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

Loreto Fernández-González,Moisés Russo Namías,Paulina Bravo

doi:10.3332/ecancer.2021.1256

Abstract

IntroductionPalliative 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.MethodsA 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.ResultsTwenty 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.ConclusionsCALM 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.

Highlights

Palliative care (PC) for advanced cancer is guaranteed by law in Chile, but the formal training for it is insufficient
Even though its provision is considered by the World Health Organization (WHO) as a human right, the same entity states that one of the most significant barriers to its correct implementation is the lack of professionals with specific training in PC [1]
This study shows the results of a training experience among Chilean professionals in Cancer and Living Meaningfully’ (CALM) psychotherapy in Santiago, identifying potential facilitators and barriers to its implementation

Summary

Introduction

Palliative care (PC) for advanced cancer is guaranteed by law in Chile, but the formal training for it is insufficient. Palliative care (PC) aims to improve quality of life and alleviate the suffering of patients and family members of those who have an advanced or potentially life-threatening disease [1] The approach to this suffering is not limited just to physical symptoms, and includes an assessment and treatment of psychosocial and spiritual aspects [2]. There is a consensus that providing psychosocial care to patients with advanced or metastatic cancer should be part of the standard of care, there is a significant gap in access to it: not just because of a lack of trained staff, and because most interventions developed in this field are relevant to high-income countries [3] This represents an access gap for professionals in the Global South due to language and cultural barriers to adapt such interventions in local contexts. Addressing this gap is key as 78% of people who require PC live in low- and middle-income countries, according to WHO data [1]

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