Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial

Abstract Background: Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g. economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method: The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation Strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when Training (Strategy I) is combined with Implementation Expanded Resources (Strategy II). There are three aims: 1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; 2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost effective use of resources consistent with family risk (institution); 3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit. Discussion: Use of the PAT across children’s cancer programs nationally can achieve the assessment Standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial Registration: ClinicalTrials.gov, NCT04446728, registered 23 June 2020

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Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial

10.21203/rs.3.rs-38392/v1 ◽

2020 ◽

Author(s):

Anne Kazak ◽

Janet Deatrick ◽

Michele Scialla ◽

Eric Sandler ◽

Rebecca Madden ◽

...

Keyword(s):

Pediatric Cancer ◽

Comparative Effectiveness ◽

Assessment Tool ◽

Psychosocial Care ◽

Implementation Strategies ◽

Interactive Systems ◽

Psychosocial Assessment ◽

Use Of Resources ◽

Healthcare Needs ◽

Cluster Randomized

Abstract BackgroundChildhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g. economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.MethodThe PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation Strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when Training (Strategy I) is combined with Implementation Expanded Resources (Strategy II). There are three aims: 1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; 2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost effective use of resources consistent with family risk (institution); 3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit.DiscussionUse of the PAT across children’s cancer programs nationally can achieve the assessment Standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial RegistrationClinicalTrials.gov, NCT04446728, registered 23 June 2020

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Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial

Implementation Science ◽

10.1186/s13012-020-01023-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Anne E. Kazak ◽

Janet A. Deatrick ◽

Michele A. Scialla ◽

Eric Sandler ◽

Rebecca E. Madden ◽

...

Keyword(s):

Risk Assessment ◽

Study Protocol ◽

Pediatric Cancer ◽

Comparative Effectiveness ◽

Assessment Tool ◽

Psychosocial Risk ◽

Psychosocial Assessment ◽

Effectiveness Trial ◽

Cluster Randomized ◽

Psychosocial Risk Assessment

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Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

Implementation Science Communications ◽

10.1186/s43058-021-00163-4 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Janet A. Deatrick ◽

Anne E. Kazak ◽

Rebecca E. Madden ◽

Glynnis A. McDonnell ◽

Katherine Okonak ◽

...

Keyword(s):

Health Equity ◽

Pediatric Cancer ◽

Universal Screening ◽

Implementation Strategies ◽

Interactive Systems ◽

Psychosocial Risk ◽

Care Providers ◽

Psychosocial Screening ◽

Universal Family ◽

Key Stakeholders

Abstract Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020

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Screening for Family Psychosocial Risk in Pediatric Cancer: Validation of the Psychosocial Assessment Tool (PAT) Version 3

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsy012 ◽

2018 ◽

Vol 43 (7) ◽

pp. 737-748 ◽

Cited By ~ 22

Author(s):

Anne E Kazak ◽

Wei-Ting Hwang ◽

Fang Fang Chen ◽

Martha A Askins ◽

Olivia Carlson ◽

...

Keyword(s):

Pediatric Cancer ◽

Assessment Tool ◽

Psychosocial Risk ◽

Psychosocial Assessment

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Drawing a Line between Hope and Accountability: Midwives’ Response to a “Psychosocial Antenatal Care” Pilot Project in Gauteng, South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/7631 ◽

2020 ◽

Vol 22 (2) ◽

Author(s):

Johanna Mathibe-Neke ◽

Kgomotso Makobe

Keyword(s):

South Africa ◽

Antenatal Care ◽

Assessment Tool ◽

Phase 1 ◽

Quality Care ◽

Healthcare Providers ◽

Psychosocial Care ◽

Pilot Project ◽

Psychosocial Assessment ◽

Human Beings

Psychosocial care during pregnancy is embedded in women-centred care, and the improvement of quality care based on compassion has become a top priority for healthcare providers. Compassion is a deep feeling of connecting to human beings’ suffering, a moral response that leads to patient care with comfort. Such caring is skilful and worthy, respects the dignity of individuals and is intertwined with professional competency. The purpose of the pilot project was to raise the midwives’ awareness of the importance of psychosocial care during pregnancy, to assess the use of the psychosocial assessment tool, to fill the gap between routine physical antenatal care and psychosocial care, and to enhance the use of psychosocial services. An exploratory and descriptive study design was applied. The study population consisted of 34 midwives who participated in the implementation of the assessment tool in the 12 participating health facilities in Gauteng, South Africa. The data collection was conducted in two phases. Phase 1 consisted of a self-administered questionnaire to establish competency when using the assessment tool. Phase 2 consisted of focus group discussions. The four main themes that emerged were the importance of psychosocial risk assessments, experiences of the implementation of the assessment tool, challenges and barriers, and identified risk factors. The results reflected the midwives’ ability and willingness to implement the tool as part of their accountability, despite the challenges experienced. Moreover, the midwives hoped that the tool will be incorporated as part of routine antenatal care.

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“Getting to Know You and Your Child” screening questionnaire: Results from a Chicago pediatric collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.163 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 163-163

Author(s):

Eugene Suh ◽

Erika D Owen ◽

Jennifer Reichek ◽

Betty Roggenkamp ◽

Julia Rachel Trosman ◽

...

