TABLE C-1 Recommendations Addressing Psychosocial Services

Report Recommendations
Assure Provision of Psychosocial Services
Improving the Quality of Health Care for Mental and Substance-Use Conditions (IOM, 2006) Overarching Recommendation 1 Health care for general, mental, and substance-use problems and illnesses must be delivered with an understanding of the inherent interactions between the mind/brain and the rest of the body.
Ensuring Quality Cancer Care (IOM, 1999)Recommendation 4 Ensure the following elements of quality care for each individual with cancer: …
  • an agreed upon care plan that outlines goals of care;
  • access to the full complement of resources necessary to implement the care plan; …
  • a mechanism to coordinate services; and
  • psychosocial support services and compassionate care.
NCCN Distress Management Clinical Practice Guidelines, (NCCN, 2006)
  • Distress should be recognized, monitored, documented, and treated promptly at all stages of disease.
  • Patients, families, and treatment teams should be informed that management of distress is an integral part of total medical care and provided appropriate information about psychosocial services in the treatment center and the community.
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (National Breast Cancer Centre and National Cancer Control Initiative, 2003)Emotional and Social Support Guideline: The extent to which a person with cancer has support and feels supported has been identified as a major factor in their adjustment to the disease. It is essential to check the extent of support available to the patient, to recommend additional support as required and to provide information about where this is available.
Gender and psychosocial support Guideline: Clinicians and the treatment team need to consider that the psychosocial needs of men and women may vary both in extent and how they are expressed. Successful strategies for meeting psychosocial support needs may therefore differ for men and women. Where the delivery method is inappropriate or insensitive, men may simply not participate or not gain a benefit.
Achieving the Promise: Transforming Mental Health Care in America (New Freedom Commission on Mental Health, 2003)Recommendation 1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
Recommendation 1.2 Address mental health with the same urgency as physical health.
Recommendation 2.3 Align relevant federal programs to improve access and accountability for mental health services.
Recommendation 2.4 Create a Comprehensive State Mental Health Plan.
Recommendation 3.1 Improve access to quality care that is culturally competent.
Recommendation 3.2 Improve access to quality care in rural and geographically remote areas.
Recommendation 4.1 Promote the mental health of young children.
Meeting Psychosocial Needs of Women with Breast Cancer (IOM and NRC, 2004) Breast cancer care clinicians, such as oncologists and other medical professionals, responsible for the care of women with breast cancer should incorporate planning for psychosocial management as an integral part of treatment. They should routinely assess and address psychosocial distress as a part of total medical care.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006) Recommendation 6 Congress should support the Centers for Disease Control and Prevention (CDC), other collaborating institutions, and the states in developing comprehensive cancer control plans that include consideration of survivorship care, and promoting the implementation, evaluation, and refinement of existing state cancer control plans.
Screening
NCCN Distress Management Clinical Practice Guidelines, (NCCN, 2006)
  • All patients should be screened for distress at their initial visit, at appropriate intervals, and as clinically indicated especially with changes in disease status (i.e., remission, recurrence, progression).
  • Screening should identify the level and nature of the distress.
  • Conduct multi-center trials that explore brief screening instruments….
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (National Breast Cancer Centre and National Cancer Control Initiative, 2003) Clinic-based protocols should be developed to ensure that all patients are screened for clinically significant anxiety and depression.
Achieving the Promise: Transforming Mental Health Care in America (New Freedom Commission on Mental Health, 2003) Recommendation 4.3 Screen for co-occurring mental and substance-use disorders and link with integrated treatment strategies.
Improving the Quality of Health Care for Mental and Substance-Use Conditions (IOM, 2006)Recommendation 5-1 To make collaboration and coordination of patients’ mental and substance-use health care services the norm, providers of the services should establish clinically effective linkages within their own organizations and between providers of mental health and substance-use treatment. The necessary communications and interactions should take place with the patient’s knowledge and consent and be fostered by:
  • Routine sharing of information on patients’ problems and pharmacologic and nonpharmacologic treatments among providers of M/SU treatment.
  • Valid, age-appropriate screening of patients for comorbid mental, substance-use, and general medical problems in these clinical settings and reliable monitoring of their progress.
