Recent changes in cancer care standards have led to increased distress screening in oncology social work. This has had many positive outcomes; screening itself, however, without effective follow-up services is not enough.
 

As primary providers of psychosocial care, oncology social workers can benefit from a tracking system that monitors the services they provide and their impact on patients. Unfortunately, there is no widely used and empirically validated instrument that captures the range of interventions provided by oncology social workers. A standardized instrument developed specifically for oncology social work and used across cancer centers could increase the power and representativeness of data so that when pooled, they reflect national trends for oncology social work in addition to informing an individual’s own clinical practice. This article describes the development of the Oncology Social Work Intervention Index (OSWii), including results of a pilot test of the instrument conducted using the listserv of the Association of Oncology Social Work.

Instrument Development

The OSWii was developed from the 2014 AOSW project, A Project to Assure Quality Cancer Care (APAQCC), which involved AOSW members representing 65 Commission on Cancer-accredited cancer programs across the United States and Canada (Zebrack, Kayser, Oktay, Sundstrom, & Sacks, 2017). When distress scores indicated need for follow-up, we used an open-ended question on a standardized form to collect distress screening data from electronic health records that asked, “What did the social worker do?”  We used the data from this question to develop the OSWii.

The research team began exploring this data using software tools like Word Count and NVivo to develop conceptual categories of similar activities. We worked on these categories until we achieved consistency, eventually developing four categories of interventions:

• Category 1 includes interventions where there was no direct contact (e.g., sending information, leaving messages);
• Category 2 includes interventions where there was direct contact, but no clinical intervention was provided (e.g., assessment, monitoring, patient declined further social work services);
• Category 3 includes interventions that educate about resources, connect patients and families to services, and/or advocate for patients and families; and
• Category 4 includes interventions that provide emotional support and/or counseling to help patients/families adjust to and cope with diagnosis and treatment.

Categories 3 and 4 are considered to be clinical interventions. Category 3 has four subcategories: financial resources, resources that facilitate treatment, in-house health professional services and community support services. Category 4 identifies three distinct subcategories of intervention: basic support (validation, normalization, empathic listening), decision-making support/counseling (treatment, end-of-life) and therapeutic counseling services (psychotherapy/CBT, couples or family counseling, and bereavement).

Testing the OSWii

In order to pretest the instrument, we developed an online version limited to the two categories that describe clinical interventions (Categories 3 and 4). Fourteen oncology social workers agreed to test the OSWii with five of their cases and to participate in a phone interview to discuss their experience using the index. Eleven completed the pre-test, providing data on 56 cases (Oktay, Rohan, Shapmire, Callahan, Burruss, & Zebrack, 2018). The feedback from the volunteer testers suggested that the online version of the index was easy to use and that it fit well with the interventions that oncology social workers provided. We made minor revisions to the index following the pre-test.

We then developed a manual to provide clarification to those who were completing the index.  We used the AOSW listserv to recruit volunteers to read the manual and provide feedback. In all, 15 volunteers provided feedback, and the manual was revised.

For the pilot test, we developed another online version of the revised instrument, this time including all four categories and the manual. We recruited volunteers using the AOSW listserv from mid-May to mid-June 2018. They were asked to provide informed consent and to select five cases randomly to use for testing the OSWii. In addition, they were asked to provide feedback on the OSWii, including suggestions for changes.

Results

Thirty-eight oncology social workers participated in the study, providing data on 156 cases. Participants indicated they found the OSWii quick and easy to use. Only one participant did not find the manual helpful.

Types of Interventions Provided by Oncology Social Workers

The OSWii showed that in 73 percent of cases, the oncology social worker provided a clinical intervention (Category 3 and/or Category 4). The most common intervention (50 percent of cases) involved a combination of both types of clinical intervention (Category 3 and Category 4). In 13 percent of the cases, the social worker had no direct contact with the patient/family (Category 1), and in the same percentage of cases, the social worker had direct contact but did not provide a clinical intervention (Category 2).  

Number of Sessions

For each case, oncology social workers estimated the number of sessions provided. The most frequent response was 2 to 3 sessions (38 percent), closely followed by 4 to 5 sessions (31 percent) and 6 or more sessions (27 percent). In 22 percent of cases, only a single session was involved. Because the data were drawn from the social worker’s current caseload on the day of data entry, additional sessions after data entry were possible. Therefore, the total number of sessions provided may have been higher than what was recorded in the pilot test.  

Further Research

The OSWii has the potential to facilitate research in oncology social work. For example, it can be used in studies to describe the interventions provided by oncology social workers, in research on social work staffing levels and, perhaps most importantly, in studies that explore the relationship between oncology social work services and outcomes valued by patients, families, communities and health system administrators.

Using the OSWii in a Practice Setting

While the OSWii was developed as an instrument to advance research, we have developed a practice version that can be used in a practice setting. Oncology social workers may want to use the practice version to demonstrate what services they provide, assess their own practice or demonstrate to administrators and/or professional colleagues the breadth and depth of services provided. They may also use it to show patients and families the wide range of psychosocial services available. The practice version is available by contacting the first author at joktay@ssw.umaryland.edu. It will also be available to AOSW members on the AOSW website.

References 

Oktay, J.S., Rohan, E., Shapmire, T. J., Callahan, C., Burruss, K., & Zebrack, B. (2018). The development and testing of an instrument to describe oncology social work interventions. APOS, Tuscon, AZ. (Psycho-Oncology, 27, S1, Session 20.1).

Zebrack, B., Kayser, K., Oktay, J., Sundstrom, L., & Sachs, A. (2017). The Association of Oncology Social Work’s Project to Assure Quality Cancer Care (APAQCC). Journal of Psychosocial Oncology, 35, 1-12.

Thank You! We offer our heartfelt thanks to all the AOSW members who helped with the development of this instrument. Whether you participated in the APAQCC study, the pretest, the pilot test or provided feedback on the manual, your help was invaluable.