A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability

Abstract

Objective ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post‐treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. Methods Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi‐structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. Results Participants were 13 males and one female with, on average, 14 years psycho‐oncology experience. Nine over‐arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention); context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways); and facilitation of implementation (intervention/service fit, intervention/patient fit, and training, support, and provided resources). Conclusions ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base; a receptive context; good fit between the intervention, therapist orientation, and patient need; and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho‐oncology interventions in routine care.

A Systematic Review of Fear of Cancer Recurrence Among Indigenous and Minority Peoples

“…Several factors are associated with a higher prevalence of FCR, including: younger age; female gender; greater burden of physical symptoms; and psychological factors (Härtl et al, 2003 ; Simard et al, 2013 ). Progress has also been made in screening for and assessing FCR (Simard and Savard, 2009 ), as well as in the development of psychological interventions to reduce FCR, which have been demonstrated to be effective predominantly in patients with early stage cancers treated with curative intent (Sharpe et al, 2017 ; Hall et al, 2018 ; Butow et al, 2019 ; Tauber et al, 2019 ). Despite these advances, little is known about FCR among cancer survivors from Indigenous, ethnic and racial minority populations and it is unclear whether existing programs and interventions aimed at reducing FCR are appropriate or effective for cancer survivors from these groups.…”

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

“… USA Primary health care setting ✓ ✓ ✓ Empirical study Arling, Doebbeling, et al [ 171 ] 2011 Improving the implementation of evidence-based practice and information systems in healthcare: A social network approach Canada Multiple settings ✓ ✓ Empirical study Bahtsevani, Willman, et al [ 172 ] 2008 Developing an instrument for evaluating implementation of clinical practice guidelines: A test-retest study Sweden Hospital setting ✓ ✓ Empirical study Boaz, Baeza, et al [ 173 ] 2016 Does the "diffusion of innovations' model enrich understanding of research use? Case studies of the implementation of thrombolysis services for stroke UK and Sweden Hospital setting ✓ ✓ Empirical study Boström, Wallin, et al [ 174 ] 2007 Evidence-based practice and determinants of research use in elderly care in Sweden Sweden Community/Social care setting ✓ ✓ Empirical study Butow, Williams, et al [ 175 ] 2019 A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability Australia Hospital setting ✓ ✓ Empirical study Carlan, Kramer, et al [ 176 ] 2012 Digging into construction: Social networks and their potential impact on knowledge transfer Canada Construction setting ✓ ✓ Empirical study Chou, Graber, et al [ …”

“…▪ 72 non-intervention studies [ 150 , 151 , 154 , 157 , 159 , 161 , 163 – 166 , 169 , 170 , 172 – 175 , 177 , 180 , 181 , 186 – 193 , 195 – 200 , 204 , 210 , 213 , 215 , 216 , 218 , 224 , 226 – 233 , 237 – 242 , 246 – 248 , 253 , 256 , 257 , 262 , 264 , 267 , 271 , 272 , 275 , 286 , 293 – 295 , 298 , 302 ]…”

“…Of the articles reporting type of setting where the implementation project/research took place, a majority were undertaken in hospitals ( n = 126) [ 26 , 27 , 30 , 38 , 39 , 41 , 42 , 45 , 49 , 51 – 55 , 60 , 62 – 64 , 67 , 70 – 72 , 77 , 84 , 85 , 88 , 89 , 95 – 98 , 103 , 106 , 107 , 111 , 115 – 118 , 120 – 122 , 128 , 131 , 132 , 136 , 137 , 139 , 143 , 146 , 149 , 151 , 153 – 155 , 157 , 161 , 165 , 167 – 169 , 172 , 173 , 175 , 180 – 182 , 184 , 186 , 190 – 193 , 205 , 207 , 212 , 215 , 221 , 223 , 227 , 230 , 231 ,…”

Study protocol: a randomized controlled trial comparing the efficacy of therapist guided internet-delivered cognitive therapy (TG-iConquerFear) with augmented treatment as usual in reducing fear of cancer recurrence in Danish colorectal cancer survivors

“…"ConquerFear" [34] is an individual face-to-face therapist-delivered intervention with demonstrated efficacy in reducing FCR compared to a relaxation training attention control group of patients with mixed cancers of whom the majority (89%) were women with breast cancer. While use of ConquerFear has been sustained by many study therapists beyond the end of the study [43], it is a resource and time-consuming approach accessible primarily to those in close proximity to major metropolitan cancer centres with highly trained psychologists. Consequently, a web-based self-management version of ConquerFear has been created (iConquerFear), similar in curriculum content but different in delivery.…”