Willingness toward psychosocial support during cancer treatment: a critical yet challenging construct in psychosocial care

Abstract

Psychosocial distress screening, mandated by the American College Surgeons' Commission on Cancer, continues to be implemented across cancer centers nationwide. Although measuring distress is critical to identifying patients who may benefit from additional support, several studies suggest that distress screening may not actually increase patients' utilization of psychosocial services. While various investigators have identified barriers that may impede effective implementation of distress screening, we posit that patients' intrinsic motivation, which we term patients' willingness, may be the biggest predictor for whether cancer patients choose to engage with psychosocial services. In this commentary, we define patient willingness towards psychosocial services as a novel construct, distinct from the intention toward a certain behavior described across pre-existing models of health behavior change. Further, we offer a critical perspective of models of intervention design that focus on acceptability and feasibility as preliminary outcomes thought to encompass the willingness construct described herein. Finally, we summarize several health service models that successfully integrate psychosocial services alongside routine oncology care. Overall, we present an innovative model that acknowledges barriers and facilitators and underscores the critical role of willingness in health behavior change. Consideration of patients' willingness toward psychosocial care will move the field of psychosocial oncology forward in clinical practice, policy initiatives, and study design.

Keywords: Health behavior change; Help seeking; Oncology; Psycho-oncology; Willingness.

Fig 1

Figure presents an innovative model that acknowledges the central role of patient willingness to accept psychosocial referrals in oncology, which significantly overlaps with “motivation” in the COM-B model of behavior [32]. Large grey bars delineate general commonalities in dominant applied models of behavior change (e.g., connecting intention to follow-through). The smaller transparent bar with an asterisk designates the parallel process of patient willingness and intention as explained by the Prototype/Willingness Model, which describes how patient willingness and the “right set of circumstances” lead to a behavior, in this case following up on referral to psychosocial support [27, 33]. This figure also acknowledges barriers and facilitators and their role in influencing patients’ follow-through with psychosocial services. Other models discuss the dynamic process of intention changing over time [33]; however, we have attempted to distill this conceptualization into one epoch of time for clinical applicability, starting with distress screening on the left side of the figure.