Patient-Centered Care
Achieving the Promise: Transforming Mental Health Care in America (New Freedom Commission on Mental Health, 2003) Recommendation 2.1 Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
Quality Improvement
Improving Palliative Care for Cancer (IOM and NRC, 2001) Recommendation 6: Best available practice guidelines should dictate the standards of care for both physical and psychosocial symptoms. Care systems, payers, and standard-setting and accreditation bodies should strongly encourage their expedited development, validation, and use. Professional societies, particularly the American Society of Clinical Oncology, the Oncology Nursing Society, and the Society for Social Work Oncology, should encourage their members to facilitate the development and testing of guidelines and their eventual implementation, and should provide leadership and training for nonspecialists, who provide most of the care for cancer patients.
NCCN Distress Management Clinical Practice Guidelines (NCCN, 2006)
  • Distress should be assessed and managed according to clinical practice guidelines.
  • Multidisciplinary institutional committees should be formed to implement standards for distress management.
  • Clinical health outcomes measurement should include assessment of the psychosocial domain (e.g., quality of life and patient and family satisfaction).
  • Quality of distress management should be included in institutional continuous quality improvement projects.
Meeting Psychosocial Needs of Women with Breast Cancer (IOM and NRC, 2004) Providers of cancer care should meet the standards of psychosocial care developed by the American College of Surgeon’s Commission on Cancer and follow the National Comprehensive Cancer Center Network’s (NCCN) Clinical Practice Guidelines for the Management of Distress.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006) Recommendation 4 Quality of survivorship care measures should be developed through public/private partnerships and quality assurance programs implemented by health systems to monitor and improve the care that all survivors receive.
Continuity of Care
Living Beyond Cancer: Finding a New Balance (President’s Cancer Panel, 2004)Recommendation 1a Upon discharge from cancer treatment, including treatment of recurrences, every patient should be given a record of all care received and important disease characteristics, this should include, at a minimum: …
  • Psychosocial … services provided.
  • Full contact information on treating institutions and key individual providers.
Recommendation 1b Upon discharge from cancer treatment, every patient should receive a follow-up care plan incorporating available evidence–based standards of care. This should include, at a minimum:
  • Information on possible future need for psychosocial support.
  • Referrals to specific follow-up care providers, support groups….
  • A listing of cancer-related resources and information (Internet-based sources and telephone listings for major cancer support organizations).
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (National Breast Cancer Centre [NBCC] and National Cancer Control Initiative [NCCI], 2003)Clinic-based protocols should be developed to ensure that:
  • All patients are able to identify a key health professional responsible for continuity of care.
  • Referral pathways for liaison psychiatry, psychologists, support groups, and relevant allied health professionals are established and known to the team.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006) Recommendation 2 Patients completing primary treatment should be provided with a comprehensive care summary and follow-up plan that is clearly and effectively explained. This “Survivorship Care Plan” should be written by the principal providers(s) who coordinated oncology treatment. This service should be reimbursed by third party payors of health care. Such a care plan would summarize critical information needed for the survivor’s long term care, including … information on the availability of psychosocial services in the community and on legal protections regarding employment and access to health insurance.
Improving the Quality of Health Care for Mental and Substance-Use Conditions (IOM, 2006)Recommendation 5-2 To facilitate the delivery of coordinated care by primary care, mental health, and substance-use treatment providers, government agencies, purchasers, health plans, and accreditation organizations should implement policies and incentives to continually increase collaboration among these providers to achieve evidence-based screening and care of their patients with general, mental, and/or substance-use health conditions. The following specific measures should be undertaken to carry out this recommendation:
  • Primary care and specialty M/SU health care providers should transition along a continuum of evidence-based coordination models from (1) formal agreements among mental, substance-use, and primary health care providers; to (2) case management of mental, substance-use, and primary health care; to (3) collocation of mental, substance-use, and primary health care services; and then to (4) delivery of mental, substance-use, and primary health care through clinically integrated practices of primary and M/SU care providers. Organizations should adopt models to which they can most easily transition from their current structure, that best meet the needs of their patient populations, and that ensure accountability.
  • DHHS should fund demonstration programs to offer incentives for the transition of multiple primary care and M/SU practices along this continuum of coordination models.
