Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy

May combine two claims.

Patients who used an avoidant coping style were thought to find the therapy more confronting, but avoidance was not found to be associated with therapy uptake or outcome in the mediator/moderator analysis.

“Patients who used an avoidant coping style were thought to find the therapy more confronting, although this has not been born out in our mediator/moderator analysis of ConquerFear, where avoidance was not found to be associated with therapy uptake or outcome [18].”

• cites [18] Butow PN, Bell ML, Smith AB, Fardell JE, Thewes B, Turner J, et al. Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer. 2013;13(1):201. sourceCould not verify

  The cited paper is a trial protocol. Its Methods/design > Outcomes section describes analyses that will be conducted, but reports no mediator/moderator results showing whether avoidance was associated with therapy uptake or outcome. Searches for avoidant coping and therapy uptake found intervention content addressing avoidant behaviours, not the claimed finding; no page numbers are available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims.

Interventions are often not implemented into routine care, are not sustainable, and thus do not lead to the real-world change they are intended to create.

“Despite clear evidence of efficacy however, interventions are often not implemented into routine care, are not sustainable [11] and thus do not lead to the real-world change they are intended to create [12].”

• cites [11] Fardell JE, Thewes B, Turner J, Gilchrist J, Sharpe L, Girgis A, et al. Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv. 2016;10(4):663–73. sourceNot checked — no full text of the source
• cites [12] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2016;44(1):1–25. sourceCould not verify

  The Discussion (p. 21) describes ACT studies as short and limited in scope, while the component-studies section (p. 13) discusses clinicians adopting treatment models and the difficulty of changing protocols. Neither passage says that efficacious interventions generally fail to enter routine care, are unsustainable, or consequently fail to produce real-world change. Searches for routine-care implementation, sustainability, and dissemination found no passage addressing that claim. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Implementing ConquerFear in their service was easier if it fitted with the usual patient flow, matched the number and length of therapy sessions usually conducted, and if their service had a sufficient number of psycho-oncologists with appropriate training.

“Therapists noted that implementing ConquerFear in their service was easier if it fitted with the usual patient flow, matched the number and length of therapy sessions usually conducted, and if their service had a sufficient number of psycho-oncologists with appropriate training.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most therapists felt there was a strong need for ConquerFear because of the prevalence and impact of FCR in their patients.

“Most therapists felt there was a strong need for ConquerFear because of the prevalence and impact of FCR in their patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most therapists discussed the importance of adequate training, mentorship and ongoing support to build their confidence in delivering the intervention and ensure a high standard of delivery.

“Most therapists discussed the important of adequate training, mentorship and ongoing support to build their confidence in delivering the intervention and ensure a high standard of delivery.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Acceptance of evidence of need for ConquerFear in their particular service was less consistent.

“Acceptance of evidence of need for ConquerFear in their particular service (e.g.clinical FCR a common patient presentation; FCR requiring a unique approach) was however, less consistent.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Some therapists reported a low level of clinical FCR in their patients, not requiring an intensive intervention.

“However, some therapists reported a low level of clinical FCR in their patients, not requiring an intensive intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most therapists believed that ConquerFear came from well respected, rigorous researchers whose credentials could be depended upon.

“Most therapists believed that ConquerFear came from well respected, rigorous researchers whose credentials could be depended upon.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Some therapists expressed concerns about moving away from an individually-delivered model, suggesting that aspects such as previous trauma and existential issues could not be fully and safely explored in a group or unsupported online environment.

“However some expressed concerns about moving away from an individually-delivered model, suggesting that aspects such as previous trauma and existential issues could not be fully and safely explored in a group or unsupported online environment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The identified themes fitted well within the three PAHRiS domains: evidence, contextual, and facilitation factors.

“We used the PARHiS model [14] to guide our questioning and analysis, and indeed found that the identified themes fitted well within the three PAHRiS domains: evidence, contextual, and facilitation factors.”

• cites [14] Nerenz DR, Leventhal H. Self-regulation theory in chronic illness. Coping with Chronic Disease: Research and Applications. 1983:13–38.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Most therapists cited their own experience of delivering ConquerFear, which provided personal evidence of its efficacy, as a strong motivator to continue using ConquerFear in routine practice.

“Most therapists also cited their own experience of delivering ConquerFear which had provided personal evidence of its efficacy as a strong motivator to continue using ConquerFear in routine practice.”

May combine two claims.

All therapists intended to continue using ConquerFear in routine practice, with some intending to follow the manual (n=4) and most intending to adapt it (n=10).

“All therapists intended to continue using ConquerFear in routine practice, some according to the manual (n=4) but most adapting it by either omitting components they found less useful, or more flexibly delivering components depending on each patient's needs (n=10).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Therapists were generally positive about alternative strategies to address barriers, including delivering ConquerFear in group or online format.

“Therapists were generally positive about alternative strategies to address these barriers, including delivering ConquerFear in group or online format”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Many therapists noted that ConquerFear was more appropriate for some patients than others.

