ArticlePublisher preview availableLiterature Review

Consultation models in psychosocial oncology

April 2025
Supportive Care in Cancer 33(5)

Authors:

Purpose Best practice regarding screening for cancer-related distress includes timely follow-up with psychosocial services to address identified needs. Cancer centers frequently struggle to identify distress via systematized, low-burden workflows and link patients to high-quality, evidenced-based care. Models of psychological and psychiatric consultation can address several known challenges of attending to patient and provider need and can be designed with varying resources and levels of integration. Consultation can be offered in inpatient and outpatient settings and function independently or within existing supportive care departments. Methods This review summarizes four models of consultation including 1) inpatient psychological consultation, 2) outpatient psychological consultation, 3) integrated and tiered psychiatric consultation, and 4) integration of behavioral health providers into subspecialty teams. We present data on utilization of each model, as well as patient clinical outcomes and satisfaction measures and provider satisfaction. Results Consultation models are utilized and offer an effective approach to optimizing timely and accessible care. Utilizing this model of care between July 2020 and June 2021, we managed more than 1200 inpatient referrals for consultation and responded to more than 1600 outpatients with positive distress screens. Programs should consider strengths and limitations of implementing consultation models, with an emphasis on available staffing and institutional investment in supportive care for cancer survivors.

Workflow for distress screening and follow-up

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Tiered model of psychiatric treatment

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Vol.:(0123456789)

Supportive Care in Cancer (2025) 33:407

https://doi.org/10.1007/s00520-025-09418-5

RESEARCH

Consultation models inpsychosocial oncology

LaurenRynar1· JonathanKaplan1· PatriciaFank1

Received: 16 October 2024 / Accepted: 29 March 2025 / Published online: 23 April 2025

Abstract

Purpose Best practice regarding screening for cancer-related distress includes timely follow-up with psychosocial services

to address identiﬁed needs. Cancer centers frequently struggle to identify distress via systematized, low-burden workﬂows

and link patients to high-quality, evidenced-based care. Models of psychological and psychiatric consultation can address

several known challenges of attending to patient and provider need and can be designed with varying resources and levels

of integration. Consultation can be oﬀered in inpatient and outpatient settings and function independently or within existing

supportive care departments.

Methods This review summarizes four models of consultation including 1) inpatient psychological consultation, 2) outpa-

tient psychological consultation, 3) integrated and tiered psychiatric consultation, and 4) integration of behavioral health

providers into subspecialty teams. We present data on utilization of each model, as well as patient clinical outcomes and

satisfaction measures and provider satisfaction.

Results Consultation models are utilized and oﬀer an eﬀective approach to optimizing timely and accessible care. Utilizing

this model of care between July 2020 and June 2021, we managed more than 1200 inpatient referrals for consultation and

responded to more than 1600 outpatients with positive distress screens.

Programs should consider strengths and limitations of implementing consultation models, with an emphasis on available

staﬃng and institutional investment in supportive care for cancer survivors.

Keywords Psychosocial oncology· Consultation· Integrated care· Cancer distress

Introduction

Psychosocial distress and psychiatric symptoms are related

to lower adherence to cancer treatment, worse health and

quality of life outcomes, and increased utilization of medi-

cal services [1, 2]. The American College of Surgeons

Commission on Cancer requires population-based distress

screening for cancer center accreditation, yet cancer cent-

ers frequently struggle to identify distress and link patients

with high-quality, evidence-based care. To oﬀer additional

guidance, an American Psychosocial Oncology Society

task force conceptualized a framework for providing popu-

lation level psychosocial services to patients with cancer

who screen positive for distress [3]. The task force iden-

tiﬁed challenges including limited allocation of resources

to improve population health, lack of integration of ser-

vices into or alongside cancer treatment, diﬃculty tracking

patient outcomes and measuring quality of interventions,

and inability to escalate care during acute changes in dis-

tress [3]. Additional challenges may exist within cancer

centers including systems level (lack of trained personnel,

lack of time, lack of systematic screening and care delivery

protocols), staﬀ level (negative perceptions about patient

distress and the quality of psychosocial interventions

oﬀered [4]), and patient level (shame and stigma [5] lead-

ing to less frequently reported distress, decisional balance

[6], self-eﬃcacy, and intrinsic motivation to engage with

services [7]. Given the mounting evidence demonstrating

signiﬁcant beneﬁt of psychological services throughout the

cancer continuum, psychosocial oncology programs must

consider creative, ﬂexible, and integrated oﬀerings that

* Lauren Rynar

lauren_rynar@rush.edu

Jonathan Kaplan

jonathan_l_kaplan@rush.edu

Patricia Fank

patricia_fank@rush.edu

1 Supportive Oncology, Rush MD Anderson Cancer Center,

1725 W Harrison Street, Suite 950, Chicago, IL60612, USA

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

ResearchGate has not been able to resolve any citations for this publication.

