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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引用次数: 0
摘要
背景：简短的基于证据的癌症管理和有意义的生活（CALM）心理治疗有效地解决了不同文化中晚期无法治愈的癌症患者常见的社会心理问题。需要制定实施战略，加快采用CALM等心理疗法，以满足临床需求。目的：本研究旨在制定和比较实施CALM转诊策略，评估培训临床医生CALM能力的可行性，并评估患者对CALM的依从性和满意度。纳入患者报告的结果以确认有效性。方法：采用一项实用的单臂混合3型有效性-实施研究，采用并行、混合方法设计，评估转诊策略的实施结果，同时收集CALM的临床有效性数据。实施研究框架的综合框架为访谈提供了信息，以获得临床医生和社区癌症护理组织领导人对CALM转诊障碍和促进因素的看法。结果：临床医生对CALM模型产生共鸣，传达了对有益干预措施变化的接受度，并重视CALM协调员在促进临床医生和患者信息转诊方面的作用。通过心理社会肿瘤学（PSO）项目转诊到CALM的患者，在痛苦筛查后，比直接由一线临床医生转诊的患者有更高的损耗率（X2 = 6.3, p = 0.01）。多学科临床医生的CALM能力培训受到人员流失的限制。结论：在已建立的PSO和姑息治疗项目中，通过新的一线肿瘤临床医生直接转诊途径，CALM的实施是可行的。一个CALM研究协调员促进转诊，并提供信息材料。培训早期职业临床医生可以支持将CALM纳入临床实践，支持晚期癌症患者的临床需求。
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.
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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