Brief training in psychological assessment and interventions skills for cancer care staff: a mixed methods evaluation of deliberate practice techniques.

OBJECTIVE: Unaddressed anxiety and depression is common among cancer patients and has significant adverse consequences. Cancer staff training is recommended for psychological assessment and interventions to address depression and anxiety, to increase access to psycho-social oncology care. However, psychological skills training has a poor track-record for improving clinical effectiveness. "Deliberate practice", receiving feedback on therapeutic micro-skills and rehearsing modifications, can enhance clinical effectiveness. This study applied deliberate practice to maximise benefits of brief psychological skills training for cancer care staff. METHODS: Seventeen one-day training workshops were provided to 263 cancer care staff, aiming to improve confidence in assessing anxiety and depression, and delivering problem-solving therapy. Training used deliberate practice methods at the expense of didactic lecturing. Staff confidence was assessed in key teaching domains using pre-post confidence ratings. Anonymous comments from 152 training attendees were examined using thematic analysis. RESULTS: One-day psychological skills training significantly improved cancer staff confidence in assessment of anxiety and depression, and delivery of brief psychological interventions. Thematic analysis indicated that focusing on practical skills was valued by participants and contributed to staff commitments to change practice. However, some participants felt the one-day training was over-filled and would be better delivered over more days. CONCLUSIONS: Similar results can be achieved by providing psychological skills training on a single-day, as compared to an established five-day programme, by abbreviating didactic teaching and focusing time on deliberate practice of skills. Training may increase the likelihood of changes in practice, but more training time may be required for maximum benefit.

Building strengths with the Six Es of medication management.

The authors provide a template of focused skills drawn from various psychotherapy modalities for integration into follow-up psychopharmacology appointments. Titled the Six E model, this approach includes strategies to elicit an agenda, externalize the presenting problem, seek exceptions, engage empathetically, utilize enactments, and offer education. The template was trialed in a child and adolescent outpatient residency clinic under the guidance of two attendings. Qualitative feedback was solicited from fellows following utilization of the template. The Six E model was felt to improve structure and subjective satisfaction of patient, family, and provider participating in the brief appointments.