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INTRODUCTION: Palliative care (PC) for advanced cancer is guaranteed by law in Chile, but the formal training for it is insufficient. Training models have emerged internationally that enable professionals to be better prepared for the provision of psychotherapy in PC. The objective of this study is to explore health professionals' perceptions of the 'Managing Cancer and Living Meaningfully' (CALM) psychotherapy and the perceived barriers and facilitators to its implementation, based on a theoretical training. METHODS: A qualitative study was carried out with health professionals working in oncology and/or PC and participating in a CALM training. A focus group was conducted after to explore the experience of CALM training and the perceived barriers and facilitators to its implementation. A thematic analysis of the content and an analysis of the facilitators and barriers to the implementation of mental health services were carried out. RESULTS: Twenty four professionals participated in the training, six of whom were part of the subsequent focus group. There was a consensus that the training was a positive professional experience and that it is a culturally sensitive and feasible intervention for application in Chile. The barriers identified include institutional bureaucracy as resistance to change, the excess workload of the clinical teams and the absence of spaces for more in-depth training. CONCLUSIONS: CALM is a useful and relevant framework for the training of health professionals working in oncology and PC. In Chile, there is a need for training spaces on this topic. Future research and organisational studies should evaluate professionals' beliefs about, and resistance to, adopting evidence-based psychotherapeutic interventions.
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INTRODUCTION: Developing instruments to screen for relevant aspects of advanced illness is key to identifying palliative needs and evaluating the effectiveness of interventions in this population. The objective of this project is to validate the Death and Dying Distress Scale in Spanish (DADDS-Sp) for screening anxiety about death and evaluating psychometric properties for people with advanced cancer. METHODS: DADDS is a 15-item self-administered questionnaire that assesses thoughts and feelings related to death and the process of dying. A cross-sectional, descriptive, psychometric validation study was conducted in two cancer centres in Santiago de Chile. Included were patients over 18 years of age with incurable and/or metastatic cancer, fluent in Spanish, and a life expectancy of more than 3 months. Reliability was analysed using Cronbach's alpha, and confirmatory factor analysis was performed following the model of the original scale. RESULTS: Seventy four patients participated in the study. The median age was 63 years. Of the sample, 59% identified themselves as women. On average, participants reported low anxiety about death (mean = 21, SD = 18). Women have more death anxiety. The reliability analysis yielded a value of α = 0.93 (IC = 0.91-0.95). Factor analysis with a one-factor structure yielded Comparative Fit Index (CFI) = 0. 0.972, Root Mean Square Error of Approximation (RMSEA) = 0.092, Standardized Root Mean Square Residual (SRMR) = 0.085 and Tucker-Lewis Index (TLI) = 0.968. The model with a two-factor structure yielded CFI = 0.989, RMSEA = 0.059, SRMR = 0.075 and TLI = 0.987, suggesting that the two-factor model has a better fit for the data studied. CONCLUSIONS: DADDS-Sp is psychometrically valid for use in a Spanish-speaking population, yielding high reliability and internal consistency. A majority of the Chilean patients reported a low level of anxiety about death although about 10% presented with severe anxiety, so their identification for adequate clinical management is fundamental.
