Identifying the ‘Active Ingredients' of an Effective Psychological Intervention to Reduce Fear of Cancer Recurrence: A Process Evaluation

Frontiers in Psychology

article

Janice M. Kan¹  Anne E. Cust²  Nadine A. Kasparian⁴  Mbathio Dieng⁶  Phyllis N. Butow⁷  Shab Mireskandari¹  Stephanie Tesson¹  Scott W. Menzies⁹  Daniel S. J. Costa^1,11  Rachael L. Morton⁶  Graham J. Mann² 

[1] School of Women's and Children's Health, UNSW Medicine, The University of New South Wales;Melanoma Institute Australia, The University of Sydney;Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney;Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, United States;Department of Pediatrics, University of Cincinnati College of Medicine, United States;NHMRC Clinical Trials Centre, The University of Sydney;Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney;Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney;Sydney Medical School, The University of Sydney;The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital;Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital;School of Psychology, University of Sydney;John Curtin School of Medical Research, College of Health and Medicine, The Australian National University

关键词: fear cancer recurrence;    intervention;    melanoma;    survivorship;    psychological stress;    process evaluation;   

DOI  :  10.3389/fpsyg.2021.661190

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Purpose: Psychological interventions targeting fear of cancer recurrence (FCR) are effective in reducing fear and distress. Process evaluations are an important, yet scarce adjunct to published intervention trials, despite their utility in guiding the interpretation of study outcomes and optimizing intervention design for broader implementation. Accordingly, this paper reports the findings of a process evaluation conducted alongside a randomized controlled trial of a psychological intervention for melanoma patients. Methods: Men and women with a history of Stage 0–II melanoma at high-risk of developing new primary disease were recruited via High Risk Melanoma Clinics across Sydney, Australia and randomly allocated to receive the psychological intervention ( n = 80) or usual care ( n = 84). Intervention participants received a tailored psycho-educational resource and three individual psychotherapeutic sessions delivered via telehealth. Qualitative and quantitative data on intervention context, processes, and delivery (reach, dose, and fidelity), and mechanisms of impact (participant responses, moderators of outcome) were collected from a range of sources, including participant surveys, psychotherapeutic session audio-recordings, and clinical records. Results: Almost all participants reported using the psycho-educational resource (97%), received all intended psychotherapy sessions (96%), and reported high satisfaction with both intervention components. Over 80% of participants would recommend the intervention to others, and a small proportion (4%) found discussion of melanoma-related experiences confronting. Perceived benefits included enhanced doctor-patient communication, talking more openly with family members about melanoma, and improved coping. Of potential moderators, only higher FCR severity at baseline (pre-intervention) was associated with greater reductions in FCR severity (primary outcome) at 6-month follow-up (primary endpoint). Conclusions: Findings support the acceptability and feasibility of a psychological intervention to reduce FCR amongst individuals at high risk of developing another melanoma. Implementation into routine melanoma care is an imperative next step, with FCR screening recommended to identify those most likely to derive the greatest psychological benefit.

【 授权许可】

CC BY