Abstract
Evidence-based psychological treatments (EBTs) for cancer patients have not been disseminated in part due to lack of available training. The biobehavioral intervention (BBI) is an EBT designed to alleviate cancer stress and enhance coping. The current study evaluates a training program and uses the Theory of Planned Behavior (TpB) to analyze factors related to intentions to implement BBI. Mental health providers (n = 62) attended a training for BBI. Attendees’ supervisors (n = 40) were later surveyed. Repeated measure ANOVAs assessed change over time in knowledge gains, attitudes towards EBTs/BBI, and self-efficacy. Linear multiple regression analyses assessed relationships between these factors and implementation intentions. BBI knowledge and attitude scores increased from pre- to post-training (ps < 0.01). Significant predictors in the final model were BBI-specific attitudes and self-efficacy (ps < 0.05). The BBI training program was an effective dissemination vehicle. Intervention-specific attitudes and self-efficacy were key factors in predicting providers’ implementation intentions.
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Acknowledgments
This was an investigator-initiated study funded by grants from the National Cancer Institute (R25E CA163917 and K05 CA098133). The funder played no role in the design, conduct, or analysis of the study, nor in the interpretation and reporting of the study findings. The researchers were independent from the funders. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
The authors wish to thank the mental health professionals who participated in the training institute and research study, our research confederates, and the Stress and Immunity Cancer Projects research staff and students, including Neha Godiwala, Claire Conley, and Kristen Williams, for their work on the project.
Conflict of interest
Brittany Brothers, Kristen Carpenter, Rebecca Shelby, Lisa Thornton, Georita Frierson, Kyle Patterson, and Barbara Andersen declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Implications
Practice: Evidence-based psychological treatments (EBTs) should be the standard of care at oncology centers.
Policy: Funding is needed for training models that educate and teach EBT implementation strategies to community providers.
Research: Training programs should be evaluated on theory-based outcomes (e.g., attitudes, self-efficacy) to determine providers’ intentions to use EBTs.
APPENDIX
APPENDIX
Sample Standardized Patient Assessment (BBI-CLIN)
The problem-solving vignette was as follows:
Jane has been experiencing memory and concentration difficulties, which her nurses have told her, are ‘chemo brain.’ She seems distressed as she describes comparing her pre-cancer functioning (managing an office, keeping her household in order, organizing family activities such as birthday parties) to her current functioning (having difficulty remembering appointments, forgetting questions she wanted to ask the doctor, struggling to understand treatment options). Currently, she is most worried about the ‘chemo brain’ problems at work. You have already spent some time defining the problem with her and the specific difficulties identified are poor memory, concentration difficulties, and forgetfulness (see attached Problem Analysis worksheet).
Your task is twofold:
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1.
Explain “brainstorming” as applied in problem solving.
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2.
Work with Jane to generate solution(s)
When there are enough solutions, STOP. Do not proceed to other stages of problem solving.
Sample BBI-CLIN scoring item
An example of one item from problem solving and the relevant content for the answer is the following:
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Item: To what extent did the therapist explain the process of “brainstorming?”
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Answer: (1) Generating multiple solutions. (Rationale: the more solutions you generate, the more likely you are to find one that works well/those who are successful at problem solving are the ones who generate more potential solutions.) (2) Deferring judgment about feasibility. (Rationale: ideas that first seem impossible may be combined with others; any idea can generate another new idea.) (3) Thinking of the “big picture” solutions. (Rationale: getting stuck in details makes it harder to think of solutions.)
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Brothers, B.M., Carpenter, K.M., Shelby, R.A. et al. Dissemination of an evidence-based treatment for cancer patients: training is the necessary first step. Behav. Med. Pract. Policy Res. 5, 103–112 (2015). https://doi.org/10.1007/s13142-014-0273-0
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DOI: https://doi.org/10.1007/s13142-014-0273-0