A Hybrid Effectiveness‐Implementation Study of the Managing Cancer and Living Meaningfully Psychosocial Intervention Across Established Psychosocial Oncology and Palliative Care Programs in Alberta's Calgary and South Zone
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".