Background:

In response to the supportive care needs of cancer patients Northern Health initiated a two day a week psychology clinic for cancer patients and their family members in March 2010. The development of strong referral pathways was a key task in the development of this service. A challenge in meeting patients’ supportive care needs is to identify patient groups that are under-referred to psychology. Referrals to the oncology psychologist were examined to identify which patients are more likely to be referred and attend therapy.

Method:

Referrals to the psychology service since it began in March 2010 until June 2011 were categorised according to clinical characteristics and number of sessions attended. Referrals that had not been contacted yet were excluded from analysis.

Results:

Eight-five patients were referred, 23 (27.1%) declined to attend and three were referred on to alternate services. Average age was 53.5 years (SD =13.0) and ranged from 18-85, 68 (80.0%) were female and 9 (10.6%) were family members. Breast cancer patients were most frequently referred, followed by colorectal cancer patients (Table 1), the two tumour groups predominantly treated at Northern Health. Referrals for family members came mainly from patients with breast cancer and ovarian cancer.

Table 1 – Referrals of Patients and Family Member by Tumour Site

Referral patterns and client attendance to the Northern Health oncology psychologist: implications for supportive care screening

The source of referrals differed according to client group (Table 2). Breast cancer patients were predominantly referred by breast cancer nurses and oncologists. For colorectal patients, referrals came mainly from nursing staff, for other tumour types oncologists were primary referrers. For family members, nurses made the majority of referrals. Analyses indicated that non-attending patients did not differ in terms of tumour type or gender. No family members referred to the service declined, while 23 (30.3%) patients declined (p=.002). Those who declined were on average younger than those who attended (55.9 years vs 48.1 years, p = .030).

Table 2 – Referral source by patient group

Discussion:

• The over-representation of breast cancer patients referred to psychology likely results from the regular contact and ability of breast cancer nurses to conduct supportive care screening (formal or informal) rather than a lack of distress in non-breast cancer patients.

• Nurses and oncologists provide referrals for other patient groups but these do not come from a well organised and robust system of screening. Rather, these referrals are more sporadic and dependent on a clinician’s skill, focus on psychological issues, and their relationship with the psychologist.

• One in four patients declined therapy. Non-attendance was more likely in patients than family members, and more likely in younger patients. Younger patients may have higher levels of distress and decline attending therapy to avoid discussing their condition.

Implications for practice:

Higher rates of referrals to psychology are obtained when there is a screening point that is a consistent part of routine cancer care. Younger patients experiencing psychological difficulties may require more encouragement or assistance to attend therapy.

Tumour Site Patients Family Members

N % N %

Breast 45 59.2 5 55.6

Colorectal 19 25.0 0 0.0

Oesophagus 1 1.3 0 0.0

Leukaemia 2 2.6 1 11.1

Lymphoma 2 2.6 0 0.0

Lung 2 2.6 1 11.1

Ovarian 2 2.6 2 22.2

Pancreatic 1 1.3 0 0.0

Testicular 2 2.6 0 0.0

Total 76 100 9 100

Referral Source Breast Colorectal Other Tumours Family MembersN % N % N % N %

Breast Cancer Nurse 30 66.7 - - - - 4 44.4Oncology Nurse 2 4.4 8 42.1 1 8.3 3 33.3Radiotherapy Nurse 2 4.4 0 0.0 0 0 0 0.0Stoma Nurse - - 2 10.5 - - - -Social Work 0 0 2 10.5 1 8.3 2 22.2Oncologist 11 24.4 3 15.8 7 58.3 0 0Surgeon 1 2.2 3 15.8 0 0 0 0Other 0 0 1 5.3 3 25.0 0 0Total 45 100 19 100 12 100 9 100

Dr Hunter Mulcare - Craigieburn Health Service, Northern Health