Abstract

IntroductionThe Managing Cancer and Living Meaningfully (CALM) therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated whether CALM was delivered as intended (therapists’ adherence); whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified (treatment differentiation).MethodsTwo trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom Management and Communication with Health Care Providers; CSR: Changes in Self and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality). A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a three-point Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.”ResultsAll 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable (n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists.ConclusionResults verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients.

Highlights

  • The Managing Cancer and Living Meaningfully (CALM) therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention (SPI) in a randomized controlled trial (RCT)

  • The objectives of our study are (1) to verify the application of CALM manual interventions within CALM therapy sessions, (2) to quantify the extent to which CALM interventions were delivered as intended by CALM therapists, (3) to test whether CALM therapists’ experience is associated with the frequency of applied treatment elements, and (4) to check whether blinded raters can distinguish the two treatment conditions (CALM vs. SPI)

  • CALM Therapists’ Experience in Psycho-Oncological Care We examined whether frequencies of applied CALM techniques differed with regard to the level of their experience using χ2 tests with a significance level of 0.003 corrected for multiple testing according to Bonferroni

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Summary

Introduction

The Managing Cancer and Living Meaningfully (CALM) therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention (SPI) in a randomized controlled trial (RCT). According to the stage model for the development of psychotherapy manuals (Carroll and Nuro, 2002), the CALM manual can be classified as a stage II manual, which specifies training and supervision, treatment elements, and evaluation of the treatment process It includes external aspects, such as the number of therapy sessions, length of a session, and the qualification of therapists, as well as internal aspects, such as general therapeutic skills important to deliver CALM therapy (e.g., empathic understanding of patient’s experience; ability to appropriately modulate the emotional state of the patient; ability to shift between supportive, exploratory, and problemsolving therapeutic frames when necessary). The manual offers a detailed description of the contents of CALM therapy: the rationale that patients with advanced cancer benefit from psycho-oncological treatment when the four dimensions (1) Symptom Management and Communication with Health Care Providers, (2) Changes in Self and Relationship with Others, (3) Spiritual Well-being and the Sense of Meaning and Purpose, and (4) Preparing for the Future, Sustaining Hope and Facing Mortality (Hales et al, 2010)

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