Introduction Emotional distress is common in palliative care and access to expert psychological help is limited. We have developed, evaluated and cascaded a brief training in CBT skills for palliative care practitioners that enables them to address patient distress and enhance coping. We will describe the cascade process and outcomes.

Background A palliative physician trained in CBT developed a hospice-based CBT practice and observed that CBT was acceptable and helpful to palliative care patients. A number of key interventions were identified to be included in a brief training package that was piloted in Newcastle and St Christopher's Hospice Sydenham. Training was effective in enabling staff to use intermediate CBT skills and in reducing patient distress. Expert CBT supervision was essential to preserve staff confidence and competence. Cascade plan: A Department of Health Innovations grant was obtained by Marie Curie Cancer Care and St Christopher's Hospice to cascade the CBT skills training over 3 years (2009 -12). Four of six training courses are now complete; each course has trained about 20 new ‘CBT First Aiders’ and two new trainers. Courses have been held across England (DH terms).

Outcomes After training, staff are able to use a repertoire of CBT-based skills in their usual practice to improve emotional distress and enhance coping with physical symptoms, address changes in body image and physical ability and reduce dysfunctional coping strategies. Access to expert supervision ensures appropriate patients are helped by the CBT First Aiders while more serious problems are referred for expert help, ensuring best possible use of limited psychologist availability. Establishing a local psychological skills pyramid ensures rapid access to emotional help for patients, increases staff job satisfaction, enables psychology experts to see selected, triaged, appropriate patients while supporting many more patients by providing group supervision to CBT First Aiders.