Integration of Psychosocial Care into Routine Cancer Care: Final Results of A Large Collaborative, Hospital-Based, Quality Improvement Study (Hucare Project)

Abstract

Background: Incorporating psychosocial research into practice is challenging. Aim of this study is to assess the feasibility in real life of interventions which have been tested in RCTs and have demonstrated to improve pts psychosocial conditions. Method(s): This is an implementation study of five EBM interventions, conducted in 28 centers. We adopted the model of Pronovost [BMJ 2008], which includes: context analysis to identify local barriers, introduction of the interventions, and evaluation of how many pts receive the recommended interventions. Primary EPs: degree of implementation detected in a blinded fashion by external trained personnel. EBM interventions included: 1) communication courses for doctors and nurses [Ann Oncol 2011]; 2) use of a question prompt list (QPL) [Cancer 2008]; 3) creation of the Point of Information and Support (PIS) in the ward [J Clin Oncol 2009]; 4) identification of a referring nurse (RN) for informing and educating pts [J Clin Nurs 2010]; 5) screening of distress and social needs [J Natl Compr Canc Netw 2010]. Result(s): 33 centers applied to partecipate, 29 were eligible and 28 are evaluable. Final blinded analisys was conducted on 305 consecutive patients. 156 oncologists and 401 nurses attended the 3 days training course. An Australian QPL was subjected to cross-cultural adaptation, yielding the first validated Italian QPL [BMC Health Serv Res 2010]. 25 centers (89%) have successfully implemented the majority of interventions; 1 is too early and 3 centers failed for various reasons: internal conflicts of the staff, poor motivation, etc. Main results for each intervention are shown in the table: Conclusion(s): Using this methodology, a successful implementation of EBM measures is possible in the vast majority of centers and yields significant improvement in the delivery of psychosocial care. (Table Presented).