The relationship between a patient and the primary oncology team is important. Although there is no single best way to talk to patients about psychosocial needs, clinical experience suggests some important concepts. First, most patients will respond to the recommendations of health care professionals who exhibit trust, expertise, warmth, care, and concern. The member of the primary oncology team who has the closest professional relationship with the patient may be the best one to discuss further psychosocial assessment.
Choice of words is important. Words that suggest the stigma of serious mental illness, such as psychiatric, psychological, mental disorder, maladjustment, or mental illness, should be avoided-in favor of words such as distress, concerns, worries, uncertainties, or stressors from the illness or its treatment. When screening and referral are done routinely, patients can be accurately informed that this is a normal routine procedure done for all patients. Suggestions for word choice include the following:
- The questionnaire you filled out helps us to understand you as a whole person, and we want to provide the best care possible for you-physically, emotionally, socially, and spiritually.
- As you may realize, a serious illness can affect the quality of your life in many ways (emotionally, socially, work, relationships, finances, energy). There is much more to this illness than just the physical, and we want to be sure we are addressing these other dimensions of your life.
- Your concerns and worries are very understandable, given your illness and its treatment. We don't want to ignore the (emotional, social, spiritual) aspects of your experience right now.
- We have found that many patients benefit greatly from a chance to talk further about their concerns with a (social worker, mental health professional, palliative care specialist, or pastoral counselor), and we would like to schedule that for you.
- For further explanation, we suggest an interview that lasts about 45 minutes with a professional who will:
- Listen closely to you.
- Want to know about your experiences with your illness.
- Ask about you, your family and friends, and other support persons.
- Ask about how you have been adjusting to your illness and may encourage you to continue (and give you feedback about) successful coping strategies you are already using.
- Have suggestions about additional ways to address your concerns.
An assessment of psychosocial adaptation will follow screening and referral to an appropriate health care professional. The psychosocial assessment is typically a semistructured interview during which the professional is evaluating how well an individual patient, a patient's family, and other significant people in a patient's life are adapting to the current demands of the illness. In general, this assessment process will consider a wide variety of factors relevant to overall adaptation. (Refer to the General Factors Influencing Adjustment section of this summary.) The experienced interviewer assessing psychosocial adaptation will consider these and other relevant variables, while also establishing a working relationship with each patient through which to begin a process of ongoing counseling and/or psychotherapy when needed.