Development of a supportive cancer care model for patients with CAncer and pre-existing SEvere MEntal Disorders.

Abstract

Purpose: Cancer patients with pre-existing severe mental disorders (SMD), including moderate to severe depression, bipolar disorder and schizophrenia, have reduced life expectancy and are less likely to receive optimal cancer treatment. The aim of this study is to develop and pilot test a supportive care model, to enhance cancer care in this population.

Methods: The model was developed through three phases. In phase I, a barrier analysis and prototype of the model were conducted from reviewing the literature and through 162 informal interviews with healthcare professionals, patients and patient representatives. In phase II, the prototype was refined through four workshops with a total of five cancer nurses, four clinical oncologists, three psychiatrists, two general practitioners, one psychologist, and 16 patient representatives. Thereafter, a pilot test with 13 patients was carried out, where continuous adaptations to the prototype from phase II, were made. The quantitative and qualitative data were analysed focusing on components which were prominent and able to fit into the clinical setting.

Results: The final CASEMED supportive cancer care model included: Early identification of psychiatric comorbidity, engagement of significant caregivers, education of the oncological HCPs, securing continuity among staff and enhanced collaboration between sectors. The latter was achieved through an online psychiatric multidisciplinary team conference where the patient's general practitioner, a psychiatrist and the patient's oncologist participated.

Conclusion: This study indicates that the model can be implemented in practice and has the potential to optimize cancer care for patients with cancer and pre-existing SMD. A larger feasibility study is currently being conducted.