Standardization of a Psycho-Oncology Model of Hospital and Community Care Using the Hub & Spoke Model

Key Contextual Factors

• As part of the National Cancer Strategy Ireland 2017–2026, the National Cancer Control Programme (NCCP) is tasked with developing a Psycho-Oncology service using a Hub and Spoke model providing fair and equitable access to all cancer patients and their families. The remit is national.
• The NCCP, the Health Service Executive (HSE), the Irish Cancer Society, and voluntary and charitable organisations involved in community cancer support are all involved.

Key Components/Steps

• Inclusion of Psycho-Oncology as a core aspect of cancer services 2017–2026
• Appointment of a National Clinical Programme Lead in Psycho-Oncology (December 2018)
• Publication of a Model of Care for Psycho-Oncology in Ireland completed in September 2020
• Best Practice Guidance for community cancer support centres and services published in August 2020 (standards include Delivery of Core Services, Governance, Adherence to Professional Conduct & Ethics, NCCP Psycho-Oncology Model of Care, Assessing outcomes and impact)
• Pilot peer review project currently being completed for self-assessment of best practice guidance in 10 cancer support centres with national roll out of annual self-assessment and peer review planned thereafter
• Funding secured for 8 posts in Psycho-Oncology multi-disciplinary teams (MDTs) in 2020 and a further 14 posts in 2021 across the four relevant disciplines of psychiatry, psychology, social work and nursing
• Development of an integrated patient pathway
• As a response to COVID-19, a national helpline was set up to support cancer patients and their families to cope with the added distress of isolation and reduced services due to the pandemic. This was a collaborative effort between statutory and the voluntary and charitable sectors

Main Impacts

• Recognition and validation of psychosocial distress as part of the cancer experience
• Early intervention for psychological distress in cancer which reduces the burden on acute services
• Delivery of psychosocial and psychological support to cancer patients in a fair and equitable manner
• Normalisation of the experience of distress in cancer which lessens social isolation
• Emergence of a more comprehensive and cohesive cancer support network across acute, voluntary and charitable sectors

Lessons Learned

• Inclusion in National Cancer Strategy is key to implementation
• Partnership with key stakeholders in the acute, voluntary and charitable sectors are important
• Development of key performance indictors to measure outcomes is essential
• Key barriers include:
  • poor awareness of the extent of psychological distress experienced by cancer patients
  • lack of understanding of Psycho-Oncology as a discipline
  • value of the service poorly promoted to patients by key health personnel
  • possible stigma of mental health difficulties experienced by cancer patients

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