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Implementing a Psychosocial Screener in Pediatric Oncology: Perspectives of Multidisciplinary Clinicians
Marnik Paeps1,2, Michele A Scialla1, Lamia P Barakat3,4
1Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA.
Insights
Implementing psychosocial risk screening in pediatric cancer is challenging but feasible. Healthcare providers see significant benefits, though discipline-specific views on barriers like EHR integration and time constraints exist.
Area of Science:
- Pediatric Oncology
- Healthcare Implementation Science
- Psychosocial Care
Background:
- Universal psychosocial risk screening is crucial in pediatric cancer care.
- Implementation of screening tools like the Psychosocial Assessment Tool (PAT) faces inconsistencies.
- Provider perspectives across disciplines can influence screening tool adoption.
Purpose of the Study:
- To identify barriers and facilitators for implementing the PAT in pediatric cancer settings.
- To explore differences in perceived barriers and facilitators among medical, social work, and psychology providers.
Main Methods:
- Surveyed 117 healthcare providers (HCPs) from 18 pediatric cancer programs using the PAT Implementation Questionnaire (PIQ).
- Assessed perceived barriers (PIQ-B) and facilitators (PIQ-F) using a 1-4 scale.
- Analyzed data by discipline (medical, social work, psychology) to identify significant differences.
Main Results:
- Overall scores for barriers and facilitators did not differ significantly by discipline.
- Facilitators (M=3.08) were perceived more significantly than barriers (M=2.03).
- Key barriers included "Language barriers/cultural considerations" and "Integrating results in EHR"; key facilitators were "Promotes psychosocial care for all families" and "Promotes positive psychosocial outcomes".
- Social workers and psychologists showed differences in ranking barriers, with social workers noting time constraints.
Conclusions:
- Multidisciplinary providers generally agree on the PAT's benefits and implementation challenges.
- Addressing discipline-specific perceptions, especially time constraints for social workers, is vital.
- Interdisciplinary collaboration and communication are essential for successful PAT implementation.
Objective:
Despite strong evidence supporting universal psychosocial risk screening in pediatric cancer implementation remains inconsistent. Factors at organizational, provider, and patient/family levels impact implementation. Potential differing perspectives regarding risk screening among multidisciplinary providers may influence uptake. This study describes perceived barriers and facilitators in implementing the Psychosocial Assessment Tool (PAT), a psychosocial risk screener and examines differences by discipline.
Methods:
One hundred seventeen healthcare providers (HCPs) representing medical, social work, and psychology from 18 pediatric cancer programs completed two scales from PAT Implementation Questionnaire (PIQ). Item scores (1-4 scale) were ranked and differences tested by discipline.
Results:
Barriers were perceived as "minor" and facilitators as "significant" and overall PIQ scale scores did not differ by discipline. PIQ-B had a significantly lower mean score (M = 2.03) than PIQ-F (M = 3.08), p < 0.001). Barriers and facilitators rated most impactful (highest mean scores) were: Barriers: "Language barriers/cultural considerations" (M = 2.37) and "Integrating results in EHR" (M = 2.26); and Facilitators: "Promotes psychosocial care for all families" (M = 3.31) and "Promotes positive psychosocial outcomes" (M = 3.25). Significant differences were found in the rank ordering of barriers and facilitators by discipline, between social workers and psychologists, with the former noting time constraints associated with screening.
Conclusions:
Multidisciplinary HCPs generally agree on the benefits and challenges in implementation of screening with the PAT. Subtle variations in perceived impact of barriers and facilitators between social workers and psychologists highlight the importance of interdisciplinary collaboration and communication to facilitate implementation.
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