National Psychosocial Oncology
Standards for Canada
July 9, 1999 (Board
Approved September, 1999)
TABLES OF CONTENTS
Section I - INTRODUCTION
Section II - DEFINITION
OF PSYCHOSOCIAL ONCOLOGY and SCOPE OF STANDARDS
Section III - PRINCIPLES
OF PRACTICE IN PSYCHOSOCIAL ONCOLOG
Section IVA - ORGANIZATION
AND STRUCTURE IN PSYCHOSOCIAL ONCOLOGY PROGRAMS
Section IVB - PROFESSIONAL
ISSUES IN PSYCHOSOCIAL ONCOLOGY
Section IVC - PATIENT
AND FAMILY SERVICE IN PSYCHOSOCIAL ONCOLOGY
Section IVD - RESEARCH
and PROGRAM EVALUATION STANDARDS FOR PSYCHOSOCIAL ONCOLOGY
PROGRAMS
Section IVE - PATIENT
AND STAFF EDUCATION IN PSYCHOSOCIAL ONCOLOGY
REFERENCES
Appendix A
Section I - INTRODUCTION
The Canadian Association of Psychosocial
Oncology (CAPO) is a professional organization, established
in 1985, to bring together the disciplines which play
a major role in the delivery of psychosocial services,
research, and education in oncology. The goals of CAPO
are:
- To provide a national network for the exchange
of ideas between clinicians, researchers and educators.
- To actively foster and encourage interdisciplinary
collaboration on oncology clinics and services.
- To establish and promote sound research and clinical
practice guidelines.
- To promote and encourage psychosocial research
- To provide and promote ongoing education programs
directed towards strengthening clinical service
and research methodology.
- To promote and encourage multi-centre collaboration
in clinical service, research and education.
- To offer advice and/or consultation services to
members of the Association and to international,
federal, provincial and local programs.
The National Standards for Psychosocial
Oncology have been developed to assist cancer facilities,
program leaders and practitioners in the delivery of
psychosocial care in Canada by providing a basic framework
for the practice of psychosocial oncology. This initiative
came about from a recognition that psychosocial oncology
standards are required to ensure that the basic principles
and quality of care in the domain of psychosocial oncology
are consistently applied and available to people living
with cancer across Canada.
It is recognized that all health care
disciplines provide some components of psychosocial
oncology care through their day-to-day contact with
patients and families. Indeed, a foundation of psychosocial
oncology is the fundamental principle of an interdisciplinary
area of expertise. These standards should not in any
way detract from that basic principle and are not meant
to restrain or limit the excellent psychosocial care
and services being provided by various professional
groups. They are intended to define the most basic and
fundamental requirements of psychosocial oncology, upon
which other professional groups, components, services
and activities could, and even should, be added as required.
During the development of these standards
comments were received about whether or not they conformed
with existing practices or were "realistic".
The Work Group struggled with the issues of existing
practices and what is "realistic". In the
final analysis, it was felt that standards are achievable
objectives towards which people strive and not simply
an affirmation of the status quo. By the same token,
they are not seen as being an ideal. Instead, they reflect,
based on existing evidence and extensive clinical and
administrative experience, the minimum basic level of
practice of patient care, education and research in
psychosocial oncology.
Psychosocial oncology professionals in
Canada are guided by discipline specific standards through
professional associations, the accreditation process,
or individual facility priorities. The CAPO Standards
of Care have been developed to augment any existing
professional standards and indications are that they
do not conflict with existing professional standards.
Process for Standards Development
This project was initiated in November,
1997, with eight professionals from across Canada representing
the major disciplines offering psychosocial care (Appendix
A). The National Standards Group conducted its work
between then and July, 1999. Three drafts were prepared
before the fourth draft was distributed widely to members
of CAPO, other psychosocial oncology practitioners,
researchers, educators, cancer agencies, and others
for input and comment. Replies were received from 65
individuals and organizations and their comments incorporated
into a revised fifth draft. A final sixth draft was
finalized on March 19 - 20, 1999 and submitted to the
CAPO Board in May, 1999 for consideration and further
action. The Board approved the Standards in principle
at the May 12, 1999 Board Meeting, and also requested
members of the Board to forward refinements in wording
to the Work Group. This final set of Standards were
completed in July, 1999 and approved by the CAPO Board
in September, 1999.
Special mention is made of Terry Bunston,
Ph.D. Dr. Bunston was a member of the Work Group from
November, 1997 until her death on September 3, 1998.
Her wisdom, insight, and commitment were greatly respected
by the Work Group and her valued contributions are reflected
throughout these Standards.
