Proactive Psycho-Oncology Consultation and Liaison Service Update: Impact on Patients and Providers

Background
A previous six-month pilot study demonstrated the feasibility of an inpatient proactive psycho-oncology service in the blood and marrow transplant population. After the creation of this specialized service, psychiatry consult rate on these units tripled from 10% to 30.5%. Other studies of proactive psychiatry, consultation services, and non-oncology populations have found significantly improved cost utilization, length of stay, and consultation latency.<sup>1 The greater sense of agency and collaboration providers feel inherent to this modality of service, has resulted in benefits to provider satisfaction, and even burn out.1

Methods
The inpatient psycho-oncology service has expanded from just blood and marrow transplant units to additional general medical oncology units and teams. The challenges inherent to scaling up and generalizing a previously established model will be discussed. As well as the curriculum development efforts necessary to incorporate general consultation-liaison fellows into a busy psycho-oncology inpatient service. Data analysis is ongoing into patient outcomes including length of stay, consultation latency, and demographic information for the first full year of the service. A survey is being distributed to the physicians, fellows, advanced practice providers, and nurses to assess the impact the service has had on their knowledge of relevant psychiatric topics, confidence in being able to access psychiatric care when needed, and overall attitude towards the service at large.

Results
Data analysis is ongoing for the service’s first full year, and will be completed in time for the meeting. The full analysis will include (1) metrics comparing patient outcomes including length of stay and consultation latency, (2) updated epidemiological data on number of consults and presence of psychopathology, and (3) provider knowledge, confidence, attitude, and qualitative feedback regarding the service over the past year.</sup>

Discussion
As the field of proactive consultation-liaison psychiatry continues to grow, there is extensive interest in further expanding this model to the domain of psycho-oncology. The updated data from our service is intended to help the development of similar models at other institutions, as guided by its impact on both patients and providers.

Conclusion
An inpatient proactive psycho-oncology service remains a viable model with significant potential benefit to both patients and providers, however, the expansion to more dispersed inpatient teams requires sufficient knowledgeable personnel and close collaboration with oncology colleagues.

References:
1. Oldham, M. A., Walsh, P., Maeng, D. D., Zagursky, J., Stewart, K., Hawkins, S. M., & Lee, H. B. (2020). Integration of a proactive, multidisciplinary mental health team on hospital medicine improves provider and nursing satisfaction. Journal of Psychosomatic Research, 134, 110112.