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Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme
  1. Nicholas J Hulbert-Williams1,
  2. Lee Hulbert-Williams1,
  3. Pandora Patterson2,
  4. Sahil Suleman3 and
  5. Lesley Howells4
  1. 1Centre for Contextual Behavioural Science, University of Chester, Chester, UK
  2. 2Research and Youth Cancer Services, CanTeen Australia, Newtown, New South Wales, Australia
  3. 3Cancer Psychological Support (CaPS) Team, St George's University Hospitals NHS Foundation Trust, London, UK
  4. 4Maggie's Cancer Centres, London, UK
  1. Correspondence to Prof Nicholas J Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester, Chester, UK; n.hulbertwilliams{at}


Background Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT).

Aims We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach.

Method We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions.

Results At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility.

Discussion Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.

  • cancer
  • communication
  • education and training
  • psychological care

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  • Twitter @profnickhw, @drleehw

  • Contributors NJH-W and LH-W conceived the original idea for the training programme. The initial training manual was developed by NJH-W, LH-W and LH; this was adapted in collaboration with PP and SS for subsequent training iterations. Data collection and analysis were undertaken by NJH-W and LH-W. NJH-W wrote the initial draft of the paper. All authors contributed to the redrafting and editing of the manuscript.

  • Funding This work has been funded through a series of research impact grants awarded to NJH-W and LH-W from the University of Chester. Additional financial support was provided by Canteen Australia, and in-kind financial support was provided by Canteen and Maggie’s Cancer Centres UK. Delivery of the second iteration of the training was supported by a service development grant awarded to Sahil Suleman by Macmillan Cancer Support, UK.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.