These Standards are divided into four
sections. The first section is this Introduction. Section
II provides a definition of psychosocial oncology and
defines the scope of these standards. Section III identifies
key principles guiding the development of these standards.
Section IV are the specific Standards organized under
the following headings; IV-A Organization and Structure,
IV-B Professional Issues, IV-C Patient and Family Services,
IV-D Research and Program Evaluation, and IV-E Patient
and Professional Education in psychosocial oncology.
Section II - DEFINITION
OF PSYCHOSOCIAL ONCOLOGY and SCOPE OF STANDARDS
DEFINITION OF PSYCHOSOCIAL ONCOLOGY
Psychosocial Oncology is a professional
sub-specialty in oncology. The domain of psychosocial
oncology includes the formal study, understanding and
treatment of the social, psychological, emotional, spiritual,
quality of life and functional aspects of cancer as
applied across the cancer trajectory from prevention
through bereavement. It seeks to develop and integrate
new knowledge and techniques of the psychosocial and
biomedical sciences as it relates to cancer care
SCOPE OF STANDARDS
Psychosocial oncology services exist in
a variety of settings, including hospitals, comprehensive
cancer centres, satellite clinics and multipurpose public
health clinics in urban and rural communities throughout
Canada. The psychosocial oncology standards apply to
this range of oncology health care services for patients,
their families and care-givers. The Psychosocial Oncology
standards are designed to guide administrators and professionals
in the development of psychosocial oncology services.
Section III - PRINCIPLES
OF PRACTICE IN PSYCHOSOCIAL ONCOLOGY
PRINCIPLE 1 - Integral
Part of Care
Psychosocial oncology is an integral part
of cancer care.
PRINCIPLE - Patient/Family
Focus of Care
The basic unit of care in psychosocial
oncology is the patient and family, as defined by the
patient.
PRINCIPE - Access to Psychosocial
Care
Patients and families are informed of
and have access to psychosocial oncology services.
PRINCIPLE 4 -Focus of Psychosocial
Care
Psychosocial oncology aims to help individuals
and families to use their own resources to promote well-being.
PRINCIPLE - Respect for
Individual Integrity
Psychosocial Oncology professionals practice
in a manner that respects the individuals' personal
dignity and integrity.
PRINCIPLE 6 - Ethical Practice
Psychosocial Oncology professionals adhere
to the ethical principles of autonomy, beneficence,
honesty and confidentiality.
PRINCIPLE 7 - Assessment
of Need
Psychosocial service needs of patients
and families are assessed systematically using appropriate
tools.
PRINCIPLE - Interdisciplinary
Respect
The interdisciplinary team is built upon
respect for each others’ expertise and knowledge base.
PRINCIPLE 9 - Evidence
Based Practice
Psychosocial practice is evidence-based
and subject to on-going evaluation.
PRINCIPLE 10 - Education
and Research
Education and research are essential components
of psychosocial oncology.
PRINCIPLE 11 Quality Improvement
Psychosocial oncology programs and services
are subject to on-going quality improvement processes.
Section IVA - ORGANIZATION
AND STRUCTURE IN PSYCHOSOCIAL ONCOLOGY PROGRAMS
Preamble
In recent years, there has been an increase
in awareness of the burden of cancer carried by patients
and their families. Adequate cancer care requires a
comprehensive range of services that integrate psychosocial
care. The organization must be structured in such a
way that provides psychosocial resources to meet the
needs of cancer patients and their support systems along
the continuum from prevention to bereavement. It is
recognized that some disciplines, by virtue of their
particular formal training, must form the minimum requirement
for a psychosocial oncology program. Yet, this does
not detract from nor should it limit the excellent psychosocial
care provide by many health care providers and anticipates
that other disciplines, components, services and activities
will, and in fact should, be part of the psychosocial
oncology program. This could include professionals with
appropriate psychosocial training from medicine, nursing,
pastoral care or other related groups. It also recognizes
that all health care disciplines provide some components
of psychosocial care.
STANDARD 1 - Organizations
will provide psychosocial care
Organizations caring for cancer patients
must provide psychosocial care.
STANDARD 2 - Psychosocial
Oncology Program
To be considered a psychosocial oncology
program, at least 2 of the clinical disciplines of social
work, psychology and/or psychiatry must provide psychosocial
care and be present within the facility providing oncology
care.
STANDARD 3 - Program Resources
The psychosocial oncology program maintains
resources to provide clinical service and education
and to conduct research.
STANDARD 4 - Continuity
of care
Facilities providing cancer care ensure
the continuity of psychosocial services for patients,
and their families across the cancer continuum, with
respect to the settings and providers.
