A feasibility study of the Mini-AFTER telephone intervention for the management of fear of recurrence in breast cancer survivors: a mixed-methods study protocol

Abstract

BackgroundFear of recurrence (FoR) is a major concern for patients following treatment for primary breast cancer, affecting 60–99% of breast cancer survivors. Mini-AFTER is a brief intervention developed to address this fear, that breast care nurses are ideally placed to deliver. However, their interest in delivering such an intervention is unknown and crucial to its introduction. This study aims to assess the perceived feasibility of the Mini-AFTER telephone intervention for implementation by breast care nurses to manage moderate levels of fear of recurrence among breast cancer survivors.MethodsA sequential explanatory mixed-methods design will be used, informed by normalisation process theory (NPT). The design will be guided by the stages of NPT. Specifically, understanding and evaluating the process (implementation) that would enable an intervention, such as the Mini-AFTER, not only to be operationalised and normalised into everyday work (embedded) but also sustained in practice (integration). Phase 1: all members on the UK Breast Cancer Care Nursing Network database (n = 905) will be emailed a link to a web-based survey, designed to investigate how breast cancer survivors’ FoR is identified and managed within current services and their willingness to deliver the Mini-AFTER. Phase 2: a purposive sample of respondents (n = 20) will be interviewed to build upon the responses in phase 1 and explore breast care nurses’ individual views on the importance of addressing fear of recurrence in their clinical consultations, interest in the Mini-AFTER intervention, the content, skills required and challenges to deliver the intervention.DiscussionThis study will provide information about the willingness of breast care nurses (BCNs) to provide a structured intervention to manage fear of recurrence. It will identify barriers and facilitators for effective delivery and inform the future design of a larger trial of the Mini-AFTER intervention.

Unidimensional scales for fears of cancer recurrence and their psychometric properties: the FCR4 and FCR7

“… a Confidence interval around point estimate ranges 5 units (bootstrap) b Confidence interval around point estimate ranges 8 units (bootstrap) 1 From Concern about Recurrence Scale [ 32 ] 2 From Fears of Cancer Recurrence Inventory [ 27 ] 3 From Worry of Cancer Scale [ 34 ] 4 From FORPSYCH study [ 35 ] …”

“…A recent comment has highlighted that some assessments of FCR are clearly designed to assess intensity of fear such as the FCRI-Severity subscale (9 items), whereas the CAR-Q includes 3 aspects of clinical symptoms that Lebel et al [ 33 ] have argued are indicative of clinical levels of FCR [ 34 ]. Our position would be that the FCR4 is a quick screen for fear itself of FCR, whereas the FCR7 would function as a possible indicator of 3 of the clinical issues recommended for assessment that could trigger early intervention [ 35 ]. We would encourage additional item development if the researcher / clinician wished to adopt a measure to locate clinical FCR.…”

“The danger still hangs over my head” Fear of Recurrence among Israeli Breast Cancer Survivors

“…They can do so through direct intervention or through referral to a suitable psychological service. Several studies (47)(48)(49) found that intervention by an oncological nurse (47,48) had a positive effect on survivors and reduced their levels of anxiety. Intervention that encourages survivors to participate in meaningful and useful activities (such as contributing to the community) may also be effective in helping survivors cope with the fear of breast cancer recurrence (11).…”

Fear of cancer recurrence in oral and oropharyngeal cancer patients: An investigation of the clinical encounter

“…Importantly, within the context of psychosocial care of cancer patients, detecting these fears (either through PCI or by simply asking about them) needs to be coupled with the provision of further support and therapeutic assistance by psycho‐oncology services, if required. Patients with moderate to extensive FCR levels need to receive patient‐centred support or intervention that is commensurate with their clinical presentation (Cruickshank et al., ). A previous report has highlighted this difficulty for cancer treatment services: There is reticence to invite discussion about psychological problems associated with the diagnosis, treatment and follow‐up care because of lack of training, poor methods of screening and minimal provision of referral centres for specialist services (Absolom et al., ).…”