Barriers to using psycho-oncology services: a qualitative research into the perspectives of users, their relatives, non-users, physicians, and nurses.

PURPOSE: The present explorative study was designed as a qualitative evaluation of the psycho-oncology services (POS) available at a psycho-oncology institution (POI) in Germany. The study focused on barriers to using these services. METHODS: Seven focus groups and five complementary individual interviews were conducted with POS users, their relatives, and POS non-users from a German POI, as well as with oncology physicians and nurses from an affiliated hospital. The focus groups and individual interviews were audiotaped and fully transcribed. Data were analyzed using the documentary method. RESULTS: Four utilization barriers were identified: (1) patients' and physicians' information deficits about POI and POS, (2) patients' and physicians' subjective norms regarding POS, (3) lack of organizational and therapeutic integration of POI and POS into routine oncology care on the ward, and (4) specific characteristics of cancer patients. The most important finding was that lack of organizational and therapeutic integration of POS in routine oncology care on the ward might have a lasting, negative effect on patients' and physicians' information deficits and subjective norms. Furthermore, the identified utilization barriers seem to be a multi-causal problem with complex interdependencies. CONCLUSION: Based on these results, the organizational and therapeutic integration of POS in routine oncology care on the POI ward appears to be a useful tool in offering widely accessible therapies and providing patients with concise, straightforward information via different channels, such as personnel, brochures, and the Internet. Nevertheless, the results should be interpreted tentatively, due to the explorative character of this study.