Barriers to accessing psycho-oncological support in head and neck cancer: A qualitative exploration of healthcare professionals’ perspectives

Article

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Apr 2022
EUR J ONCOL NURS

Purpose Disease- and treatment-related consequences in Head and Neck Cancer (HNC) can result in psychological issues for which specialist psychological support, dubbed psycho-oncology, is recommended. Health and Social Care Professionals (HSCPs) function as a crucial link between survivors and these services, through onward referral pathways. However, little is known about these HSCPs’ perspectives on barriers to accessing psycho-oncology in HNC. The current study sought to investigate such perspectives. Methods Eleven HSCPs from national cancer centres across Ireland were recruited using purposive sampling. A qualitative, cross-sectional research design was implemented utilising virtual semi-structured interviews. Interviews were audio-recorded, transcribed, and analysed using inductive, reflexive thematic analysis. Results The researcher identified four themes relating to barriers to psycho-oncology access: Lack of Access and Perceived Elitism in Onward Referral; Communication Barriers; Stigma Associated with Mental Illness and Psychological Services, and Inadequate Signposting and Advertising of Existing Psycho-Oncology Services. These findings indicate that HSCPs face multiple barriers when attempting to refer HNC survivors to psycho-oncology services. Some of these barriers relate to survivors, others to HSCPs themselves, and some to professionals within psycho-oncology services. Conclusions By removing barriers in onward referral faced by HSCPs, HNC survivors may more readily link in with pre-existing psycho-oncology services in the future. The following may assist with removing such barriers: increased inter-professional dialogue between HSCPs and psycho-oncology services and communication skills training; mental health stigma reduction campaigns targeted at survivors, HSCPs, and wider society; and increased signposting of available psycho-oncology services and in-service training for HSCPs.

Consultation-Liaison Psychology: Training and Research Recommendations for This Emerging Interprofessional Practice

Article

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Mar 2020

Consultation-liaison (CL) is a specialized area of practice in psychiatry delivering mental health care to medical patients in inpatient and outpatient settings. In this article, we describe the development of an inpatient-focused interprofessional CL training program customized to fellow-level psychologists. This includes a description of CL psychology experiences, important ethical and professional development topics particularly relevant for psychologists in CL settings, and contributions of the psychologist to the interprofessional CL treatment team. Finally, we offer recommendations for advancing research in this still emerging area of psychology practice.

Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review

Article

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Jan 2020
J GEN INTERN MED

Background: Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). Methods: We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. Results: Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. Discussion: Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.

The Supportive Oncology Collaborative: Expanding upon Collaborative Care to Increase Supportive Care Access in Underserved Populations

Article

Apr 2024
J PALLIAT MED

Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country.

Identifying patient-level factors associated with interest in psychosocial services during cancer: A brief report

Article

Oct 2020
J PSYCHOSOC ONCOL

Objectives: Uptake of psychosocial services during cancer treatment remains relatively low. To use these services efficiently, novel approaches - based on evidence-based theory - are needed to understand cancer patients' readiness to seek psychosocial services. Guided by the transtheoretical model (TTM), we investigated individuals' readiness to use psychosocial services by assessing decisional conflict (pros/cons) and self-efficacy, which are established as the most important constructs of predicting a specific behavior. Methods: In these secondary analyses, we examined demographic and treatment-related factors in a national sample of adult cancer patients and survivors in the United States as predictors of decisional balance (pros/cons) and self-efficacy (i.e., two core TTM constructs) of engaging in psychosocial services. Participants were recruited through an online survey. In addition to examining demographic factors (age, sex, race, and marital status) as independent variables using t tests and correlations, treatment-related variables, such as having multiple cancers, type of cancer, type of treatment, and treatment setting were included. Results: Four hundred and sixty-six participants completed the survey. The sample was primarily Caucasian (79%) and female (54.7%); average age was 47.9 (SD = 14.8). While no significant relationships emerged for self-efficacy, younger age and non-Caucasian race were significantly related to greater cons of seeking psychosocial care. Finally, those with multiple cancers versus reporting only one malignancy endorsed more cons of seeking psychosocial care. Conclusions: These data highlight the importance of measuring the cons of seeking psychosocial care during cancer treatment, with younger age, non-Caucasian, and those reporting experience with multiple cancers endorsing greater cons. This may impact eventual uptake of available services. Future research should identify individuals at risk for declining services based on perceived cons of seeking psychosocial care during cancer.