  • Purchasers should modify policies and practices that preclude paying for evidence-based screening, treatment, and coordination of M/SU care and require (with patients’ knowledge and consent) all health care organizations with which they contract to ensure appropriate sharing of clinical information essential for coordination of care with other providers treating their patients.
  • Organizations that accredit mental, substance-use, or primary health care organizations should use accrediting practices that assess, for all providers, the use of evidence-based approaches to coordinating mental, substance-use, and primary health care.
  • Federal and state governments should revise laws, regulations, and administrative practices that create inappropriate barriers to the communication of information between providers of health care for mental and substance-use conditions and between those providers and providers of general care.
Recommendation 5-3 To ensure the health of persons for whom they are responsible, M/SU providers should:
  • Coordinate their services with those of other human-services and education agencies, such as schools, housing and vocational rehabilitation agencies, and providers of services for older adults.
  • Establish referral arrangements for needed services.
Patient Education and Illness Self-Management
Living Beyond Cancer: Finding a New Balance (President’s Cancer Panel, 2004)Recommendation 2 Procedures should be established within diverse patient care settings to better inform patients/survivors and their caregivers about available legal and regulatory protections and resources [e.g., pertaining to employment and insurance.].
Recommendation 5a All survivors should be counseled about common psychosocial effects of cancer and cancer treatment and provided specific referrals to available support groups and services.
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (National Breast Cancer Centre and National Cancer Control Initiative, 2003)Clinic-based protocols should be developed to ensure the following goals:
  • Copies of evidence-based information about treatment options are provided to all patients.
  • Listings of other information resources which may be of value are provided to all patients.
Achieving the Promise: Transforming Mental Health Care in America (New Freedom Commission on Mental Health, 2003) Recommendation 2.5 Protect and enhance the rights of people with mental illness.
Meeting Psychosocial Needs of Women with Breast Cancer (IOM and NRC, 2004) The National Cancer Institute (NCI), the American Cancer Society (ACS), and professional organizations (e.g., American Society of Clinical Oncology, American College of Surgeons, American Association of Colleges of Nursing, American Psychosocial Oncology Society, American Society of Social Work, American Society for Therapeutic Radiology and Oncology, Oncology Nursing Society) need to partner with advocacy groups (e.g., National Breast Cancer Coalition, National Alliance of Breast Cancer Organizations, Wellness Community, National Coalition Cancer Survivorship [NCCS]) to focus attention on psychosocial needs of patients and resources that provide psychosocial services in local communities and nationally.
Public Education
Living Beyond Cancer: Finding a New Balance (President’s Cancer Panel, 2004)Recommendation 4a National public education efforts sponsored by coalitions of public and private cancer information and professional organizations and the media (e.g., film, television, print, and broadcast news) should be undertaken to:
  • Raise awareness of survivor experiences and capabilities, and of the continuing growth of the cancer survivor population. These efforts should seek to enhance understanding of the post-treatment experiences of cancer survivors of various ages and their loved ones and the need for life-long follow-up care.
Recommendation 5c Providers should include psychosocial services routinely as part of comprehensive cancer care treatment and follow-up care and should be knowledgeable about local resources for such care for patients/survivors, caregivers, and family members. In particular:
  • The transition from active treatment to social reintegration is crucial and should receive specific attention in survivor’s care.
  • Primary and other health care providers should monitor caregivers, children, and siblings of survivors for signs of psychological distress both during the survivor’s treatment and in the post-treatment period.
Care Coordination
NCCN Distress Management Clinical Practice Guidelines (NCCN, 2006) Licensed mental health professionals and certified pastoral caregivers experienced in psychosocial aspects of cancer should be readily available as staff members or by referral.
Reimbursement
Living Beyond Cancer: Finding a New Balance (President’s Cancer Panel, 2004)Recommendation 7b Adequate reimbursement for prosthetics must be provided and it must be recognized that:
  • Many prostheses must be replaced periodically.
  • Access to prostheses is an integral part of psychosocial care for cancer.
Recommendation 7c [Health Insurance] Coverage should be routinely provided for psychosocial services for which there is evidence of benefit both during treatment and post-treatment as needed.
