Characteristics and outcomes of psychology referrals in palliative care.

230 Background: Despite high distress, a small percentage of cancer patients are referred for psychological care. MD Anderson's interdisciplinary Palliative Care team recruited 2 clinical psychologists in 9/2013. The demand for services exceeded capacity; thus a 3rd psychologist and 3 counselors were added in 6/2015.

METHODS: Retrospective review of 2827 unique patients (6451 total contacts) from 9/1/2013 to 2/29/2016, including billable (psychologists) and non-billable (counselors) services.

RESULTS: Psychologists saw 1958 unique patients (4987 contacts): 1662 (85%) inpatients and 296 (15%) outpatients. Mean inpatient and outpatient session length was 37 (SD = 15) and 51 (SD = 19) minutes, respectively. 865 (44%) patients had 1 session, 507 (26%) had 2, and 585 (30%) had 3 or more. At first visit, DSM-5 diagnoses were: 1681 (86%) adjustment disorders and 226 (12%) major mood or anxiety disorders. Most first visits included assessment (N = 1666; 85%); other services were also provided: 1545 (79%) supportive expressive counseling; 300 (15%) family counseling; 114 (6%) cognitive-behavioral therapy (CBT); and 40 (2%) relaxation skills. From 6/2015-2/2016, counselors saw 869 unique patients (1464 contacts): 759 (87%) outpatients, 99 (11%) inpatients, and 11 (1%) outreach through web-based video or phone. Mean session length for outpatient, inpatient, and outreach was respectively, 37 (SD = 17), 34 (SD = 18), and 17 (SD = 8) minutes. 560 (64%) patients had 1 session, 166 (19%) had 2, and 143 (17%) had 3 or more. Services at first visit included: 994 (93%) supportive expressive counseling; 654 (61%) assessment; 139 (13%) relaxation skills; 99 (9%) CBT; and 73 (7%) acceptance and commitment therapy (ACT).

CONCLUSIONS: The 128% increase in psychology services after expanding providers underscores the value placed by the Palliative Care team. With the majority receiving only 1 session, results indicate the need to improve screening for earlier referral, allowing for more sophisticated services such as CBT and ACT, which are most effective for major mood or anxiety disorders and may prevent adjustment disorders from progressing to greater clinical distress. Our new efforts at outreach could also enhance access and types of services provided.