title: Barriers to using psycho-oncology services: a qualitative research into the perspectives of users, their relatives, non-users, physicians, and nurses.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Health Services Research Cologne (ZVFK), Medical Department of the University of Cologne, 50933 Cologne, Germany. mella.neumann@web.de
authors.forename: Melanie
authors.initials: M
authors.lastname: Neumann
authors.forename: Maren
authors.initials: M
authors.lastname: Galushko
authors.forename: Ute
authors.initials: U
authors.lastname: Karbach
authors.forename: Hadass
authors.initials: H
authors.lastname: Goldblatt
authors.forename: Adriaan
authors.initials: A
authors.lastname: Visser
authors.forename: Markus
authors.initials: M
authors.lastname: Wirtz
authors.forename: Nicole
authors.initials: N
authors.lastname: Ernstmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Ommen
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D016522:Oncology Service, Hospital; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*