working groups for interdisciplinary exchange and further training are helpful and should therefore be established and expanded in the care regions [125].