The PACT Study: Psychosocial Assessment, Care and Treatment of patients with urological and head and neck cancers.

The PACT (Psychosocial Assessment, Care and Treatment) model, targeting patients with head and neck (H&N) or urological cancers at John Hunter Hospital, will be developed as part of this study. This model aims to systematise the approach to screening for distress and responding to that distress in a coordinated manner, including facilitating continuity of care for patients who reside some distance from the acute care setting where their cancer treatment was received. As part of the newly developed model of care, all inpatient and outpatient urology and H&N cancer patients will be screened at their first diagnostic or treatment visit and at each subsequent follow-up visit, using the Distress Thermometer (DT) and accompanying Problem Checklist, which will inform the development of a care plan to address the issues identified through the screening and second-line inquiry. The care plan will facilitate provision of care tailored to specific needs of patients and promote continuity of care across care settings and providers, including with health care providers (HCPs) in rural and regional areas. The screening and problem checklist will act as a trigger for frontline staff to inquire about and discuss the cause/s of distress with patients whose distress levels are above the recommended cut-off of 4 out of 10. Training for frontline staff will focus on discussing the cause of the distress, developing an evidence-based psychosocial care plan to address identified concerns, providing information and/or basic counselling or referring patients with significant or persistent distress to the psycho-oncology service, and facilitating continuity of care including linking patients with hospital and community services as required. Training will be delivered in 2.5-3 hour sessions on a quarterly basis throughout the duration of the intervention period. Long-term sustainability of these service changes will be promoted through organisational leadership and management support; engagement of cancer clinician leaders in each unit in the design and evaluation of the service model; and development of a model with the aim of adaptability and flexibility to diversity of locations and patient complexity (e.g. through complex case review and revision of psychosocial care plans and active involvement of clinicians from rural locations in this process). This new model of care is expected to be implemented for a period of 15 months.