"I Don't Feel I Have a Lot of Training in Mental Health…": A Qualitative Assessment of Provider Perspectives on Behavioral Health Support for Patients Undergoing Cystectomy.

OBJECTIVE

To explore provider-perceived barriers to delivering psychosocial care throughout the perioperative cystectomy pathway and identify opportunities for system-level improvement. Despite increasing recognition of the psychological burden of bladder cancer and radical cystectomy, structured mental health support remains inconsistently integrated into uro-oncology care.

METHODS

Four semi-structured focus groups were conducted with nurse navigators, ostomy nurses, and urology advanced practice providers (n = 14) at a high-volume academic center. Discussions explored perceptions of patient distress, workflow barriers, and opportunities to integrate psychosocial support into routine care. Transcripts were analyzed using a hybrid inductive-deductive approach with reflexive thematic analysis, supported by NVivo and the Sort & Sift, Think & Shift method.

RESULTS

Providers identified 3 interrelated system-level barriers to consistent psychosocial care: (1) limited role clarity and training in addressing psychological distress, (2) fragmented communication and diffuse ownership across multidisciplinary teams, and (3) non-standardized resources compounded by workforce and time constraints. These barriers contributed to inconsistent distress recognition, delayed referrals, and reliance on informal, provider-dependent approaches to behavioral health support.

CONCLUSION

Providers recognize the psychological burden of cystectomy but face structural barriers that limit consistent delivery of psychosocial care. Embedding standardized screening, clarifying care ownership, and integrating accessible behavioral health resources within clinical workflows may enhance patient-centered outcomes and improve continuity of care.