title: Frequency of psycho-oncologic and social service counseling in cancer centers relative to center site and hospital characteristics: Findings from 879 center sites in Germany, Austria, Switzerland, and Italy.
abstract: BACKGROUND
  There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Society's cancer center certification system include the routine provision of psycho-oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers.
  
  
  METHODS
  Data routinely collected during the certification process regarding the percentages of psychosocial care provision and characteristics of center sites and hospitals were matched with data with regard to size of the municipality, teaching hospital status, and institutional ownership. Linear multilevel regression analyses were performed to identify the characteristics of hospitals and center sites that were related to psychosocial care provision.
  
  
  RESULTS
  Substantial differences were found for different types of cancer (eg, a greater provision of psychosocial care in centers specializing in breast rather than prostate cancer). There was more POC provision in longer-certified centers and less in rural areas and university hospitals. Much of the variation between hospitals remains unexplained.
  
  
  CONCLUSIONS
  Although the implementation of mandatory psychosocial services generally provides patients with access to POC and social service counseling, the wide differences in the provision of counseling indicate that additional measures are needed to avoid inequalities resulting from the center at which a patient receives cancer treatment. Cancer 2016;122:3538-3545. © 2016 American Cancer Society.
authors.affiliation: Department for Certification, German Cancer Society, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kowalski
authors.affiliation: OnkoZert, Certification Institute of the German Cancer Society, Neu-Ulm, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Ferencz
authors.affiliation: Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz University Medical Centre, Mainz, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Singer
authors.affiliation: Association for Social Work in the Health-Care System, Berlin, Germany.
authors.forename: Ilse
authors.initials: I
authors.lastname: Weis
authors.affiliation: Department for Certification, German Cancer Society, Berlin, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Wesselmann
keywords: cancer centers; certification; health care disparities; multidisciplinary treatment; psycho-oncology; social work