Managing Cancer and Living Meaningfully (CALM): A qualitative study of a brief individual psychotherapy for individuals with advanced cancer

Nissim, Rinat; Freeman, Emily; Lo, Chris; Zimmermann, Camilla; Gagliese, Lucia; Rydall, Anne; Hales, Sarah; Rodin, Gary

doi:10.1177/0269216311425096

Cited by 101 publications

(115 citation statements)

References 47 publications

(79 reference statements)

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“…CALM participants were estimated to have 1.72 times greater odds of improvement on attachment anxiety and 1.58 times greater odds of improvement on attachment avoidance than usual care participants. These findings are consistent with previous research demonstrating that attachment security is responsive to psychotherapy20 and with a qualitative study indicating that CALM helped participants to resolve relational problems 24. Attachment security may be particularly amenable to therapeutic intervention because the threat posed by illness and death and the anticipation of increasing dependency needs heightens the salience of attachment security 3 4.…”

Section: Discussionsupporting

confidence: 88%

“…CALM is a brief, manualised, individual psychotherapy consisting of 3–6 sessions delivered over 3–6 months that addresses four empirically derived domains: symptom management and communication with healthcare providers, changes in self and relations with close others, sense of meaning and purpose, and concerns related to the future and mortality 16 21 24. CALM is individualised in that it is tailored to the particular needs of the patient in content and process.…”

Section: Methodsmentioning

confidence: 99%

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Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Hales

Chiu

et al. 2016

BMJ Support Palliat Care

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b study, which introduces procedures for randomization and improved rigor in preparation for a phase 3 randomized controlled trial (RCT). Aims:To test trial methodology and assess feasibility of a confirmatory RCT.Design: A parallel-arm RCT (intervention vs. usual care) with 3 and 6 month follow-ups. Assessment of feasibility included rates of consent, randomization, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalized anxiety, death anxiety, spiritual wellbeing, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and posttraumatic growth. Bayesian conjugate analysis was used in this low-powered setting.Setting/participants: Sixty adult patients with advanced cancer from the Princess Margaret Cancer Centre.Results: Rate of consent was 32%, randomization 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, Odds Ratio (OR) = Conclusions:A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d = 0.40, with greater attention to issues of compliance and contamination. Registration: ClinicalTrials.gov NCT02353546.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Hales

Chiu

et al. 2016

BMJ Support Palliat Care

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“…Participants in this study were part of a clinical trial examining the efficacy of a brief psychotherapy intervention, Managing Cancer And Living Meaningfully (CALM) (24,27) to alleviate distress in patients with advanced cancer. It was delivered by clinicians (i.e.…”

Section: Setting/contextmentioning

confidence: 99%

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Shaw

Chrysikou

Davis

et al. 2017

Patient Education and Counseling

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Aim: To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this self-reported symptom and its clinical presentation. Design: Participants were part of a psychotherapy trial in advanced cancer. First therapy session transcripts were analyzed using interpretive description in patients reporting low, moderate and high death anxiety on the Death and Dying Distress Scale (DADDS). Setting/participants: 16 participants (10 women and 6 men) with advanced or metastatic cancer were recruited at The Princess Margaret Cancer Centre, Toronto, Canada. In this sample, 6 reported low death anxiety scores (DADDS 0-19), 5 moderate (DADDS 20-50), and 5 high (DADDS 51-75). Results: The low death anxiety group exhibited psychological readiness for death, or contrastingly, non-reflectiveness about death. The moderate group recognized the imminence of mortality, which impacted treatment decisions and future plans. Prior experience with death was discussed as raising the salience of mortality. The high group felt dominated by powerful emotions and could not make sense of their situation. Their distress was exacerbated by substantial relational concerns. Conclusions: Self-reported death anxiety is affected by the awareness and ability to reflect on mortality. DADDS scores may facilitate exploration of this symptom as part of a clinical assessment and may serve to guide treatment approaches. Greater attention to death anxiety is consistent with and recommended by contemporary approaches to palliative care.

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“…They were recruited from June, 2011 to February, 2012 into a phase 2b pilot study of a psychological intervention to 6 alleviate distress (27,28). After providing written informed consent, participants were assessed on the Short Orientation-Memory-Concentration Test (SOMC) (29), a measure of cognitive impairment, and Karnofsky Performance Status (30), and gave other basic medical and demographic information.…”

Section: Participants and Proceduresmentioning

confidence: 99%

Initial Validation of the Death and Dying Distress Scale for the Assessment of Death Anxiety in Patients With Advanced Cancer

Krause

Rydall

Hales

et al. 2015

Journal of Pain and Symptom Management

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters. 1 Full citation and link to published version:Krause S, Rydall A, Hales S, Rodin G, Lo C. Abstract ContextThe experience of death anxiety in patients with advanced cancer has been understudied partly due to the lack of a tailored measure for this population. The Death and Dying Distress Scale (DADDS) was constructed to address this gap. Although an initial version of this instrument has shown promising psychometric properties, validation of the finalized version is needed. ObjectivesThis study aims to validate the recent 15-item DADDS by examining its factor structure and construct validity. MethodsSixty participants with advanced or metastatic cancer were recruited from the Princess Margaret Cancer Centre, Toronto, Canada, into a pilot trial of a psychological intervention. This paper analyzes the baseline measures on death anxiety, depressive symptoms (PHQ-9, SCID), generalized anxiety (GAD-7), and preparation for end of life (QUAL-EC). Exploratory factor analysis was conducted. Construct validity was assessed by correlations between measures. ResultsFactor analysis revealed a dominant single factor explaining over 75% of the shared variation between items. Factor loadings were high, ranging from 0.57 to 0.86. Item communalities were evenly ranged from 0.33 to 0.75 and with the 15:1 variable to factor ratio, suggest the viability of parameter estimates despite the small sample size. Cronbach's alpha was 0.95. Death anxiety was associated with less preparation for end of life, r = -0.68, p < 0.0001, and more generalized anxiety, r = 0.63, p < 0.0001, and depressive symptom severity, r = 0.50, p < 0.0001. Individuals with major depression had greater death anxiety than the non-depressed, mean difference = 17, CI .95 = (1.5, 33), as did individuals with minor depression, mean difference = 25, CI .95 = (10, 41). ConclusionThe DADDS is a valid measure of death anxiety in patients with advanced cancer. It may provide useful information in the assessment and treatment of distress in patients near the end of life.4

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Managing Cancer and Living Meaningfully (CALM): A qualitative study of a brief individual psychotherapy for individuals with advanced cancer

Abstract: Findings from a qualitative study suggest that the CALM intervention provides substantial benefits for patients with advanced cancer prior to the end of life. Findings informed the development of a randomized controlled trial to evaluate the effectiveness of this intervention.

Cited by 101 publications

References 47 publications

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Initial Validation of the Death and Dying Distress Scale for the Assessment of Death Anxiety in Patients With Advanced Cancer

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