Objective: Clinical experience reveals a gap between recommended psychosocial care and actual support for psycho-oncology. Physicians are essential for managing psychosocial distress and for the successful implementation of psycho-oncology.The aim was to explore physician's attitudes towards psycho-oncology, their selfperceived barriers towards referral to psycho-oncology, and their personal psychosocial competencies in a maximum-care hospital. Method: Semistructured interviews informed the development of a questionnaire administered to a monocentric sample of 120 physicians at the University Hospital Frankfurt. The data were exploratively analysed. Results: One hundred two physicians completed the questionnaire. Physicians provided high ratings concerning the value of psycho-oncology, beliefs about its efficacy, and their personal commitment to psycho-oncology. Physicians noticed especially barriers that originated from patients themselves. They estimated their own psychosocial education and knowledge as moderate but rated their psychosocial skills and abilities as higher. Frequency of integration of psychosocial care was most strongly influenced by physicians' psychosocial competencies and their personal commitment to psycho-oncology. Integration of psycho-oncological issues occurs in 43% of patients. Conclusion: Physicians are an important indicator of successful implementation. The discrepancy between the positive evaluation and actual support for psychooncology may be explained by several factors, eg, the lack of support from clinic leaders. Patient-related barriers, most often identified by physicians, seem to be an indication of actual lack of psychosocial competencies. Physicians' psychosocial competencies positively affect the implementation of psycho-oncology. Sound knowledge of psychosocial topics may result in increased integration of psychosocial aspects into treatment. Therefore, medical training should focus more on psychosocial issues. SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Senf B, Fettel J, Demmerle C, Maiwurm P. Physicians' attitudes towards psycho-oncology, perceived barriers, and psychosocial competencies: Indicators of successful implementation of adjunctive psycho-oncological care?

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This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60+ years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. Public Significance StatementOur study provides unique insight into psychotherapists' experiences conducting at-home therapy with home-living older adults (60+ years) with long-term care needs and depression. Psychotherapists experienced three dilemmas reflecting difficulty balancing the goals of "curing" and "caring." Addressing these dilemmas in clinical training and supervision may help prepare psychotherapists to work with homeliving older adults with long-term care needs.