Psychosocial Assessments
Completing a psychosocial assessment with a patient is usually the first interaction an oncology social worker has with a patient. It allows the social worker to gather important information to help guide interventions for the patient.
​It is best to complete a psychosocial assessment with a patient as early in their treatment process as possible. The sooner an assessment is completed, the sooner social work interventions and supports can be provided to address any barriers to care, determine the patient's needs, and provide emotional support.​ In relation to the Family System-Illness Model, an assessment also allows for the oncology social worker to explore the patient's knowledge of their illness and the family dynamics a patient experiences.​
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You can also use this document to follow along with the descriptions and breakdowns of each section below.
Introduction
Before you meet with a patient, make sure you review their chart so you know the basics about them, including their diagnosis. You want to go into an assessment having some knowledge about their medical status, but to meet with them without any preconceived notions about them as a person or assumptions about how they are handling their diagnosis. The next part of completing a psychosocial assessment is finding a quiet, private place to meet with your patient. This can sometimes be difficult in a busy cancer center or hospital setting, but do your best to find a peaceful place to meet with limited possibilities of interruptions. You first want to introduce yourself by name and your role in the patient's treatment team and explain you would like to meet to complete a psychosocial assessment to evaluate for possible needs during the patient's treatment process. Keep in mind, sometimes people may get nervous when hearing the phrase "social worker" so make sure to clarify your role in the cancer center is to make sure the patients have as much emotional and practical support as possible as they go through their cancer journey. You can say something such as, "My name is (name). I am a social worker here at (name of cancer center). My role in your treatment team is helping with things outside of the medical care provided by the nurses and doctors to try to help make this process a bit easier for you and your family. Would you be free to meet with me so I can gather some more information about you to see what I might be able to help you with?" Patients should also be made aware they are welcome to have any friends or family members attend the assessment with them. Having another person attend the assessment with the patient can be beneficial in gathering more information and different perspectives.
Exploring the Patient's Coping and Concerns
Once the patient (and possibly loved ones) are settled, start by exploring how they have been doing since receiving their diagnosis. You don't want to jump straight into detailed questions about their life that could seem interrogative. You can start by asking: *How have you been feeling since receiving your diagnosis? *What were some of your first thoughts when you heard the news? *What led up to you receiving your diagnosis? These questions can help gather how the patient is feeling thus far into their treatment process. Some patients may be completely overwhelmed and terrified, while others may be more accepting and understanding of their diagnosis. You never know where a patient may be mentally during a cancer journey, so it is important to gauge where they are emotionally so you can proceed with your assessment and providing support. This is also an important time to be able to see a patient's understanding of their diagnosis and possible treatment recommendations. Sometimes, doctors can speak using advanced, medical jargon that can be very confusing to someone without a medical background. As social workers, we sometimes act as translators for the medical team to make sure a patient understands their medical status and treatment recommendations.
Exploring Support Systems
Next in the assessment, you want to gather information about how the patient is doing physically and what supports they have in their lives. You can ask questions such as: *What is your living situation like? Are you living alone or with any friends or family? *How to you get to and from your medical appointments? Is anyone available to drive you? *Are they available to help you as you go through treatment, if needed? *How are your loved ones handling the news of your diagnosis? *Do you have children? Do they know about your diagnosis, and how are they handling it? Sometimes during someone's diagnosis, the people we would assume to be most supportive (i.e. their family) end up causing disappointment and sadness when they may not be as available or supportive as a patient hopes. It is important to keep this in mind when asking questions about a patient's family, and to try to not make any assumptions about who may be there for support for a patient. It is good practice to explore all supports outside of a patient's family, such as their friends, coworkers, church community, and neighbors. You can also ask a patient about any pets they may have at home - pets are a huge source of emotional supports for many patients. It is also important to explore if the patients have children, especially if they are young children, who may have difficulty understanding their parent's cancer diagnosis. You may need to connect the family with Child Life Specialists or other supports that may be helpful to working directly with the children to help increased their understanding and emotional support. Furthermore, part of exploring the patient's support system includes finding out if they have any Advance Directive or Health Care Proxy documents completed. It may be difficult to bring up this subject early in meeting with a patient because often an immediate reaction is to think something serious is happening to them that warrants having possible end of life discussions. You must reassure the patients this is a standard question to ask and offer to explore the documents further with them. These documents are important for any one to have completed, not just a person with cancer.