NCCN Distress Management Clinical Practice Guidelines (NCCN, 2006) Medical care contracts should include reimbursement for services provided by mental health professionals.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006)Recommendation 2 Patients completing primary treatment should be provided with a comprehensive care summary and follow-up plan that is clearly and effectively explained. This “Survivorship Care Plan” should be written by the principal providers(s) who coordinated oncology treatment. This service should be reimbursed by third party payors of health care.
Recommendation 9 Federal and state policy makers should act to ensure that all cancer survivors have access to adequate and affordable health insurance. Insurers and payors of health care should recognize survivorship care as an essential part of cancer care and design benefits, payment policies, and reimbursement mechanisms to facilitate coverage for evidence-based aspects of care.
Support of Informal Caregivers
Living Beyond Cancer: Finding a New Balance (President’s Cancer Panel, 2004)Recommendation 5b A caregiver plan should be developed and reviewed with a survivor’s caregiver(s) at the outset of cancer treatment. It should include, at a minimum:
  • An assessment of the survivors’ social and support systems.
  • A description of elements of patient care for which the caregiver will be responsible. Caregivers should be provided adequate and, as needed, ongoing hands-on training to perform these tasks.
  • Telephone contacts and written information related to caregiver tasks.
  • Referral to caregiver support groups or organizations either in the caregiver’s local area or to national and online support services.
Recommendation 8a Qualified providers in the treatment setting should train and assist parents to assume their crucial roles in helping the child with cancer return to school and becoming an educator and advocate with individual teachers and the school system.
Recommendation 8b Pediatric cancer centers should offer and promote teacher training as a part of their community outreach efforts to help ensure that the needs of pediatric cancer survivors returning to the classroom are met. Internet-based training modules also should be considered to extend the geographic reach of these training efforts. If possible, continuing education units (CEUs) should be provided to participating teachers.
Recommendation 8c NCI and the Dept. of Education should explore collaborative opportunities to improve the classroom re-entry and reintegration of young people with cancer or other chronic or catastrophic illnesses (e.g., remote learning, teacher training).
Recommendation 9b As part of the process of transitioning survivors of childhood cancers into the adult care setting, information about young adult support groups, Internet sites, and other sources of information and support specific to this age group should be provided to survivors and their families.
Recommendation 10 Cancer care providers should inform families of cancer patients about supportive services, including special camps for families and siblings.
Recommendation 12a Family members, primary care providers, cancer specialists, and others who are close to or provide medical care to adolescent and young adult survivors should be made aware that depression, anxiety, or other psychosocial issues may affect the survivor long after treatment ends and should be instructed on how to intervene should the survivor experience such difficulties.
Recommendation 12b Adolescent and young adult survivors should be taught self-advocacy skills that may be needed to secure accommodations for learning differences resulting from cancer or its treatment. Physicians and other providers should act as advocates for survivors when necessary.
Recommendation 16 Health care providers must ascertain the strength of an older survivor’s social and caregiver support system. This should be assessed at diagnosis, during treatment, and at intervals after treatment is completed. Oncology nurses, nurse practitioners, other advanced practice nurses, physician assistants, social workers, patient navigators, or other non-physician personnel may be best able to make these assessments and arrange assistance and services for survivors who lack adequate support.
Recommendation 17 Health care providers should not assume that older cancer survivors and their partners are uninterested in sexuality and intimacy. Survivors should be asked directly if they have concerns or are experiencing problems in this area and should receive appropriate referrals to address such issues.
Employment
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006)Recommendation 8 Employers, legal advocates, health care providers, sponsors of support services, and government agencies should act to eliminate discrimination and minimize adverse effects of cancer on employment, while supporting cancer survivors with short-term and long term limitations in ability to work. The following text follows the recommendation:
  • Cancer professionals, advocacy organizations, and the NCI and other government agencies should continue to educate employers and the public about the successes achieved in cancer treatment, the improved prospects for survival, and the continued productivity of most patients who are treated for cancer.
  • Public and private sponsors of services to support cancer survivors and their families should finance programs offering education, counseling, support, legal advice, vocational rehabilitation, and referral for survivors who want to work.
  • Providers who care for cancer survivors should become familiar with the employment rights that apply to survivors who want to work and make available information about employment rights and programs that provide counseling, legal services, and referral.
