A Hybrid Effectiveness-Implementation Study of the Managing Cancer and Living Meaningfully Psychosocial Intervention Across Established Psychosocial Oncology and Palliative Care Programs in Alberta's Calgary and South Zone.
J M de Groot, A Feldstain, C Sears, K Silveira, L Labelle, S Hales, C Hao, G Liu, J Gamboa, K Sitter, H Roth, F Strohschein
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Abstract
Background: The brief evidence-based Managing Cancer and Living Meaningfully (CALM) psychotherapy effectively addresses common psychosocial concerns among people with advanced non-curative cancers across cultures. Implementation strategies are required to speed uptake of psychotherapies, such as CALM, to address clinical needs.
Aims: The study aimed to develop and compare implementation referral strategies for CALM, assess the feasibility of training clinicians for CALM competence and assess patient adherence and satisfaction with CALM. Patient-reported outcomes were included to confirm effectiveness.
Methods: A pragmatic single-arm Hybrid Type 3 effectiveness-implementation study with concurrent, mixed-methods design was used to evaluate implementation outcomes of referral strategies, while collecting clinical effectiveness data for CALM. The Consolidated Framework for Implementation Research framework informed interviews to obtain clinician and community cancer care organization leaders' perspectives on barriers and facilitators to CALM referrals.
Results: Clinicians resonated with the CALM model, conveyed receptivity to change for beneficial interventions and valued a CALM coordinator in facilitating referrals with clinician and patient information. Patients referred to CALM through the psychosocial oncology (PSO) programme, after distress screening, had higher attrition (X2 = 6.3, p = 0.01) than patients directly referred by frontline clinicians. Training multidisciplinary clinicians to CALM competence was limited by attrition.
Conclusion: CALM implementation was feasible with new direct referral pathways by frontline oncology clinicians across established PSO and palliative care programs. A CALM study coordinator facilitated referrals, and provided information material, Training early career clinicians may support integration of CALM into clinical practice and support clinical needs of patients with advanced cancer.
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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