Abstract
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 (X(2) = 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.