Keyword(s):

Pediatric Cancer ◽

Screening Tool ◽

Assessment Tool ◽

Psychosocial Assessment ◽

Psychosocial Stressors ◽

Institute Of Medicine ◽

Family Needs ◽

Children With Cancer ◽

Family Structures ◽

Adolescent Oncology

163 Background: In 2012, a congressional symposium identified the need for services to address psychosocial issues of children with cancer. In 2013, the Institute of Medicine recommended supportive oncology services be initiated at cancer diagnosis. Chicago providers of pediatric cancer are collaborating to improve care for children with cancer and their families focusing on psychosocial stressors and quality of life. Methods: The collaborative conducted a structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; with input from providers on stressors throughout the care continuum. The resulting screening tool was created and piloted in English and Spanish at 7 pediatric cancer hospitals. Social workers (SW) informally reported assessment of its usefulness. Results: Parents (n = 85) completed “Getting to Know You and Your Child” screening tool which inquired about caregivers, siblings, child’s interests, school, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported families found the tool useful “to think about support needs.” The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.4 (range 0-11). Most frequent stressors included: lack of support from friends, family, community (29%), paying for food (26%), job flexibility (26%), paying for utilities (25%), medical costs (23%), emotional support for family (22%), school concerns (21%). All who reported temporary residence also reported difficulty paying for housing (p < 0.01). Ten SWs reported this screening tool generated new insight into family structures, identified stressors and informed resolution efforts. Provider recommended adjustments to the screening tool: simplify terms for siblings, hobbies and spiritual, add pet question. Conclusions: Pilot testing of a psychosocial screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Six of the seven pilot sites are implementing this tool as a standard practice. Preliminary data suggests patients and providers find the screener easy to use and informative.

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"Getting to know you and your child" screening questionnaire: Results from a Chicago-based collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.150 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 150-150

Author(s):

Christine B. Weldon ◽

Betty Roggenkamp ◽

Erika D Owen ◽

Jennifer Reichek ◽

Zayda Stewart ◽

...

Keyword(s):

Pediatric Cancer ◽

Assessment Tool ◽

Psychosocial Assessment ◽

Institute Of Medicine ◽

Family Needs ◽

Social Stressors ◽

Family Structures ◽

Standard Manner ◽

Almost All ◽

Adolescent Oncology

150 Background: In 2013 the Institute of Medicine recommended that supportive oncology services be initiated at time of cancer diagnosis. Providers of pediatric cancer care in the Chicago metro area, supported by The Coleman Foundation, created and pilot tested a standard psycho-social stressors screening instrument for children with cancer and their families. Methods: The collaborative conducted structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; and collected input from social workers and oncology providers on stressors throughout the care continuum. The resulting tool was piloted in English and Spanish at 7 pediatric cancer hospitals. Providers qualitatively reported assessment of its usefulness. Results: Patients/family (n = 57) completed the “getting to know you and your child” instrument which inquired about caregivers, siblings, child’s likes/hobbies, school situation, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported that almost all families found the tool useful “to think about support needs”; one said it was invasive. The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.49 (range 0-11). The most frequent stressors were support from friends, family, community (30%), paying for food (26%), job flexibility (26%), school concerns (25%), emotional support for family (25%), and medical costs (23%). All who reported temporary housing also reported difficulty paying for a place to live (p < 0.0001). Providers reported that the standard tool generated new insight into family structures, challenges and needs informing resolution efforts. Provider recommended adjustments: simplify terms for siblings, hobbies and spiritual, adding question about pets in the home. Conclusions: Pilot testing of a psycho-social screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Four of the seven sites involved in the pilot are now implementing this tool as a standard practice; the remaining sites are performing analyses on how to incorporate the tool into their care processes.

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"Cancer Life ReiMagined:" The CaLM model of whole-person cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.74 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 74-74

Author(s):

Rebekkah Schear ◽

S. Gail Eckhardt ◽

Elizabeth Ann Kvale ◽

Robin Richardson ◽

Barbara L. Jones

Keyword(s):

Cancer Care ◽

Assessment Tool ◽

Care Delivery ◽

Psychosocial Assessment ◽

Care Plan ◽

Initial Visit ◽

Use Of Resources ◽

Patient Reported ◽

Whole Person ◽

Swat Team

74 Background: Despite advances in cancer treatment, the orientation of our health system does not address the whole cancer patient or support the wellbeing of the heart, soul, and mind. We launched the CaLM Model of Whole Person Cancer Care, an oncology medical home approach that integrates high acuity, sub-specialty clinical cancer care with comprehensive, ongoing supportive care. The CaLM Model operationalizes the six components in the conceptual framework set forth in the NASEM’s 2013 report. Delivering High-Quality Cancer Care. Methods: Beginning December 2018, we piloted a “flipped” ambulatory care model in GYN and GI oncology delivering daily care through a subset of providers, the SWAT Team: a palliative NP, med onc NP, clinical social worker, and navigator. The SWAT Team triages all physical and social needs. As opposed to anchoring care with the oncologist and referring the patient out to social services, the SWAT team anchors care and the oncologist plugs in for treatment planning. The CaLM Model also utilizes coordinated, interdisciplinary care including financial and fertility navigation, nutrition, genetic counseling, pharmacy, and psychiatry, to manage the patient’s needs via a team-based approach by assessing and addressing the patient’s needs according to their values and preferences. We designed a new clinical and psychosocial assessment tool and patient-facing care plan; launched a Multi-Disciplinary “whole-person” case review process with all interdisciplinary providers and measured patient reported outcomes using the FACT-G, PHQ, GAD, and MD Anderson Symptom Inventory at baseline (initial visit) and every clinical visit. Measured at initial visit and every 6 months. Results: Early data show that the CaLM Model reduces patient symptom burden while improving quality of life. Conclusions: The CaLM Model is an efficient use of resources, compared to a traditional oncologist-focused model of cancer care. Further research is underway to assess cost benefit to the system, the patient and the payers. Ultimately, the CaLM Model may shift the paradigm of cancer care by demonstrating the feasibility and effectiveness of a patient-centered model of care delivery that builds a foundation for a value-based payment model.

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