Referral and Utilization of Mental Health Services by Older Adults With Cancer and Factors Influencing Referral From Health Professionals.

Abstract

Objective: Older adults with cancer commonly experience psychological distress. However, the rate at which they receive mental health services is low, and reasons are inconsistently documented. This study aims to characterize adults with cancer referred to mental health services, explore how age influences referrals, and examine factors influencing healthcare professionals' referrals within the Capability, Opportunity, Motivation, and Behavior (COM-B) model.

Methods: We retrospectively collected data from 557 adults with cancer referred to the Clinical Psychology Department at Peter MacCallum Cancer Center in Melbourne, including demographics, clinical details, and referral information. Additionally, we surveyed 18 healthcare professionals using the General Help-Seeking Questionnaire, the Gatekeeper Behavior Scale, Mental Health Literacy Scale, and Attitude Questions, which assessed capability (e.g., knowledge), opportunity (e.g., resources), and motivation (e.g., beliefs) in the COM-B model.

Results: Adults < 65 were more likely to be referred to mental health services than those ≥ 65 (p < 0.001), but among those referred there was no significant difference in referral acceptance/uptake rates (p = 0.25). Adults < 65 are more likely to be referred for adjustment reasons compared to those ≥ 65 (p < 0.05). Healthcare professionals endorse opportunity and motivation factors more when referring adults ≥ 65, but capability factors are a bigger barrier, with fewer than 60% of professionals endorsing nearly half of the capability items.

Conclusions: Older adults with cancer may face inequities in mental health service referrals, but those referred were equally willing to engage. Capability factors present the greatest barrier for professionals referring for mental health, highlighting the need for training.