Exploring Financial Situations
Next, it is an important part of a psychosocial assessment to understand the patient's financial and socioeconomic status. Depending on someone's income amount or source, they may be eligible for certain resources. Furthermore, if someone shares they are struggling financially, the social workers will be able to connect the patients to resources they may help them financially. Some questions you can ask to explore someone's financial status are: *Next, I would like to learn more about what your life is like outside of your diagnosis. Are you working right now, or what is your source of income? *What type of insurance coverage do you have? This is also an important time to evaluate and educate the patient about disability options. Depending on the location and work history, patients may be eligible for apply for short- or long-term disability benefits to help with finances while taking time off from work for medical treatment. They also may be eligible for Family Medical Leave Act (please see the Resources tab for more information).
Exploring History of Risk Factors
Another important part of an assessment is exploring any parts of a patient's life that could make their treatment process more difficult for them, such as any history of substance abuse, physical or sexual traumas throughout their life, and/or any mental health diagnoses or concerns. Without have any assumptions about someone who has experienced any of these things, social workers must explore these as possible stressors a patient may have to try to help avoid any additional undue strain on the patient. For example, if a patient has a history of sexual abuse, exams and treatments required for prostate or gynecological cancers could be very triggering for the patient and require extra care, attention, and sensitivity from the medical team. (Visit the Sensitive Practice Training on the Clinicians Resource tab for further training on this topic). Some questions you can ask to explore this section are: *Next, I would like to learn more about any history of trauma or other stress you may have experienced in your life that would be important for your medical team to know as you go forward with treatment. Do you have any history of substance abuse? If so, what kind of substances and how often? *Do you have any history of physical or sexual abuse or traumas in your life? If so, could you tell me a bit about them if you are comfortable? *Do you have any history of mental health concerns, even if they haven't been diagnosed by a professional? Could you tell me more about them? If a patient identifies having substance abuse issues, you should refer them to Recovery Specialists or connect them with services that specialize in substance recovery. If a patient identifies mental health concerns, you should refer them to counseling and behavioral health services. If a patient identifies physical or sexual trauma in their lives, you can explore referring them to appropriate specialists who may help with these things. (please refer to the Patient Resources tab for more information) You also want to make sure the patient is agreeable to you sharing these things with the medical team so they can be aware when working with a patient through their treatment process.
Exploring Resilence Factors
After exploring some extra stressors a patient may be experiencing, you should then explore positive factors in their lives that could be a source of coping, support, and resilience. This includes exploring their ethnic or cultural identifies and religious or spirituality beliefs. A patient's cultural and ethnic identities could be a source of strength and community during their treatment process. Religion and spirituality are also sources of strength for many patients. You can ask things like: *Next, I would like to learn more about your background and any identities that are important to you. Can you tell me about any cultural or ethnic identities you have? *How do they impact your cancer diagnosis and treatment? *Are you a religious or spiritual person? If so, how do your beliefs effect your view on your diagnosis and treatment? *Do you find strength in your religion/spiritual beliefs? You can also explore a patient's hobbies and interests. It is important for patients to lean into things that bring them joy and happiness during a cancer journey, so as a social worker, it is important to encourage them to (safely) spend time doing the things they love and even to try new things. While patients may be limited to things they can do because of side effects from treatments, they can try new hobbies at home, such as painting, drawing, or reading more. Patients are often so busy in day-to-day life that a cancer diagnosis can cause them to "slow down" a bit and have more time for themselves and their interests.
Clinician Assessment, Goals, and Interventions
The conclusion of the assessment is where a social worker would evaluate the patient's overall coping with their diagnosis, discuss goals with the patient, and provide the patient with resources and referrals. You can re-explain your role in the patient's treatment team and ask them specifically what they hope to achieve from working with you. The assessment also helps the social worker determine if a patient has a lack of support, and thus may require more social work attention during their whole treatment process. Some patients may identify little to no needs while others will need a lot of support in various ways. Always make sure you end the assessment with a summary of the things you will do moving forward and how the patient can reach you when they need to discuss something with you. Another part of the psychosocial assessment is to complete a distress screening, which is a measurable tool to evaluate a patient's stress level.