Feasibility, acceptability, and safety of the Recapture Life videoconferencing intervention for adolescent and young adult cancer survivors

Abstract

Objective: Online psychological therapies provide a way to connect adolescent and young adult (AYA) cancer survivors to evidence-based support. We aimed to establish the feasibility, acceptability, and safety of Recapture life, a six-session group-based online cognitive-behavioural intervention, led by a facilitator, for AYAs in the early post-treatment period.Methods: A randomised-controlled trial compared Recapture Life to an online peer-support group control and a waitlist control. Participants could nominate a support person. Acceptability was assessed using study opt-in and retention rates, participant-reported benefits/burdens of participation, and group facilitator burden.We also assessed the feasibility (eg, frequency/impact of technological difficulties) and psychological safety (ie, occurrence of clinically concerning distress) of the program.Results: Sixty-one participants took part (45 AYAs, 51.1% female; 19 support people). The opt-in rate was 30%, the enrolment rate was 87%, and 75% of participants took part in ≥5/6 sessions. AYAs reported high benefit and low burden of participation. Overall, 95 online group sessions were conducted; few required rescheduling by group facilitators (3%), but many took place outside of office hours (~90 hours). It took 40 days on average to create online groups, but established weekly sessions commenced quickly (M = 4.0 minutes). Technological difficulties were common but had a low impact on intervention delivery. Although 54% of AYAs returned a clinically concerning distress screen at some point, none reflected acute mental health risks. Conclusions: The data largely indicate that Recapture Life is an acceptable, feasible, and safe model of evidence-based psychological support for AYAs during early survivorship, which nevertheless experienced common challenges in online/AYA intervention delivery. 28:284-292. wileyonlinelibrary.com/journal/pon KEYWORDS adolescent, feasibility, cancer, psychological interventions, oncology, online videoconferencing, survivorship, young adult AYAs High perceived benefit a post booster session / 12m-FU [N (%)] 20 (61%) / 16 (70%) 13 (59%) /12 (75%); 7 (64%) /4 (57%) Low perceived burden ‡ post booster session / 12m-FU [N (%)] 30 (91%) / 20 (87%) 20 (91%) /14 (88%); 10 (91%) /6 (86%) Support persons High perceived benefit a post booster session / 12m-FU [N (%)] 3 (25%) / 1 (11%) 1 (11%) /1 (13%); 2 (67%) /0 (0%); Low perceived burden ‡ post booster session / 12m-FU [N (%)] 12 (100%) / 9 (100%) 9 (100%) /8 (100%); 3 (100%) /1 (100%) Note: Statistics represent summary statistics across all trial arms, with the exception of homework completion. AYA = adolescent and young adult; FU = follow-up; U(x,y) = Mann-Whitney U test statistic, with n 1 = x, n 2 = y observations in each group. aComprised "quite a bit" and "very much" benefit ratings. ‡ Comprised "not at all" and "a little bit" burden ratings.

Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress

“…Importantly, study findings provide a more comprehensive understanding of the distress experienced by the population than existing models, by integrating data from different sources (e.g., case formulations, clinical notes). As such, study results have important clinical implications for further developing psychological support for the population and expand the growing literature on CBT-based interventions for the population (Campo et al, 2017;Sansom-Daly et al, 2018). However, it should be noted that only 10 participants were recruited raising concerns regarding the feasibility and acceptability of individualized CBT for the population.…”

“…Key characteristics were worry about the future and fear of cancer recurrence, causing decisional anxiety and depressive as well as existential rumination. Indeed, other research has shown AYA cancer survivors to imagine their future in more illness focused and overgeneralized way, in comparison to AYAs without cancer (Sansom-Daly et al, 2018). Given adaptive problem solving and goal setting are associated with the ability to imagine future events more specifically (Schacter, Addis & Buckner, 2007) such overgeneralized thinking may be an important target for psychological interventions for the AYA cancer survivor population (Sansom-Daly et al, 2018).…”

“…Still, a preliminary evaluation was conducted and findings highlight important feasibility concerns in the recruitment of AYA cancer survivors. In addition, a number of important feasibility outcomes were not examined, for example, intervention acceptability, acceptability of study outcome measurements, safety, study resources, cost, and therapist training needs and competence (Eldridge et al, 2016;Sansom-Daly et al, 2018). Future studies may benefit from examining a wider range of feasibility outcomes.…”

“…Indeed, CBT-based interventions have shown promise in reducing psychological distress in AYAs diagnosed with cancer during childhood (Fisher et al, 2015;Seitz et al, 2014;Van der Gucht et al, 2017). Whilst some recognition has been given the specific and unique challenges associated with being diagnosed with cancer during adolescence (Abrams, Hazen & Penson, 2007;Seitz, Besier & Goldbeck, 2009), so far only a few CBT based psychological interventions have been developed with adaptation and tailoring to this population (Campo et al, 2017;Sansom-Daly et al, 2018).…”

Author reply

“…Using examples from our research, ethics‐related delays have meant that some AYA living in rural/remote Australia missed out on the opportunity to access evidence‐based, online psychological treatment in survivorship and AYA with uncertain/unfavourable cancer prognoses did not receive the opportunity to access an age‐appropriate advance‐care planning tool to guide them through challenging end‐of‐life conversations …”