Association of pre-existing mental illness with all-cause and cancer-specific mortality among Medicare beneficiaries with pancreatic cancer

Article

Aug 2020

Background Among patients with pancreatic cancer, the association of pre-existing mental illness with long-term outcomes remains unknown. Methods Individuals diagnosed with pancreatic adenocarcinoma were identified in the SEER-Medicare database. Patients were classified as having mental illness if an ICD9/10CM code for anxiety, depression, bipolar disorder, schizophrenia or other psychotic disorder was recorded. Results Among the 54,234 Medicare beneficiaries with pancreatic cancer, roughly 1 in 12 (n = 4793, 8.83%) individuals had a diagnosis of a mental illness. The majority (n = 4029, 84.1%) had anxiety or depression, while 16% (n = 764) had bipolar/schizophrenic disorders. On multivariable analysis, among patients with early stage cancer, individuals with pre-existing anxiety/depression and bipolar/schizophrenic disorders had 22% (OR 0.78, 95% CI 0.69–0.86) and 46% (OR 0.54, 95% CI 0.42–0.70) reduced odds, respectively, to undergo cancer-directed surgery. Furthermore, patients with a pre-existing history of bipolar/schizophrenic disorders had a 20% (HR 1.20, 95% CI 1.21–1.40) higher risk of all-cause mortality and 27% (HR 1.27, 95% CI 1.17–1.37) higher risk of pancreatic cancer-specific mortality compared to individuals without a history of mental illness. Conclusion One in twelve patients with pancreatic cancer had a pre-existing mental illness. Individuals with mental illness were more likely to have worse overall and cancer-specific long-term outcomes.

Development and Implementation of a Psychological Service for Patients With Cancer

Article

Jun 2020
COGN BEHAV PRACT

Cancer patients frequently experience considerable distress during diagnosis and treatment. The aims of this study were to describe the development and utilization of a psychological service for cancer patients at a community hospital—and to provide preliminary results on clinical outcomes in a “real-world” clinical setting. This program was developed collaboratively by individuals from a university-based clinical psychology doctoral program and a community hospital. The psychological service was comprised of a licensed, PhD-level clinical psychologist and seven clinical psychology doctoral students. Patients were typically referred by their oncologists or nurses. Distress, depression, and anxiety were evaluated for a small subsample of participants. From the time the program was initiated, 238 patients between ages 18 and 95 (M = 66.4) were evaluated over a 3-year period. Most patients (77.8%) were offered psychosocial care. Although 49.8% declined treatment, 23.6% attended one session and 26.6% attended two or more. Average number of individual sessions was 2.77 (SD = 8.31, range = 0–96) and 0.06 (SD = 0.43, range = 0–4) for groups sessions. Patients referred through the Survivorship Training and Rehabilitation (STAR) Program® (i.e., a program providing multidisciplinary services) were more likely to engage in psychosocial care than those who found out about behavioral health in other ways. Patients experienced declines in depression (Wilks' Λ = 0.580, F(2, 14) = 5.08, p = .022), but not anxiety (Wilks' Λ = 0.613, F(2, 12) = 3.79, p = .053) across sessions. An in-depth case description is provided. Distress tracking may be improved if nurses, oncologists, and behavioral health providers administer measures. Partnerships between clinical psychology doctoral programs and hospitals may be mutually beneficial – and may advance the dissemination and implementation of evidence-based psychosocial interventions. Hospitals offering cancer treatment may benefit from generating referrals for comprehensive cancer care. These efforts can serve as a model for other hospitals seeking to integrate behavioral health into routine cancer treatment.

