Sears Carly, Strohschein Fay, Patten Scott, Feldstain Andrea, Simon Jessica, de Groot Janet
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
Department of Oncology, University of Calgary, Calgary, Canada.
Psychooncology. 2025 Jan;34(1):e70067. doi: 10.1002/pon.70067.
The evidence-based Managing Cancer and Living Meaningfully (CALM) psychotherapeutic intervention was designed to address the complex needs of those with advanced cancer. Ample evidence supports the efficacy of CALM therapy; less is known about the patient-specific factors that influence initiation and continuation of CALM sessions.
To gain understanding of patient-specific factors and referral routes that influence initiation and continuation of CALM.
An Interpretive Description framework and concurrent triangulation mixed-methods design was used to analyse baseline patient-specific variables for prediction of engagement (number of sessions) in CALM following recruitment from cancer centres, palliative care services, and community cancer care organisations across Southern Alberta, Canada. Patient input (n = 10) occurred through semi-structured interviews exploring experiences with advanced cancer, CALM referral and engagement.
Among consented individuals (n = 69), those directly referred by healthcare providers (HCPs) and self-referred (total n = 32), engaged in more CALM sessions (M = 4.97, SD = 3.51) than those referred indirectly (M = 3.19, SD = 2.26, p < 0.05), particularly younger participants (< 65 years) and those with longer life expectancy (> 10 months). Participants chose CALM based on experiences of distress, wanting to talk openly, and expecting benefit.
Greater patient engagement in the CALM intervention following HCPs' direct referrals may be based on trust in the HCP-patient relationship, and accurately prognosticating sufficient physical well-being for participation and benefit. Future health systems research may evaluate systematic programing with offering CALM referrals following an advanced cancer diagnosis.
基于证据的“管理癌症与有意义地生活”（CALM）心理治疗干预旨在满足晚期癌症患者的复杂需求。大量证据支持CALM疗法的疗效；但对于影响CALM治疗开始和持续的患者特定因素知之甚少。
了解影响CALM治疗开始和持续的患者特定因素及转诊途径。
采用解释性描述框架和同步三角测量混合方法设计，分析从加拿大艾伯塔省南部的癌症中心、姑息治疗服务机构和社区癌症护理组织招募的患者的基线特定变量，以预测其参与CALM治疗（疗程数）的情况。通过半结构化访谈收集了10名患者的意见，探讨他们在晚期癌症、CALM转诊和参与治疗方面的经历。
在同意参与的69名个体中，由医疗服务提供者（HCPs）直接转诊和自我转诊的患者（共32名）参与的CALM疗程数（M = 4.97, SD = 3.51）多于间接转诊的患者（M = 3.19, SD = 2.26, p < 0.05），尤其是年龄较小（< 65岁）和预期寿命较长（> 10个月）的参与者。参与者选择CALM是基于痛苦经历、想要坦诚交谈以及期望获得益处。
在HCPs直接转诊后，患者对CALM干预的参与度更高，这可能基于对HCP - 患者关系的信任，以及准确预测有足够的身体健康状况以参与并从中受益。未来的卫生系统研究可以评估在晚期癌症诊断后提供CALM转诊的系统规划。