STANDARD 5 Program Workload
Data
The psychosocial oncology program collects
data on patient care services, contacts and program
delivery.
STANDARD 6 - Represented
in Administrative Structure
Psychosocial services are represented
in the administrative structures of the health care
facility. Involvement in administration ensures direct
input into resource allocations, integration of psychosocial
services within program structures and accountability
for psychosocial program evaluation and performance
management.
STANDARD 7 - Integrated
Documentation
Psychosocial professionals maintain complete
and comprehensive records on patient encounters, which
are consistent with discipline standards. These records
are part of the official record maintained by the health
care facility.
STANDARD 8 - Diversity
The diversity that characterizes the community
where services are provided is reflected in the provision
of psychosocial oncology services.
STANDARD 9 - Psychosocial
Program Leadership
Leadership in psychosocial oncology comes
from one of the three disciplines of social work, psychology
or psychiatry. The leader is responsible for the development,
evaluation and resource allocation of psychosocial programs
and services within the cancer care facility.
Section IVB - PROFESSIONAL
ISSUES IN PSYCHOSOCIAL ONCOLOGY
Preamble
Psychosocial Oncology functions within
an interdisciplinary model of service delivery. Services
are provided within a variety of organizational structures.
Psychosocial oncology is an area of specialization,
with few formal training opportunities. The purpose
of this section is to ensure that psychosocial oncology
professionals are qualified and trained, have relevant
experience, and functions within a structure which supports
their unique skills and expertise and ensures that they
are able to maintain a high level of competence.
STANDARD 10 - Professional
Codes of Ethics
Psychosocial oncology professionals adhere
to their respective profession's Code of Ethics.
STANDARD 11 - Accountability
for Qualifications
The psychosocial leader is responsible
for ensuring that the qualifications and competencies
of each professional within the psychosocial program
are met.
STANDARD 12 - Position
Profile
Qualifications and competencies (skill
set) for professionals working in psychosocial oncology
programs are defined in writing and are consistent with
and augment provincial standards.
STANDARD 13 - Qualifications
of Staff
Psychosocial oncology professionals will
have
1) a graduate degree in social work, psychology,
or psychiatry OR
2) at least 3 years supervised experience
in psychosocial oncology post-Baccalaureate
STANDARD 14 - Plan to
Upgrade Qualifications
A written plan is in place to ensure the
qualifications/competencies will be achieved.
STANDARD 15 - Supervision
Professional staff with less than 3 years
of psychosocial oncology experience will receive at
least 4 hours/month of supervision/consultation until
they achieve 3 years experience in psychosocial oncology.
This can include one-to-one supervision, case discussions,
research presentations, or other forms of consultation.
STANDARD 16 - Performance
Reviews
Psychosocial oncology professionals meet
annually with their immediate supervisor to review their
work, performance, career and education plans, goals
and objectives. A summary of that discussion is retained
for reference and subsequent review.
STANDARD 17 - Regular
Meetings
A forum exists for the psychosocial team
to meet to discuss clinical, program, professional and
administrative issues.
STANDARD 18 - Translating
Research into Practice
Psychosocial oncology professionals identify
research relevant to their practice and incorporate
the results of research into practice.
Section IVC - PATIENT AND
FAMILY SERVICE IN PSYCHOSOCIAL ONCOLOGY
Preamble
Timely and effective psychosocial services,
provided to patients and families prevent or reduce
distress, enhance coping and quality of life, and improve
compliance with therapeutic recommendations.
STANDARD 19 - Information
Information regarding psychosocial and
therapeutic resources and services are conveyed in a
timely and sensitive manner.
STANDARD 20 - Equitable
Access of Services
Patients have access to psychosocial services
regardless of diversity in diagnosis, cultural/ethnic
background, language, gender, sexual orientation, or
geographical location. If services are not available
in the patient’s community, efforts are made to facilitate
access as required.
STANDARD 21 - Appropriate
Services are Available
Psychosocial programs and services are
available and appropriate to the needs of cancer patients
and their families.
STANDARD 22 - Informed
Consent
Patients and their families receive sufficient
information about the intended nature of the psychosocial
oncology intervention, potential outcomes and other
options available to them to make an informed decision
before accepting psychosocial care.
STANDARD 23 - Advocacy
Psychosocial oncology professionals assist
and advocate on behalf of patients and care-givers where
real or perceived barriers exist in the provision of
optimal care.
STANDARD 24 - Open Referral
Policy
Patients and families can self-refer to
available psychosocial services. Where direct access/self-referral
is not possible (e.g. direct access to psychiatry),
it is the responsibility of the psychosocial professional
to facilitate the appropriate referral.
