Biopsychosocial assessment is a dynamic process. As indicated previously, the initial assessment undertaken at the time of diagnosis or hospital discharge should be re-examined at crisis points throughout the course of an illness. These crisis or transition points can occur at times of disease progression or relapse or at times of functional change. The shift into the posttreatment period also represents a significant transition (see the Special Considerations section). Other critical points could occur at the time of a psychosocial crisis such as death or illness of a loved one or the caretaker, or at the time of a social crisis such as loss of a job or the transition to a nursing home. Members of the health care team performing reassessments should be aware that new care needs for both patient and family are often associated with change in the patient’s mobility and the inability of the support system to provide adequate care.[1] Changes in biopsychosocial status can occur rapidly, and it is advisable that the biopsychosocial reappraisal be built into any outpatient or home care routine.

Finally, any biopsychosocial model of care must recognize that an illness, fatal or not, engenders losses and thus the psychological mechanism of bereavement. (Refer to the PDQ summary on Loss, Grief, and Bereavement for more information.) Cancer temporarily or permanently disrupts lives, dreams, hopes, careers, aspirations, integrity, and a sense of security. Feelings are played out in ways that are unique to each patient and family. These feelings are healthy and necessary for psychological healing and renewal. However, if these feelings are not understood and are acted out in destructive ways, the effects can be devastating. Likewise, if the emotional crisis generated by an illness is successfully managed, patients and families can experience psychological growth and maturity. Psychosocial management of cancer, regardless of its outcome, should be an integral part of care and should be available in all cancer settings to ensure complete recovery, in its most broad sense.[2,3]

References

1. Mor V, Allen SM, Siegel K, et al.: Determinants of need and unmet need among cancer patients residing at home. Health Serv Res 27 (3): 337-60, 1992.  [PUBMED Abstract]
   
   
2. McDaniel S, Hepworth J, Dogerty W: A new prescription for family health care. Family Therapy Networker 17 (1): 18-29, 1993. 
   
   
3. Whittam EH: Terminal care of the dying child. Psychosocial implications of care. Cancer 71 (10 Suppl): 3450-62, 1993.  [PUBMED Abstract]
   
   

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