Hulbert-Williams Nicholas J, Hulbert-Williams Lee, Patterson Pandora, Suleman Sahil, Howells Lesley
Centre for Contextual Behavioural Science, University of Chester, Chester, UK
Centre for Contextual Behavioural Science, University of Chester, Chester, UK.
BMJ Support Palliat Care. 2021 Mar 24. doi: 10.1136/bmjspcare-2020-002786.
Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT).
We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach.
We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions.
At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees' stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility.
Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.
心理痛苦在癌症患者中普遍存在，且常常表现为未得到满足的支持性护理需求。在临床实践中，与痛苦相关的需求通常由护士和非心理学家的联合医疗保健专业人员来处理，他们在心理治疗框架方面的培训可能有限，尤其是对最近开发的干预措施，如接纳与承诺疗法（ACT）。
我们为从事癌症支持性和姑息性护理工作的专业人员制定了一个单日培训计划，以改变关于心理痛苦和折磨的临床沟通性质，使其朝着与ACT一致的方法转变。
我们报告了在英国和澳大利亚的政府资助及慈善部门进行的三次培训迭代中，培训实施的经验以及关于培训满意度和将培训应用于临床实践的意愿的评估数据。116名癌症护理专业人员参加了培训。使用自我报告调查从53名参与者（在2周或3个月随访时，或两者都有）收集评估数据，包括定量和自由文本问题。
在2周随访时，73%的学员认为我们的课程与他们的工作相关，在3个月随访时，46%的学员同意他们更有能力提供更好的临床服务。定性反馈支持纳入基于ACT技术的体验式学习和理论解释。参加此次培训并未显著增加学员的压力水平，采用这种新的工作方式也未对员工的幸福感产生负面影响。报告了在沟通行为和态度方面出现了积极的、与ACT一致的变化，然而心理灵活性方面缺乏显著变化。
该培训对支持性和姑息性医疗保健的可接受性和适用性是积极的。心理灵活性缺乏变化表明培训计划可能需要更多的体验式内容。一个培训组中的后勤挑战表明未来需要更强大的培训培训师模式。
