Our research team culturally adapted a metacognition-based, manualized ‘ConquerFear’ intervention for local cancer survivors with high fear of cancer recurrence (namely ConquerFear-HK). The ConquerFear-HK also has a less resource-intensive web-based version (eConquerFear-HK) developed by our research team for those with mild-to-moderate fear of caner recurrence. We are conducting an ongoing randomised controlled trial (RCT) to test the effectiveness of ConquerFear-HK in managing high FCR.
As a part of the RCT study, we developed a FCR screening program which is embedded in routine oncology outpatient clinics. Patients attending the participating out-patient oncological clinics are assessed on the severity of fear of cancer recurrence using a standardized screening tool (i.e. Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF). Using a screening cut-off score of ≥ 13, patients screened with subclinical-to-clinical fear of cancer recurrence who accept onward referral to JCICC become case for further support for fear of cancer recurrence management. Patients screened with normal range of fear of cancer recurrence (i.e., FCRI-SF < 13) are provided with generic self-management advice. So far, a total of 255 cancer patients have been screened with the FCRI-SF. Of this, 130 (51%) met the cut-off scores of subclinical-to-clinical levels with 94 (72%) consenting for further support. The uptake rate of 70% suggests that the support offered for managing fear of cancer recurrence is acceptable by patients. Using preliminary data, patients receiving the ConquerFear-HK intervention reported significantly lower FCR at post-intervention. Our RCT study demonstrated potential feasibility, effectiveness and acceptability of the FCR screening and referral system to local cancer patients. The next step is therefore to incorporate FCR screening and referral into routine cancer care to ensure patients in need receive timely intervention.
This implementation study aims to evaluate the process and outcomes of an implementation program designed to implement FCR screening, referral and management into routine cancer care clinics, using a stepped-wedge cluster randomized controlled trial. We aim to test if a systematic FCR screening program that employs implementation strategies including training, reflecting, evaluating, facilitating and adapting, increases the proportion of eligible patients screened and referred compared to usual control with no implantation strategies used.
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