In 2013, as the Holden Comprehensive Cancer Clinic (HCCC) introduced its Psychosocial Oncology Program, it joined a cohort of tertiary cancer centers in which cutting-edge medical services had outpaced psychosocial support for cancer survivors. That was about to change.
Arwa Aburizik, MD, MS, took on a pivotal role upon joining University of Iowa Health Care chairing the Psychosocial Oncology Task Force. Their first charge was the initiation of the HCCC’s psychosocial distress screening initiative, another component of the same goal of providing cancer care for the whole patient. The development of the screening process was also a new criterion for the continued accreditation of major cancer centers nationwide. The Psychosocial Oncology Task Force had fewer than six months to design and implement the screening program and help HCCC fulfill this critical mandate.
Preparing for this screening presented complicated challenges: vague guidelines required careful interpretation by the task force; each iteration of the adopted screening tool required approvals from the National Comprehensive Cancer Network; integrating the screening into existing processes proved complex.
“A culture shift was needed in implementing the Biopsychosocial Distress Screening Program, including considerations for the clinic’s workflow, respect for coworkers’ autonomy, and support for staff with diverse goals and perspectives,” Aburizik said. “Moreover, screening for distress in cancer patients goes beyond merely posing questions, and should trigger meaningful system responses to the concerns identified by our cancer patients. As such, the strategy for this population-based screening had to consider our teams’ buy-in and capacity, and had to select the most appropriate patients for personalized consultation. This was simultaneously a source of anxiety and relief for our psychosocial teams.”
Today, ten years later, HCCC’s Biopsychosocial Distress Screening is a nationally instructive program for identifying and addressing whole-person needs in cancer. It feeds into a triage algorithm within the UI Health Care system that proactively initiates referrals, connecting cancer patients with chaplains, social workers, or psychiatrists. It does so systematically and consistently, improving access and facilitating care for cancer survivors who are in dire need for psychosocial support, while minimizing unnecessary referrals through education and accurate triage.
“One of the wonderful things about working in an academic center is the availability of interdisciplinary and interdepartmental collaborations and research support to check our work and showcase our accomplishments,” Aburizik shares. “Since the start of the program, we have tested and evaluated our interventions and surveyed our providers to inform our clinical initiatives.”
Iterative research on the efficacy of the program included conducting surveys on provider knowledge, behavior, and attitudes toward mental health in cancer patients. The results revealed nuances that led to further provider education and system query. Trends of referral patterns related to gender and race yielded actionable results, to which the growing psychosocial oncology program was swiftly responsive in order to improve health care inequities. Evaluation of the Integrated Behavioral Health model adopted by the Psychosocial Oncology Program showed a tightened connection between highly distressed patients identified by the distress screening program and the triggered referrals received in psycho-oncology, proving the translational nature of UI Health Care teams at the Holden Comprehensive Cancer Center.
In addition to addressing immediate patient needs, the Psychosocial Oncology Program also conducts wide-ranging research from evaluating access to artificial intelligence in health care. “We are currently studying provider empathy, a crucial construct tied to provider attunement with patients’ psychological states, their outcomes and even provider wellness,” Aburizik said. “On our multiscale assessment, we discovered that providers who had high scores on subscales of interpersonal distress were more inclined to refer their patients to psycho-oncology than those who scored highly on other subscales of this intricate assessment for empathy.”
Another study, she said, focused on depression and anxiety outcomes, comparing cases in which cancer patients’ care teams consisted of only therapists versus collaborations between psychiatrists and psychologists. “Hands down, psychiatry and psychotherapy together proved to be better for depression outcomes in cancer patients than psychotherapy alone.”
Read more about artificial intelligence’s ability to detect empathy.
The ten-year anniversary of Psychosocial Oncology at HCCC marks significant growth, with approximately 1,000 new referrals to the Behavioral Oncology Clinic per year and about 200 cancer patients screened and triaged for distress each day. This was made possible by rich, interdisciplinary teams and interdepartmental collaborations, and the psychosocial core team. In 2023, the Behavioral Oncology clinic welcomed clinicians Jessica Thomas, ARNP; Gregory Gullickson, PhD; and graduate assistants Aubrey McEnroe and Kun Wang, while it anticipates hiring additional psychologists and training more graduate students.
“These core team members are truly outstanding and are the drivers of the program’s success. Without them, the program would not be viable,” Aburizik adds.
The positive impact the psychosocial oncology program has had on mental health in the cancer population correlates to a positive impact on oncology clinicians, patient caregivers, and on the institution as a whole. New pathways have been created for coordinating biomedical treatment and mental health support in cancer patients who did not have access to these services a decade ago.