Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

A hybrid effectiveness-implementation study of the Managing Cancer and Living Meaningfully (CALM) intervention across established psychosocial oncology and palliative care programs in Alberta’s Calgary and South Zone (126803)

Janet M de Groot 1 2 , Andrea Feldstain 3 , Carly Sears 1 , Kristen Silveira 4 , Laura Labelle 2 , Sarah Hales 5 , Chloe Hao 1 , Grace Liu 1 , Jessame Gamboa 1 , Kathleeen C Sitter 6 , Hollis Roth 1 7 , Fay Strohschein 1
  1. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
  2. Psychosocial Oncology, Arthur JE Child Comprehensive Cancer Centre, Calgary, Alberta, Canada
  3. Psychology, University of Calgary, Calgary, AB, Canada
  4. Psychology, Island Health Authority, Victoria, BC, Canada
  5. Consultation/Liaison Psychiatry, UHN - Princess Margaret Cancer Centre, Toronto, ON, Canada
  6. Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
  7. Palliative Care Team, Alberta South Zone, Lethbridge, AB, Canada

Background: People with advanced non-curative cancers are a growing population, with prominent psychosocial concerns. The brief evidence-based Managing Cancer and Living Meaningfully (CALM) psychological intervention comprehensively addresses the problems. We studied referral strategies for CALM across established psychosocial and palliative care programs in Alberta’s Calgary and South Zones.

Aims: The study’s primary objectives were to 1) compare implementation outcomes of new and existing referral pathways, including feasibility of obtaining CALM referrals, barriers and facilitators to CALM referrals, and attrition rates; 2) determine feasibility of training clinicians for CALM competence; and 3) assess adherence and patient satisfaction in delivering CALM. The secondary objective was to 4) assess effectiveness with patient-reported outcomes.

Methods: Our pragmatic single-arm Hybrid Type 3 effectiveness-implementation study focused on implementation outcomes for referral strategies while collecting clinical outcome findings. A concurrent, mixed-methods design contributed to comparing quantitative and qualitative data about front-line clinicians' and community cancer support organization leaders' implementation perspectives.

Results:  Patients referred to CALM through the psychosocial oncology program, after distress screening, had higher attrition (X2=6.3, p=.01) than patients directly referred by frontline clinicians. Clinicians resonated with the CALM model, conveyed receptivity to change for beneficial interventions and valued a CALM coordinator in facilitating referrals using clinician and patient information. Multidisciplinary clinicians (one-third of the anticipated aim) were trained to CALM competence. Patient adherence (> 3 CALM sessions) was met by 60% of consented patients, and CALM satisfaction was evident. Patients endorsed reduced depression, death anxiety and enhanced quality of life at 3 months, with no change at six months.

Conclusions: CALM implementation was feasible with new referral routes, facilitated by a CALM Coordinator and informational resources, across established PSO and palliative care programs. Training early career clinicians may support integration of CALM into clinical practice and support the clinical needs of patients with advanced cancer.

  1. Kool M, Hafkamp E, Gol J, Aukema EJ, Malfitano C, Reyners A, Hales S, van de Poll L, Rodin G, de Vries F. Managing cancer and living meaningfully (CALM): Implementation in Dutch Cancer Care. Psycho-oncology 2023; https://doi.org/10.1002/pon.6281
  2. Landes SJ, McBain SA, Curran GM. An introduction to effectiveness-implementation hybrid designs. Psychiatry Res 2019; 280: 112513. doi: 10.1016/j.psychres.2019/112513