Exploring patient-related contextual factors and personal reflections about patient engagement in the Managing Cancer and Living Meaningfully (CALM) intervention: A mixed methods study among adults with advanced cancer in Southern Alberta
Date
2024-07-04
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Abstract
Background: 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. Objective: This study aimed to enhance our understanding of the impacts of patient-specific factors, referral routes, and timing of referral on engagement in CALM therapy, with particular attention to the integration of patient voices through in-depth interviews. Methods: This study used a concurrent triangulation mixed methods design involving analysis of baseline questionnaire data and referral details from participants in the CALM Implementation study (n = 69). Participants who consented to follow-up (n = 24) were invited to participate in brief, virtual interviews after completion of CALM therapy. Thematic analysis, within an Interpretive Description framework, was used to analyze interview responses (n = 10). Results: Triangulation of quantitative and qualitative results suggests that initiation and continuation of CALM sessions is affected by multiple, complex factors including mood symptoms, referral route, need for support outside of family/friends, and decline in health status. Patients directly referred to CALM by healthcare providers (HCP) and those who self-referred (total n = 32) engaged in more CALM sessions (M = 4.97, SD = 3.51) versus those first referred to general Psychosocial Oncology (i.e., indirect referral; M = 3.19, SD = 2.26, p < 0.05). Stratified analysis found this effect was significant among younger participants (<65 years) and those with longer life expectancy (>10 months). Some participants suggested automatic referral to CALM following an advanced cancer diagnosis. Provision of comprehensive intervention information, highlighting benefits while being sensitive to mortality fears, was deemed valuable to allow for informed decision-making. Conclusion: Findings suggest that timing and referral route are important to our understanding of participation in CALM. Greater patient engagement in the CALM intervention following direct referral from a HCP may be based on trust in the HCP-patient relationship. Future health systems research may evaluate an automatic referral system in which CALM is offered to all patients following an advanced cancer diagnosis.
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Keywords
advanced cancer, psychosocial oncology, early palliative care, referral routes, psychological intervention
Citation
Sears, C. S. (2024). Exploring patient-related contextual factors and personal reflections about patient engagement in the Managing Cancer and Living Meaningfully (CALM) intervention: a mixed methods study among adults with advanced cancer in Southern Alberta (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.