Psychological Services Integration in Gynecological Oncology Clinics

Washington University School of Medicine101 enrolled

Overview

The purpose of this study is to understand the feasibility and impact of integrated psychological care in outpatient gynecologic oncology clinics with the goal of creating a new standard of care. The investigators propose an intervention study comparing patient-centered outcomes (assessed by surveys) between women who receive usual care versus integrated psychological care. The investigators' objectives are to learn about the process of integration of psychological care directly into outpatient gynecologic oncology clinics and the impact of such integration on patients' well-being, presentation of symptoms, psychological functioning, coping mechanisms, awareness of support services offered, and perception of quality of care. As this is a feasibility study, aims are focused on assessing patient willingness for psychological intervention in the medical office, provider willingness to have psychologist present in clinic, and impact of psychological intervention. With such data to warrant further integration and time of psychologists in medical clinics, next steps for immediate and long-term projects may include focus on high risk populations, specific disease sites, additional provider clinics, more psychologist time spent in gynecological oncology clinics, and effectiveness of interventions with higher power. The investigators hope the results will serve as preliminary data for an integrated psychosocial care model that can be implemented in other oncology clinics.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Enrollment

101

Conditions

Gynecologic Oncology Patient

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged 18 years or older * Scheduled for an appointment in a gynecologic oncology clinic at the Siteman Cancer Center at the Center for Advanced Medicine or the Women's Tumor Clinic at the Center for Outpatient Health at Barnes-Jewish Hospital * Patients may or may not have a cancer diagnosis. * All gynecologic cancer types, histologic grades, primary or recurrent disease. * Patients actively undergoing treatment or close observation * Pregnant or lactating patients * Able to speak and read English * Able to consent Inclusion criteria (correlative studies only) -Patients who are undergoing pre-operative work-up for evaluation of an adnexal mass by a Washington University gynecologic oncologist. Exclusion Criteria: -Impaired by a psychiatric or cognitive disorder that limits their ability to give consent or communicate with their medical providers about symptoms (as determined by the patient's medical team) Exclusion criteria (correlative studies only) * Neoadjuvant chemotherapy * Treatment within the past month with antidepressant medications that affect serotonin physiology * Specific histology: low malignant potential tumors, non-epithelial cancer histology. * Previous cancer diagnosis within the past five years or recurrent cancer * Regular steroid use in the last month * Presence of comorbidities with known effects on the immune system (e.g., systemic lupus erythematosus, multiple sclerosis, and rheumatoid arthritis), congestive heart failure, pregnancy, or stroke within the past six months * Major surgery in the past month.

Outcomes

Primary Outcomes

Feasibility of integrating psychosocial care by a trained psychologist into gynecologic cancer outpatient clinics as measured by patient enrollment

-Willingness to participate with integrated care as quantified by proportion of enrolled patients from the number of approached eligible patients

Time frame: Completion of patient enrollment (approximately 12 months)

Secondary Outcomes

Provider willingness to have a psychologist present

-5 item survey about willingness to have psychologist present in clinic

Time frame: 6 months after start of study enrollment

Differences in clinic visit duration with and without a psychologist present

-Clinic visit duration is defined as the time from check-in to patient discharge

Time frame: Day 1

Difference in psychological correlates of daily functioning as measured by patient distress between women who receive usual care versus integrated psychological care

* NCCN Distress Thermometer: picture of thermometer that states to circle the number that best describes how much distress has been experienced in the past week (10=extreme distress and 0=no distress) * Next section contains categories of Practical Problems, Family Problems, Emotional Problems, Physical Problems, Spiritual/religious concerns - participant is to mark yes or no to indicate if they have had problems in the past week * The distress thermometer score of 0-10 is recorded. The problem areas endorsements are tallied within each problem area.