Background: Fear of cancer recurrence or progression (FCR) is a key concern for cancer carers. Nearly half of all carers (48%) report FCR levels considered clinically significant among cancer survivors, but few interventions have been evaluated for carer FCR. A carer-specific intervention, underpinned by a clinically relevant model of carer FCR, is needed. Conquer Fear, based on the Cognitive Processing Model, is a 5-session psychologist delivered intervention with demonstrated efficacy in reducing survivor FCR.
Aims: We aimed to adapt the evidence-based Conquer Fear FCR intervention for cancer carers.
Methods: We first mapped caregiver-specific FCR experiences to the Cognitive Processing Model and then used a co-design methodology to review and adapt the Conquer Fear intervention to reflect the constructs underpinning carer FCR and an online format. As part of co-design, an expert panel (psycho-oncology clinicians and researchers; n= 11) provided feedback on the clinical content and cancer carers (n= 14) reviewed the format and overall online approach.
Results: Many of the constructs in the model were common with FCR for cancer survivors, therefore the following components were retained: attention training, metacognitive therapy, detached mindfulness and values clarification. However, carers also expressed unique concerns including fear of losing a loved one and difficulties in communication around FCR. In response, we added context for carer FCR addressing the fears of losing a loved one and personal responsibility. We also added a session on the importance of communication. Although hypervigilance was identified amongst carers with high FCR, the behavioural contract relating to surveillance was removed. These adaptions resulted in a 4-session online program.
Conclusions: We have developed a theoretically derived, carer-specific FCR intervention, ready for evaluation. Involving carers in co-designing the intervention may increase acceptability and will be assessed in our planned pilot study.