Section IVD - RESEARCH
and PROGRAM EVALUATION STANDARDS FOR PSYCHOSOCIAL ONCOLOGY
PROGRAMS
Preamble
Psychosocial oncology research is essential
for the advancement of knowledge and the development
of services for patients and families. It is of prime
importance that the body of knowledge in psychosocial
oncology be acquired through research and evaluation
and that new knowledge be translated into clinical practice.
These standards are elaborated with the intention that
University and teaching centres initiate and conduct
psychosocial research and that smaller hospitals participate
in these studies.
STANDARD 25 - Supportive
Research Environment
The psychosocial oncology program creates
an environment conducive to collaborative research by;
(a) Valuing and encouraging research.
(b) Facilitating collaboration between
clinicians and researchers.
(c) Developing linkages with other
cancer care facilities, hospitals, universities and
research organizations.
(d) Ensuring protected time for clinicians
to participate in research activities..
(e) Ensuring that research findings
are integrated into clinical practice.
STANDARD 26 -Psychosocial
Program Evaluation
The evaluation of psychosocial care and
services is integrated into the psychosocial oncology
program.
STANDARD 27- Research
and Ethics Review
Psychosocial oncology research studies
have institutional scientific and ethics review.
STANDARD 28 - Research
Resources Available
The cancer facility ensures or facilitates
the availability of financial resources available to
support psychosocial oncology research.
Section IVE - PATIENT AND
STAFF EDUCATION IN PSYCHOSOCIAL ONCOLOGY
Preamble
Education in the field of psychosocial
oncology involves planned provision of information to
patients, families, psychosocial oncology professionals,
other health care providers and the general public.
For patients and families the provision of education
can facilitate informed decision making and understanding
of the cancer experience. The provision of education
to psychosocial and other health care providers promotes
continuous improvement of programs and professional
development.
STANDARD 29 - Educational
Needs Are Identified
A process is in place for identifying
the unique learning needs of patients and their families
and caregivers, community groups, governing bodies,
and psychosocial oncology professionals.
STANDARD 30- Educational
Resources are Easily Accessible
Psychosocial educational programs and
resources are readily accessible to patients and their
families and care-givers, community groups, governing
bodies, and psychosocial oncology professionals.
STANDARD 31 - Relevance
of Educational Material
Educational programs, resources, and materials
build on the capacity of the learner and are tailored
to the diversity of the intended recipients.
STANDARD 32 - Continuing
Professional Education
Educational needs of psychosocial professionals
are met in accordance with professional competency requirements.
STANDARD 33 - Formal Evaluation
of Educational Programs
As a component of quality improvement,
psychosocial oncology education programs and materials
are monitored and evaluated on an ongoing basis.
REFERENCES
Devine, E.C. and Westlake, S. K. (1995)
The effects of psychoeducational care provided to adults
with cancer: meta-analysis of 116 studies, Oncology
Nursing Forum, 22 (9), 1369-1381.
Fawzy, F.I., Fawzy, N.W., Arndt, L.A.,
and Pasnau, R.O. (1995). Critical review of psychosocial
interventions in cancer care. Archives of General Psychiatry,
52 (Feb.1995), 100-113.
Fox, B. H. (1995). The role of psychological
factors in cancer incidence and prognosis. Oncology,
9(3), 245-256.
Gotay, C., and Stern, J. D. (1995). Assessment
of psychological functioning in cancer patients. Journal
of Psychosocial Oncology, 13 (1/2), 123-160.
Hearn, J. and Higginson, I. J., (1997).
Outcome measure in palliative care for advanced cancer
patients: A review. Journal of Public Health Medicine,
19 (2), 193-199.
Iacovino, V. and Reesor, K. (1997). Literature
on interventions to address cancer patients' psychosocial
needs: what does it tell us?. Journal
of Psychosocial Oncology, 15 (2), 47-71.
Meyer, T. J. and Mark, M. M. (1995). Effects
of psychosocial interventions with adult cancer patients:
A
meta-analysis of randomized experiments.
Health Psychology, 14 (2), 101-108.
van't-Spijker, A., Trijsburg, R.W., Duivenvoorden,
H.J. (1997). Psychological sequelae of cancer diagnosis:
A meta-analytical review of 58 studies after 1980. Psychosomatic
Medicine, 59 (3), 280-293.
Trijsburg, R. W., van Knippenberg, F.C.E.,
and Rijpma, S.E. (1992). Effects of psychological treatment
on cancer patients: A critical review. Psychosomatic
Medicine, Vol. 54, 489-517.
