Use of psycho‐oncological services by prostate cancer patients: A multilevel analysis

Abstract

Background Cancer patients often suffer from psychological distress. Psycho‐oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs). Methods Center‐reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted. Results Model 1 showed that utilization of POS in PCCs is associated with patients’ age (OR = 0.98; 95%‐CI = 0.96‐0.99; P < .001), number of comorbidities (1‐2 vs 0, OR = 1.27; 95%‐CI = 1.00‐1.60; P=.048), disease staging (localized high‐risk vs localized intermediate risk, OR = 1.41; 95%‐CI = 1.14‐1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%‐CI = 0.10‐0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%‐CI = 0.02‐0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%‐CI = 0.03‐0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%‐CI = 0.02‐0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high‐risk vs localized intermediate risk, OR = 1.31; 95%‐CI = 1.05‐1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%‐CI = 0.01‐0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics. Conclusions Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects – for example, less need following radiotherapy – or because access to POS is more difficult for those receiving radiotherapy.

Predictors for the utilization of social service counseling by prostate cancer patients

“…The presence of a comorbidity and risk classification of locally advanced (T3/4) were associated with a higher likelihood of SSC utilization. This is in line with previous findings [24]. An absence of comorbidities may be helpful in managing daily requirements, so that healthier patients may have a lower need for SSC in assisting with practical matters.…”

“…A second finding regarding therapy was that patients who underwent radical prostatectomy were more likely to utilize SSC than patients who received primary radiotherapy or active surveillance and watchful waiting. The same associations have been shown in another analysis of earlier data from the same study concerning the utilization of psycho-oncological counseling [24]. These findings may either indicate differences in study inclusion between different wards or may indicate different levels of need for SSC depending on the treatment.…”

“…The model also revealed a negative association between university hospitals and SSC utilization in comparison with academic teaching hospitals. This association has also been found for the utilization of psychooncological services in prostate cancer centers [24] and may be related to difficulties in the processes needed for SSC provision. Ansmann et al [28], for example, showed that employees in breast cancer centers affiliated to university hospitals experience more process problems and difficulties in interaction and cooperation between wards than employees in non-teaching hospitals.…”

‘It was like taking an inner bath’: A qualitative evaluation of a collaborative advance care planning-approach

“…18 Strikingly, even though a nationwide voluntary certification process in Germany led to an increase in psycho-oncological care-frequency, the minority of cancer patients make use of psycho-oncological services, with weak data pointing to individual reservations, hindering patient characteristics, but also organisational-structural hurdles. 19–22…”

Incorporating psychosocial care into routine oncological care: Insights into challenges and strategies from certified cancer centers' audit data

“…8,9,11,12 In the context of certified cancer centers, percentages of POS and SSC utilization have been related to whether the center is a university hospital. 17,18 In line with the published literature, Andersen et al's 19 Behavioral Model of Health Services Use (BM) follows a multilevel approach and posits that factors at the individual level, such as patients, and at the contextual level, such as the health-care organization and its environment, may influence the utilization of health services. It further states that -at both the individual and also the contextual levelthere are factors that predispose people to use or not to use health services, such as sociodemographic factors or beliefs, enabling factors that facilitate or prevent the use of health services, such as organizational structures, as well as need factors.…”