Abstract:
About 1.6 million new cancer diagnoses are expected in 2016 and most individuals will receive treatment in one of 1500 outpatient community cancer centers (ACS, 2016). While many are successfully treated, other individuals will transfer from cancer care to alternative forms of care, including hospice. Positive transitions to new care settings result from good, clear communication between professionals and patients/families. The present study was designed to examine how care transitions are carried out, including team communication (interdisciplinary team and family meetings) about changing goals/plans of care, transition protocols, and follow-up procedures. Also investigated were the specific social work roles and activities that help prepare and support patients and families throughout changes in treatment and care settings, with a particular focus on transitions near the end of life. Distress screening practices were examined along with their impact on social work services. An online quantitative survey constructed for this study was conducted with a national random sample of outpatient oncology social workers drawn from facilities accredited by the Commission on Cancer (CoC) and stratified according to center classification. Of 481 cancer centers contacted, 119 had no social workers on staff. A total of 329 social workers were surveyed; 111 responded for a response rate of 34%. Findings indicated that patients/families were more prepared for the transition to hospice care when patients and families participated in family meetings addressing goals of care and were more involved in decision-making processes. Most centers did not have procedures to follow-up after the transition to another formal care provider. Social workers indicated challenges with the inclusion of distress screening measures (CoC mandate), including variation in administration, interpretation, and notification of distress screening scores. Greater demand for social work services has resulted in higher caseloads, with no promise of increased staff forthcoming. Study implications include the need to improve patient/family preparation for care transitions in cancer centers through improved communication and education, especially for transitions to hospice. Social workers can take the lead in development of clear protocols for care transitions that will ensure continuity of care and positive quality of life outcomes.