Framework for Planning the Delivery of Psychosocial Oncology Services: An American Psychosocial Oncology Society Task Force Report

Article

May 2020

Objective: While screening for psychosocial distress is now standard of care in oncology, little guidance is available for how best to deliver services in response to identified needs. The American Psychosocial Oncology Society (APOS) convened a task force with the goal of creating a framework which could aid in planning services and justifying requests for resources. Methods: Ten experts from multiple disciplines within psychosocial oncology served on the task force, first meeting together as a larger group over two days to set an agenda and then subsequently working in smaller teams to execute the goals. The task force used consensus methods for developing recommendations. Results: Three principles were identified for the framework. First, psychosocial oncology is a key component of population health, and population-based approaches to care delivery are required. Second, several key parameters shape psychosocial oncology services: resources, aims, and scope. To guide resource allocation, example priorities were identified for the aims and scope of services. Finally, cancer care centers should strive to ensure the delivery of high quality psychosocial oncology care across all components of care. A range of practices were ranked by their potential contributions to achieving that goal. Conclusions: This framework may aid in planning, evaluating, and refining the delivery of responsive psychosocial oncology services.

Bridge: Person‐Centered Collaborative Care for Patients with Serious Mental Illness and Cancer

Article

Jan 2019

Background: Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative care trial for SMI and cancer. Subjects, materials, and methods: We developed the Bridge intervention for patients with SMI (schizophrenia, bipolar disorder, and severe major depression) and cancer. Bridge includes proactive identification of SMI, person-centered care from a psychiatrist and case manager, and collaboration with oncology. We conducted a 12-week, single-group trial in patients with SMI and a new breast, gastrointestinal, lung, or head/neck cancer. We assessed the feasibility of patient identification, enrollment and study completion; evaluated acceptability and perceived benefit with exit interviews with patients, caregivers, and oncology clinicians; and examined change in psychiatric symptoms with the Brief Psychiatric Rating Scale (BPRS). Results: From November 2015 to April 2016, 30/33 eligible patients (90.9%) enrolled, and 25/29 (86.2%) completed assessments at all timepoints, meeting feasibility criteria. Of 24 patients, 23 (95.8%) found meeting with the psychiatrist helpful; 16/19 caregivers (84.2%) shared that Bridge addressed key caregiving challenges. Oncology clinicians evaluated Bridge as "very" or "most" useful for 94.3% of patients. Exit interviews with all participant groups suggested that Bridge fostered patient-clinician trust, increased access to psychiatric treatment, and enabled patients to initiate and complete cancer treatment. Psychiatric symptoms on the BPRS improved from baseline to 12 weeks. Conclusion: Bridge is a feasible and acceptable care delivery model for patients with SMI, their caregivers, and oncology clinicians. Randomized trials are warranted to assess the efficacy of improving cancer outcomes in this underserved population. Implications for practice: Serious mental illness affects 13 million U.S. adults who experience increased cancer mortality. To improve outcomes, new models of integrated oncology and mental health care are urgently needed. This study found that it was feasible to identify, enroll, and retain patients with serious mental illness and a new cancer in a trial of integrated mental health and cancer care (Bridge). Patients, caregivers, and oncologists reported that Bridge facilitated the initiation and completion of cancer care. Randomized trials are warranted to investigate the impact on cancer outcomes. Trial procedures may inform consent, engagement, and trial retention for patients with mental illness.

Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers

Article

Dec 2018

Routine distress screening in United States oncology clinics has been mandatory since 2015. Objective: This study was the first to assess distress in a geographically diverse sample of cancer patients following mandated distress screening implementation by oncology social workers. Methods: Sites were self-selected via social workers who applied to participate in the Association of Oncology Social Work’s Project to Assure Quality Cancer Care, advertised through their social media outlets and conference. Electronic screening records were collected from 55 cancer treatment centers in the United States and Canada. Cases required cancer diagnoses and Distress Thermometer (DT) scores to be included. Distress rates and rates by age, sex, cancer type, and ethnicity were examined. Results: Of 4664 cases, 46% (2157) experienced significant distress (DT score ≥ 4). Being female, age 40-59, and having diagnoses of pancreatic or lung cancer was associated with increased likelihood of distress. Half of cases experience clinically-significant distress, though this need was not evenly distributed across patient or cancer types. Conclusion: Identifying those at risk for distress may help inform optimal resource allocation. Methods to address needs of distressed patients in cases of limited resources are discussed.