L care alone. In the Princess Margaret CCT244747 Cancer Centre this contains routine remedy and

L care alone. In the Princess Margaret CCT244747 Cancer Centre this contains routine remedy and follow-up in health-related, surgical andor radiation outpatient oncology clinics, as well as a clinic-based distress screening program, referred to as DART (Distress Assessment and Response Tool) [35], with results supplied in the time on the clinic pay a visit to to oncology clinic employees. Clinic staff could refer any patient for specialized psychosocial oncology solutions (provided by trained volunteers and by social perform, psychiatry and psychology employees) or to palliative care, based on clinical judgment, patient requests andor distress screening scores. Inside the occasion that a usual care participant reports suicidal intent, the principal investigators are contacted and also the patient is assessed by a psychiatrist in the Division of Supportive Care. Approximately one particular third of patients with metastatic cancer are referred PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/2129593 for psychosocial care in the Princess Margaret, two thirds of whom are seen by a social worker [36]. About 65 of social function consultations involve provision of practical or instrumental care (e.g., urgent drug coverage, referral for admission to the Acute Palliative Care Unit, complex continuing care placement, etc.); 35 of consultations involve brief supportive interactions to alleviate emotional distress in sufferers andor family members. Control participants do not typically receive structured counseling from social work as part of usual care. Of those referred to psychiatry or psychology, less than one third receive a structured or semi-structured psychotherapy. Overall, less than 10 of individuals with metastatic cancer at the Princess Margaret Cancer Centre receive any form of semi-structured psychotherapy that is similar to CALM therapy. To avoid contamination with the control group in the occasion of a referral to the Division of Supportive Care, controls referred for psychosocial care will be seen, if possible, by therapists within the division who have not received prior training in CALM therapy (i.e., non-CALM-trained therapists). Contamination will be monitored and documented and is defined as having two or more sessions with a CALM-trained therapist.Lo et al. Trials (2015) 16:Page 4 ofTreatment integrityThe treatment integrity from the intervention arm is ensured by means of weekly group supervision of therapists with case presentations. CALM sessions are audio-recorded, and therapists document sessions in a written report. Senior clinicians (GR, SH) assess overall and topic-specific competencies using remedy integrity rating scales adapted from Spiegel and Spira’s [18] tools. Evaluations are discussed with each therapist to improve competencies.RandomizationPermuted block randomization is used to allocate participants to a trial condition with stratification by PHQ-9 score ( or 10). Stratification ensures that highly depressed individuals will be balanced in both arms. The randomization process is managed by the Department of Biostatistics in the Princess Margaret Cancer Centre, which is independent of the trial team.Outcome measuresThe primary outcome measure is the Patient Health Questionnaire-9 (PHQ-9) [37], a reliable and valid 9item measure of depression that has been used widely with advanced cancer patients [38]. This brief measure is a subscale on the Patient Health Questionnaire (PHQ), a patient self-report version on the Primary Care Evaluation of Mental Disorders (PRIME-MD), a widely used tool to screen for mental health.