Facilitators and barriers perceived by health professionals in the implementation of Managing Cancer and Living Meaningfully (CALM) psychotherapy in Santiago

Abstract

Introduction: Palliative care (PC) for advanced cancer is guaranteed by law in Chile, but the formal training for it is insufficient. Training models have emerged internationally that enable professionals to be better prepared for the provision of psychotherapy in PC. The objective of this study is to explore health professionals' perceptions of the 'Managing Cancer and Living Meaningfully' (CALM) psychotherapy and the perceived barriers and facilitators to its implementation, based on a theoretical training.Methods: A qualitative study was carried out with health professionals working in oncology and/or PC and participating in a CALM training. A focus group was conducted after to explore the experience of CALM training and the perceived barriers and facilitators to its implementation. A thematic analysis of the content and an analysis of the facilitators and barriers to the implementation of mental health services were carried out.Results: Twenty four professionals participated in the training, six of whom were part of the subsequent focus group. There was a consensus that the training was a positive professional experience and that it is a culturally sensitive and feasible intervention for application in Chile. The barriers identified include institutional bureaucracy as resistance to change, the excess workload of the clinical teams and the absence of spaces for more in-depth training.Conclusions: CALM is a useful and relevant framework for the training of health professionals working in oncology and PC. In Chile, there is a need for training spaces on this topic. Future research and organisational studies should evaluate professionals' beliefs about, and resistance to, adopting evidence-based psychotherapeutic interventions.

Effects of CALM intervention on neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence and quality of life in patients with lung cancer

“…This experiment fully proves that the CALM intervention can effectively improve patients' anxiety and depression symptoms, increase end-of-life preparation, reduce the pain of facing death, and improve communication with family members and medical staff [20]. The CALM treatment includes four areas: self-symptom management and the relationship with medical staff; changes in interpersonal relationships; spiritual beliefs and sense of purpose; making plans, keeping hope and facing death [21].…”

“…The CALM intervention is a novel, simple and personal form of manual psychological treatment intervention aimed at reducing the psychological pain of cancer patients and increasing their social well-being. It mainly includes four areas: self-symptom management and the relationship with medical staff; changes in interpersonal relationships; spiritual beliefs and sense of purpose; making plans, keeping hope alive, and facing death [19,21]. In each CALM intervention, participants decide which areas to address based on their current highest concern and supportive care needs.…”

Managing cancer and living meaningfully (CALM): Implementation in Dutch cancer care

“…31 More specifically, institutional bureaucracy as resistance to change, the excess workload of the clinical teams, and the absence of space for more in-depth training, were barriers to implement CALM in Chile. 32 However, despite such barriers, once therapists started providing CALM in this study, they continued to do so. This appeared to be because they perceived the therapy to be effective for their patients, and valued the CALM framework and the community of practice.…”

“…The negative perceptions or lack of knowledge of physicians about the scientific validity or benefits of psychosocial interventions, and limited resources and referral options, have been emphasized as barriers to the implementation of psychosocial care for adults with cancer 31 . More specifically, institutional bureaucracy as resistance to change, the excess workload of the clinical teams, and the absence of space for more in‐depth training, were barriers to implement CALM in Chile 32 . However, despite such barriers, once therapists started providing CALM in this study, they continued to do so.…”