  • Providers should routinely ask patients who are cancer survivors if they have physical or mental health problems that are affecting their work, with the goal of improving symptoms and referring patients for rehabilitative and other services.
  • Employers should implement programs to assist cancer survivors. Examples include short- and long-term disability insurance, return to work programs, wellness programs, accommodation of special needs, and employee assistance programs.
  • Cancer survivors should tell their physicians when health problems are affecting them at work. Survivors should educate themselves about their employment rights and contact support organizations for assistance and referrals when needed.
Workforce Education
NCCN Distress Management Clinical Practice Guidelines (NCCN, 2006) Educational and training programs should be developed to ensure that health care professionals and pastoral caregivers have knowledge and skills in the assessment and management of distress.
Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (National Breast Cancer Centre and National Cancer Control Initiative, 2003) Clinic-based protocols should be developed to ensure that all staff working with patients with cancer have participated in relevant communication skills training.
Meeting Psychosocial Needs of Women with Breast Cancer (IOM and NRC, 2004)
  • Sponsors of professional education and training programs (e.g., NCI, ACS, American Society of Clinical Oncology [ASCO], Oncology Nursing Society, Association of Oncology Social Work, American Cancer Society-Commission on Cancer, American Psychosocial Society) should support continuing education programs by designing, recommending, or funding them at a level that recognizes their importance in psycho-oncology for oncologists, those in training programs, and nurses and for further development of programs similar to the ASCO program to improve clinician’s communication skills; and
  • Graduate education programs for oncology clinicians, primary care practitioners, nurses, social workers, and psychologists should evaluate their capacity to incorporate a core curriculum in psychooncology in their overall curriculum taught by an adequately trained faculty in psycho-oncology and to include relevant questions in examination requirements.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006)Recommendation 7 The National Cancer Institute (NCI), professional associations, and voluntary organizations should expand and coordinate their efforts to provide educational opportunities to health care providers to equip them to address the health care and quality of life issues facing cancer survivors.(The text below follows the recommendation):Immediate steps to facilitate the development of programs include:
  • Establish a clearinghouse of available sources of survivorship education and training (and guidelines), with opportunity for feedback.
  • Appoint an interdisciplinary consortium to review available resources, identify promising approaches, develop new programs, and promote cost-effective approaches.
  • Increase support of model formal training programs (undergraduate and graduate levels, continuing medical education) that could be adopted by others.
By specialty:
Physicians
  1. Add more survivorship-related CME:
    • The American Board of Medical Specialties’ new program, “Maintenance of Certification,” will require continuous assurance of professional skills for board-certified physicians. The development of a model on cancer survivorship as part of this program could facilitate the assurance of competence for these and other specialty providers.
  2. Improve online survivorship information aimed at health care providers:
    • Expand physician data query to include more information on survivorship care.
    • Centralize survivorship guidelines online.
    • Encourage the development and adoption of evidence-based guidelines.
    • Ease finding survivorship-related guidelines included in the AHRQ-sponsored guideline clearinghouse (e.g., add the term survivorship to the search engine to pick up surveillance guidelines for cancer).
  3. Expand training opportunities to promote interdisciplinary shared care.
Nurses
  1. Increase survivorship content in undergraduate and graduate nursing programs.
  2. Expand continuing education opportunities on survivorship for practicing nurses.
  3. Increase the number of nursing schools that provide graduate training in oncology.
  4. Increase the number of nurses who seek certification in oncology (incentives are needed).
  5. Endorse activities of those working to ease the nursing shortage.
Social workers and other providers of psychosocial services
  1. Support efforts of APOS to standardize and promote continuing education.
  2. Endorse activities of those working to maintain social services in cancer programs.
Research and Demonstrations
NCCN Distress Management Clinical Practice Guidelines (NCCN, 2006) Conduct multicenter trials that … pilot treatment guidelines.
Meeting Psychosocial Needs of Women with Breast Cancer (IOM and NRC, 2004)
  1. Research sponsors (e.g., NCI, ACS) and professional organizations (e.g., American Society of Clinical Oncology, American College of Surgeons, American Association of Colleges of Nursing, American Psychosocial Oncology Society, American Society of Social Work, American Society for Therapeutic Radiology and Oncology, Oncology Nursing Society) need to support efforts in collaboration with advocacy groups (e.g., National Breast Cancer Coalition, National Alliance of Breast Cancer Organizations) to enhance practice environments to promote coordinated, comprehensive, and compassionate care.
