Harvard Medical School, Boston, MA, 02215, USA.
Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02215, USA.
Transl Behav Med. 2023 Jul 1;13(7):511-517. doi: 10.1093/tbm/ibac121.
Psychosocial distress screening, mandated by the American College Surgeons' Commission on Cancer, continues to be implemented across cancer centers nationwide. Although measuring distress is critical to identifying patients who may benefit from additional support, several studies suggest that distress screening may not actually increase patients' utilization of psychosocial services. While various investigators have identified barriers that may impede effective implementation of distress screening, we posit that patients' intrinsic motivation, which we term patients' willingness, may be the biggest predictor for whether cancer patients choose to engage with psychosocial services. In this commentary, we define patient willingness towards psychosocial services as a novel construct, distinct from the intention toward a certain behavior described across pre-existing models of health behavior change. Further, we offer a critical perspective of models of intervention design that focus on acceptability and feasibility as preliminary outcomes thought to encompass the willingness construct described herein. Finally, we summarize several health service models that successfully integrate psychosocial services alongside routine oncology care. Overall, we present an innovative model that acknowledges barriers and facilitators and underscores the critical role of willingness in health behavior change. Consideration of patients' willingness toward psychosocial care will move the field of psychosocial oncology forward in clinical practice, policy initiatives, and study design.
美国外科医师学院癌症委员会规定的心理社会困扰筛查继续在全国癌症中心实施。尽管衡量困扰程度对于确定可能需要额外支持的患者至关重要，但多项研究表明，困扰筛查实际上可能不会增加患者对心理社会服务的利用。虽然许多研究人员已经确定了可能阻碍困扰筛查有效实施的障碍，但我们认为，患者的内在动机，我们称之为患者的意愿，可能是癌症患者是否选择接受心理社会服务的最大预测因素。在这篇评论中，我们将患者对心理社会服务的意愿定义为一个新的概念，与之前健康行为改变模型中描述的针对特定行为的意图不同。此外，我们对关注可接受性和可行性的干预设计模型提出了批判性的观点，认为这些初步结果包含了本文所描述的意愿概念。最后，我们总结了几个成功将心理社会服务与常规肿瘤学护理相结合的卫生服务模式。总的来说，我们提出了一个创新的模型，承认了障碍和促进因素，并强调了意愿在健康行为改变中的关键作用。考虑患者对心理社会护理的意愿将推动心理肿瘤学在临床实践、政策倡议和研究设计方面的发展。