Appendix A
Canadian Association of Psychosocial Oncology
(CAPO)
NATIONAL STANDARDS WORK GROUP
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(Left
to right) Mr. Alan Gavin, London, ON; Dr. Mary
Elliott, Toronto, ON; Mr. John Farber, Winnipeg,
MB; Dr. Roanne Segal, Ottawa, ON; Dr. Barry Bultz,
Calgary, AB; Dr. Michelle Deschamp, Montreal,
PQ; Dr. Zeev Rosberger, Montreal, PQ; Mr. Richard
Doll, Vancouver, BC. Missing: Ms. Sharon Dublin,
Halifax, NS; Missing: Dr. Terry Bunston, Toronto,
ON.
|
Members
Barry Bultz, Ph.D., Director
Department of Psychosocial Resources
Tom Baker Cancer Centre, Alberta Cancer
Board
1331 - 29th Street NW
CALGARY, AB T2N 4N2
Phone: 403-670-1767
Fax: 416-480-2128
Email: bdbultz@acs.ucalgary.ca
Terry Bunston, Ph.D.
Princess Margaret Hospital
Toronto, ON
November 1997 - September 1998
Michele Deschamps, R.N., Ph.D., Chercheure
Direction de la sante publique
Organisation et evaluation des services
preventifs
4835, avenue Christophe-Columb
MONTREAL, PQ H2J 3G8
Phone: 514-528-2400 x 3571
Fax: 514-528-2598
Email: mdescham@santepub-mtl.qc.ca
Richard Doll, M.S.W., M.Sc., Provincial
Leader
Cancer Rehabilitation Network
BC Cancer Agency
600 West 10th Avenue
VANCOUVER, BC V5Z 4E6
Phone: 604-877-6126
Fax: 604-872-4596
Email: rdoll@bccancer.bc.ca
Sharon Dublin, BSc BN MN RN
Assistant Professor
Department of Nursing
St. Francis Xavier University
P.O. Box 5000
ANTIGONISH, NS B2G 2W5
Phone: 902-867-2434
Fax: 902-867-2322
Email: sdublin@stfx.ca
Joined July, 1998
Mary Elliott, M.D., FRCPC, Co-ordinator
of Psychiatry
Department of Psychosocial Oncology
Princess Margaret Hospital
610 University Ave.
TORONTO, ON M5G 2M9
Phone: 416-946-2000 ext 5405
Fax 416-946-2947
Email: Mary_Elliott@pmh.toronto.on.ca
Joined February, 1999
John Farber, M.A., Director
Department of Psychosocial Oncology
Manitoba Cancer Treatment and Research
Foundation
100 Olivia Street
WINNIPEG, MB R3E 0V9
Phone: 204-787-1325
Fax: 204-783-6875
Email: john.farber@mctrf.mb.ca
Alan Gavin, M.S.W., C.S.W., Coordinator
Psychosocial Research and Education
Supportive Care
London Regional Cancer Centre
790 Commissioners Road E.
LONDON, ON N6A 4L6 Phone: 519-685-8622
Fax: 519-685-8636
Email: agavin@lrcc.on.ca
Zeev Rosberger, Ph.D., Director
Psychology Division
Sir Mortimer B. Davis
Jewish General Hospital
4333 Cote Ste. Catherine Rd.
MONTREAL, PQ H3T 1E4
Phone: 514-340-8210 x 5227 or 4215
Fax: 514-340-8290
Email: zeev@psych.McGill.CA
Roanne Segal, M.D., FRCPC, Medical Director
Oncology Rehabilitation Programs
Ottawa Regional Cancer Centre
501 Smyth Road
OTTAWA, ON K1H 8L6
Phone: 613-737-7700 x 6815
Fax: 613-247-3511
Email: rsegal@cancercare.on.ca
Others Assisting
Stephen Hansen, M.Ed., Provincial Education
Leader
B.C. Cancer Agency
600 West 10th Avenue
VANCOUVER, BC V5Z 4E6
Phone: 604-877-6098 x 2505
Fax: 604-877-6144
Email: shansen@bccancer.bc.ca
Carol Smillie, Ph.D., Professor
School of Nursing
Dalhousie University
1st Floor, Forrest Bldg.
5869 University Avenue
HALIFAX, NS B3H 1W2
Phone: 902-494-2032
Fax: 902-494-3487
Email: csmillie@kilcom1.ucis.dal.ca
Joined August, 1998
Marilyn Colton, Assistant Executive Director
Cancer Care, Acute Care and Community Care
Canadian Council of Health Services Accreditation
Ottawa, Ontario
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