  2. Research sponsors (e.g., NCI, ACS) should continue to support basic and applied psycho-oncology research. This might include:
    • Further development of simple, rapid screening tools for identifying the patient with distress in outpatient offices and training of primary oncology teams in diagnosis of distress that exceeds the “expected” and when referral to supportive services should be made;
    • Studies that assess the relative effectiveness of various psychosocial interventions, using population-based patient samples of adequate size, the timing and duration of intervention, and innovative and inexpensive modes of administration (e.g., Internet-based approaches);
    • A consensus conference to develop a battery of standard instruments for outcome measures to permit comparison of data from studies carried out by different research groups;
    • Organization of a psychosocial clinical trials group in which a network of researchers could address key questions in multi-center studies that would allow access to large, population-based samples;
    • Clinical trials of psychosocial interventions that are conducted within routine breast cancer care in which cost and quality of life are outcome measures; and
    • A registry of ongoing psychosocial research/trials to assist researchers in identifying and tracking new areas of study.
  3. The NCI should support a special study to ascertain the use of, and unmet need for, cancer-related supportive care services (including psychosocial services) in the United States. The results of such a study could provide benchmarks against which care can be measured and performance monitored. Such a study would document existing disparities in service use by age, race/ethnicity, geography, and insurance coverage.
Evidence Report on the Occurrence, Assessment, and Treatment of Depression in Cancer Patients (Pirl, 2004)More research is needed on factors that may cause varying rates of depression and that predict which patients are most at risk. Longitudinal studies are needed to estimate the incidence of depression starting at the time of or, ideally, before diagnosis of cancer.Many instruments with a wide range of complexity are currently being used to measure depressive symptoms…. Multiple methods of assessment make it difficult to compare studies. A consensus choice of instruments may help to standardize research on depression that is comorbid with cancer.
From Cancer Patient to Cancer Survivor: Lost in Transition (IOM and NRC, 2006)Recommendation 5 The Centers for Medicare and Medicaid Services (CMS), National Cancer Institute (NCI), Agency for Healthcare Research and Quality (AHRQ), the Department of Veterans Affairs (VA), and other qualified organizations should support demonstration programs to test models of coordinated, interdisciplinary survivorship care in diverse communities and across systems of care.
Recommendation 10 The NCI, CDC, AHRQ, CMS, VA, private voluntary organizations such as the American Cancer Society, and private health insurers and plans should increase their support of survivorship research and expand mechanisms for its conduct. New research initiatives focused on cancer patient follow-up are urgently needed to guide effective survivorship care.Research is especially needed to improve understanding of …
  • The cost-effectiveness of alternative models of survivorship care and community-based psychosocial services including:
  • Survivors’ and caregivers’ attitudes and preferences regarding outcomes and survivorship care;
  • Needs of racial, ethnic groups, residents of rural areas, and other potentially underserved groups; and
  • Supportive and rehabilitation programs.
  • Interventions to improve the quality of life, including:
    • Family and caregiver needs and access to supportive services.
    • Mechanisms to reduce financial burdens of survivorship care (e.g., the new Medicare prescription drug benefit should be carefully monitored to evaluate its impact, especially how private plan formularies cover cancer drugs).
    • Employer programs to meet return-to-work needs.
    • Approaches to improve health insurance coverage.
    • Legal protections afforded cancer survivors through the Americans with Disabilities Act (ADA), Family and Medical Leave Act, Health Insurance Portability and Accountability Act (HIPAA), and other laws.
  • Survivorship research methods including barriers to participation, impact of HIPAA, and methods to overcome challenges of survivorship research (e.g., methods to adjust for bias introduced by nonparticipation; methods to minimize loss-to follow-up).

From: C, Recommendations from Prior Selected Reports

Cover of Cancer Care for the Whole Patient
Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.
Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting; Adler NE, Page AEK, editors.
Washington (DC): National Academies Press (US); 2008.
Copyright © 2008, National Academy of Sciences.

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