Why psychological assessment is important
Surgery and recovery can present multiple significant challenges that affect the psychosocial wellbeing of both the individual and their family. These challenges may include changes in health, physical functioning, body image, identity, relationships, sexual wellbeing, employment, and financial circumstances.
A comprehensive yet focused prehabilitation psychological assessment helps identify the individual’s strengths, concerns, and support needs. This enables psychological interventions to be tailored to the person’s unique circumstances, supporting adjustment, engagement in care, and optimal surgical recovery.
Who can assess
Psychological prehabilitation assessments can be conducted by mental health professionals such as a psychologist, psychiatrist, mental health nurse, or social worker.
Who should receive a psychological assessment
Individuals identified through screening as requiring targeted or specialist psychological intervention should be offered a comprehensive psychological assessment.
Routine referral for psychological assessment is also recommended for all individuals undergoing high-risk or complex surgical procedures (e.g. pelvic exenteration surgery), due to the increased risk of significant psychological and psychosocial impacts before and after surgery.
What and how to assess
It is important to assess factors that are relevant for prehabilitation engagement, surgery preparation, coping during inpatient admission, and recovery. The Psychological prehabilitation assessment template can be used to guide the assessment. The focus of the assessment will be informed by the individual’s presentation, screening information, surgery type and clinician judgment.
For any presenting concern, it is important to assess the onset, severity, and frequency of concerns, the impact on functioning, motivation, and the barriers and enablers to engage in other prehabilitation interventions such as exercise or nutrition.
In addition to the below factors, a typical cancer psychosocial assessment should also be included.
Prehabilitation psychological assessment might include an assessment of:
- Clinical or demographic factors that increase risk of surgery recovery challenges1. See Psychology screening
- Concerns specific to surgery and recovery:
- Factors that may affect prehabilitation engagement2:
- Motivation to engage in all prehabilitation interventions
- Self-efficacy and sense of control
- Social, family, or carer supports
- Physical symptoms including pain and fatigue
- Sleep concerns
- Relationship concerns
- Communication concerns with healthcare professionals
- Cognitive functioning.
- Mental health symptoms that may impact prehabilitation or recovery:
- Anxiety or mood symptoms
- Previous traumatic experiences
- Substance or alcohol use
- Personality traits.
- Existing coping strategies that may negatively impact prehabilitation or recovery:
- Avoidance and denial
- Self-harm
- Emotional eating
- Social isolation or withdrawal
- Excessive googling.
Assessment can be undertaken during the initial appointment of either the targeted or specialist psychological intervention. The clinician could also consider utilising a number of outcome measures to further understand the individuals concerns and monitor their progress. Commonly used tools are summarised in Psychological measures.