Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Study Measures
2.2.1. Demographics and Medical History
2.2.2. FCR Assessments
- Fear of Cancer Recurrence Inventory Short Form (FCRI-SF; [31]). The FCRI-SF is a 9-item self-report questionnaire that was used as a screening and outcome measure to assess FCR. The questionnaire assesses the presence, frequency, intensity, and duration of thoughts associated with FCR. Total scores range from 0 to 36, with higher scores indicating higher levels of FCR. A score of 13–21 was used to identify participants with subthreshold FCR [31,32], while a score of ≥22 was used to identify participants with high levels of FCR [32,33]. The FCRI-SF has shown strong internal consistency (alpha = 0.95), temporal stability (r = 0.89), and construct validity [31].
- Fear of Progression Questionnaire Short Form (FoP-Q-SF; [34]). The FoP-Q-SF is a 12-item self-report questionnaire used as a screening and outcome measure to assess the level of fear of cancer progression. Total scores range from 12 to 60. A cut-off score of 24–33 was used to suggest subthreshold levels of fear of progression [35] and a score ≥34 was used to identify participants with high levels of fear of progression [36]. FoP-Q-SF has shown high reliability (Cronbach’s alpha = 0.87 to 0.90), with evidence of construct validity [34,37].
2.2.3. Acceptability and Feasibility
- The Screening Survivor Experiences Survey was administered to all participants directly after screening. This seven-item measure included rating scales of the degree to which they agreed or disagreed that the screening questionnaires were easy to complete, easy to understand, and acceptable. Open-response items asked participants about how important they considered screening for FCR.
- The Self-Management Survivor Experiences Survey was administered after completion of the self-management intervention. The 13-item measure assessed participants’ previous experience of FCR support, the most and least useful aspects of the intervention, whether they would recommend the intervention and subjective changes in FCR.
- The Individual Therapy Survivor Experiences Survey was administered after the individual therapy. This 10-item measure assessed the participants’ previous FCR supports, experience of the individual therapy, whether they would recommend it, and subjective changes in FCR.
2.2.4. Operational Data
2.3. Study Procedures
2.3.1. Stepped Care Intervention
Step 1: Treatment as Usual
Step 2: Self-Management Intervention
Step 3. Individual Therapy
- Session 1: FCR-specific assessment and model to explain treatment, discussion of existential changes brought on by cancer, value identification and goal setting.
- Session 2: Discussion of the impact of vulnerability factors on FCR; rationale and practice of the Attention Training Technique.
- Session 3: Introduction to detached mindfulness.
- Session 4: Discussion of self-examination practices and medical surveillance, discussion of metacognitive beliefs that underpin FCR, and worry postponement.
- Session 5: Review of goal-setting task, consolidation of skills, and relapse prevention planning.
2.4. Data Analysis
3. Results
3.1. Stepped-Care Pathways
3.2. Feasibility and Acceptability
3.2.1. Screening
3.2.2. Self-Management Intervention
3.2.3. Individual Therapy
3.3. Impact
3.3.1. Self-Management Intervention
3.3.2. Individual Therapy
4. Discussion
4.1. Clinical Implications
4.2. Further Research
4.3. Study Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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FCR Screening Subcategories N = 61 | Total Sample | |||
---|---|---|---|---|
No FCR | Subthreshold FCR | Clinical FCR | ||
n (%) | 22 (36%) | 27 (44%) | 12 (20%) | 61 |
Age | ||||
Mean (SD) | 69.2 (9.6) | 60.0 (10.7) | 50.3 (5.4) | 61.4 (11.6) |
Minimum | 47 | 36 | 39 | 36 |
Maximum | 82 | 76 | 60 | 82 |
Sex | ||||
Male (%) | 16(73%) | 19 (70%) | 6 (50%) | 41 (67%) |
Female (%) | 6 (27%) | 8 (30%) | 6 (50%) | 20 (33%) |
Treatment Agent Currently or Previously Received | ||||
Immunotherapies (%) | 18 (82%) | 19 (70%) | 6 (50%) | 43 (70%) |
Targeted therapies (%) | 2 (9%) | 6 (22%) | 3 (25%) | 11 (18%) |
Both immunotherapies and targeted therapies (%) | 2 (9%) | 2 (7%) | 3 (25%) | 7 (11%) |
Treatment Status | ||||
Having active treatment (%) | 14 (64%) | 14 (52%) | 9 (75%) | 37 (61%) |
Treatment stopped a (%) | 8 (36%) | 13 (48%) | 3 (25%) | 24 (39%) |
FCRI-SF | ||||
Mean (SD) | 6.95 (3.12) | 17.22 (5.37) | 23.42 (4.93) | 14.74 (7.77) |
Range | 0, 11 | 6, 33 | 12, 31 | 0, 33 |
FoP-Q-SF | 16.82 (3.79) | 26.37 (6.41) | 38.92 (9.26) | |
Mean (SD) | 25.39 (10.12) | |||
Range | 12–23 | 15–43 | 20–54 | 12–54 |
Self-Management | Individual Therapy | |
---|---|---|
n | 21 | 7 |
FCRI-SF | ||
Pre-intervention mean (SD) | 17.67 (6.03) | 24.29 (4.19) |
Post-intervention mean (SD) | 16.90 (7.69) | 20.57 (6.35) |
FoP-Q-SF | ||
Pre-intervention mean (SD) | 29.14 (8.21) | 37.29 (8.56) |
Post-intervention mean (SD) | 29.00 (7.79) | 33.71 (7.87) |
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Lynch, F.A.; Katona, L.; Jefford, M.; Smith, A.B.; Shaw, J.; Dhillon, H.M.; Ellen, S.; Phipps-Nelson, J.; Lai-Kwon, J.; Milne, D.; et al. Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma. J. Clin. Med. 2020, 9, 2969. https://doi.org/10.3390/jcm9092969
Lynch FA, Katona L, Jefford M, Smith AB, Shaw J, Dhillon HM, Ellen S, Phipps-Nelson J, Lai-Kwon J, Milne D, et al. Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma. Journal of Clinical Medicine. 2020; 9(9):2969. https://doi.org/10.3390/jcm9092969
Chicago/Turabian StyleLynch, Fiona A, Lynda Katona, Michael Jefford, Allan Ben Smith, Joanne Shaw, Haryana M Dhillon, Steve Ellen, Jo Phipps-Nelson, Julia Lai-Kwon, Donna Milne, and et al. 2020. "Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma" Journal of Clinical Medicine 9, no. 9: 2969. https://doi.org/10.3390/jcm9092969