Protocol for the implementation of a stepped-care model to address fear of cancer recurrence in patients previously diagnosed with early-stage (0-II) melanoma

Jake R Thompson; Andrea L Smith; Serigne N Lo; Nadine A Kasparian; Robyn Pm Saw; Mbathio Dieng; Linda Seaman; Linda K Martin; Pascale Guitera; Donna Milne; Helen Schmid; Anne E Cust; Iris Bartula

doi:10.1136/bmjopen-2021-054337

Protocol for the implementation of a stepped-care model to address fear of cancer recurrence in patients previously diagnosed with early-stage (0-II) melanoma

BMJ Open. 2022 Mar 3;12(3):e054337. doi: 10.1136/bmjopen-2021-054337.

Authors

Jake R Thompson¹, Andrea L Smith^{2

3}, Serigne N Lo⁴, Nadine A Kasparian^{5

6}, Robyn Pm Saw^{4

7}, Mbathio Dieng⁸, Linda Seaman⁹, Linda K Martin^{4

10}, Pascale Guitera^{4

11}, Donna Milne¹², Helen Schmid^{3

13}, Anne E Cust^{4

3}, Iris Bartula⁴

Affiliations

¹ Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia jake.thompson@melanoma.org.au.
² Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
³ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.
⁴ Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia.
⁵ Cincinnati Children's Center for Heart Disease and Mental Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁷ Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁸ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Consumer Representative, Sydney, New South Wales, Australia.
¹⁰ Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
¹¹ Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹² Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹³ Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Introduction: Fear of cancer recurrence (FCR) is commonly reported by patients diagnosed with early-stage (0-II) melanoma and can have a significant impact on daily functioning. This study will pilot the implementation of the Melanoma Care Program, an evidence-based, psychological intervention to reduce FCR, into routine practice, using a stepped-care model.

Methods and analysis: Intervention effectiveness and level of implementation will be investigated using a hybrid type I design. Between 4 weeks before and 1 week after their next dermatological appointment, patients with melanoma will be invited to complete the Fear of Cancer Recurrence Inventory Short-Form, measuring self-reported FCR severity. Using a stepped-care model, clinical cut-off points will guide the level of support offered to patients. This includes: (1) usual care, (2) Melanoma: Questions and Answers psychoeducational booklet, and (3) three or five psychotherapeutic telehealth sessions. This longitudinal, mixed-methods pilot implementation study aims to recruit 108 patients previously diagnosed with stage 0-II melanoma. The primary effectiveness outcome is change in FCR severity over time. Secondary effectiveness outcomes include change in anxiety, depression, stress, health-related quality of life and melanoma-related knowledge over time. All outcomes are measured at baseline, within 1 week of the final telehealth session, and 6 and 12 months post-intervention. Implementation stakeholders at each study site and interested patients will provide feedback on intervention acceptability and appropriateness. Implementation stakeholders will also provide feedback on intervention cost, feasibility, fidelity and sustainability. These outcomes will be measured throughout implementation, using questionnaires and semistructured interviews/expert group discussions. Descriptive statistics, linear mixed-effects regression and thematic analysis will be used to analyse study data.

Ethics and dissemination: Ethics approval was granted by the Sydney Local Health District-Royal Prince Alfred Zone (2020/ETH02518), protocol number: X20-0495. Results will be disseminated through peer-reviewed journals, conference presentations, social media and result summaries distributed to interested participants. TRIAL REGISTRATION DETAILS: (ACTRN12621000145808).

Keywords: adult oncology; anxiety disorders; dermatological tumours; mental health; qualitative research.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Fear / psychology
Humans
Melanoma* / psychology
Melanoma* / therapy
Melanoma, Cutaneous Malignant
Quality of Life
Skin Neoplasms* / psychology
Skin Neoplasms* / therapy