This developmental study represents the first phase of a program of research designed to evaluate interventions to improve quality of life for patients with cancer in a managed care setting. Psychosocial interventions for people with cancer are recognized as they components of comprehensive cancer management. Yet, it is clear from the available literature that cancer psychosocial support services appeal primarily to white, middle to upper middle- class women. Information regarding services that might appeal to a broader range of patients with cancer, and data on patients'awareness of, interest in, and utilization of such services, as well as the barriers that may prevent them from using available services, is lacking. In order to lay the groundwork for future research, the proposed study will evaluate a representative sample of HMO patients with cancer to understand more about their perceptions and use of existing psychosocial resources. The proposed study will identify psychosocial services available to HMO patients with cancer, both within the HMO and ina the surrounding community, and assess patients' awareness of, interest in, patterns of use and satisfaction with these services, as well as perceived barriers to their use. This information will be used, in consultation with HMO managers, providers, patients, and community resource organizations, to develop strategies to increase patient access to and participation in existing services. The goal of the developmental study is to provide the background from future studies which will assess the reach, efficacy, cost- effectiveness, and ultimately the disseminability of various approaches to improving the quality of life of patients with cancer in an HMO. These issues are particularly important from the managed care perspective, where questions as to the most effective ues of health care resources predominate. The managed care setting offers a unique opportunity to evaluate psychosocial interventions in cancer from a population-based perspective. It affords access to a defined population of patients, and thus allows for the evaluation of important issues such as the reach, appeal, and participation rates of a given intervention.
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