“Many therapists noted that ConquerFear was more appropriate for some patients than others.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Therapists felt the evidence-base increased their own confidence and made it easy to sell the intervention to oncologist and nurse colleagues.

“They felt the evidence-base both increased their own confidence and made it easy to “sell” the intervention to their oncologist and nurse colleagues.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The evidence and theory-base behind ConquerFear was well-recognized and accepted by almost all therapists, and this acted as a motivator and facilitator for sustainability.

“The evidence and theory-base behind ConquerFear was well-recognized and accepted by almost all therapists, and this acted as a motivator and facilitator for sustainability.”

May combine two claims.

Services in which psychosocial support was less embedded, routine screening for distress was not routine, and where Oncology staff lacked the confidence and skills to recognize and refer patients with high FCR, struggled to implement ConquerFear.

“Similarly, services in which psychosocial support was less embedded, routine screening for distress was not routine, and where Oncology staff lacked the confidence and skills to recognize and refer patients with high FCR, struggled to implement ConquerFear.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Many therapists noted that survivorship, including FCR, was not a priority in their services, making it more difficult to justify spending time on treating FCR.

“Many therapists noted that survivorship (and FCR, as a component of survivorship) was not a priority in their services, making it more difficult to justify spending time on treating FCR.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some therapists noted they were reliant on referral from oncology colleagues to identify patients with high FCR, and that this was not always forthcoming.

“Some therapists noted they were reliant on referral from oncology colleagues to identify patients with high FCR, and that this was not always forthcoming.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Theoretical saturation was reached after 14 interviews.

“Theoretical saturation was reached after 14 interviews.”

Probably not a substantial claim: may not pass S2 (checkable).

Flexibility of delivery and ability to adapt to patient need would assist sustainability.

“Flexibility of delivery and ability to adapt to patient need would assist sustainability.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Intervention sustainability is enhanced if it is responsive to clinical needs and flexible in its delivery, for example, by dividing up sessions into components that can be delivered in a flexible number of sessions.

“Clearly, intervention sustainability is enhanced if it is responsive to clinical needs and flexible in its delivery, for example, by dividing up sessions into components that can be delivered in a flexible number of sessions.”

May combine two claims.

The present results confirm that ConquerFear is sustainable, provided it can accommodate local resources and constraints.

“The present results confirm that ConquerFear is sustainable, provided it can accommodate local resources and constraints.”

• AssumptionRests on an assumption: Therapists' expressed intentions and views about ConquerFear are a valid basis for judging its sustainability in routine clinical practice.
• AssumptionRests on an assumption: The views of the interviewed trial therapists are representative of barriers and facilitators to sustainability in routine clinical practice more broadly.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

E-health has become increasingly popular over recent years, with evidence that e-health interventions can be equally effective as face-to-face formats.

“E-health has become increasingly popular over recent years [20], with evidence they can be equally effective as face-to-face formats.”

• cites [20] Devilly GJ, Borkovec TD. Psychometric properties of the credibility/ expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The final themes alongside exemplar quotations were discussed with the research team, including two ConquerFear therapists, as a form of member checking.

“The final themes alongside exemplar quotations were discussed with the research team, including two ConquerFear therapists, as a form of member checking”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The PAHRiS framework proved to be a useful lens with which to understand sustainability issues and might be usefully employed to design a sustainability strategy.

“The PAHRiS framework proved to be a useful lens with which to understand sustainability issues and might be usefully employed to design such a strategy.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The PARiHS framework posits that successful implementation occurs when the evidence is robust, the context supportive, and the intervention appropriately facilitated.

“One such framework is the Promoting Action Research in Health Services determinant framework (PARiHS) [14], which posits that successful implementation occurs when the evidence is robust, the context supportive, and the intervention appropriately facilitated.”

• cites [14] Nerenz DR, Leventhal H. Self-regulation theory in chronic illness. Coping with Chronic Disease: Research and Applications. 1983:13–38.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

ConquerFear is an effective intervention for fear of cancer recurrence, producing greater improvements on Fear of Cancer Inventory scores than control immediately post-intervention and at 3- and 6-month follow-up.

“ConquerFear participants had clinically and statistically greater improvements than control participants from baseline to immediately post-intervention on Fear of Cancer Inventory (FCRI) scores (P < .001)and most secondary outcomes; differences on FCRI scores were maintained at 3-and 6-months follow-up.”

• cites [5] Herschbach P, Berg P, Waadt S, Duran G, Engst-Hastreiter U, Henrich G, et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom. 2010;79(1):31–8. sourceNot checked — no full text of the source

May combine two claims.

Facilitators of ConquerFear sustainability included a sound evidence-base, a context where survivorship care is incorporated into service goals, and a good fit between the intervention and both therapist orientation and patient need.

“Facilitators included a sound evidence-base, a context where survivorship care is incorporated into service goals, and a good fit between the intervention and both therapist orientation and patient need.”

Probably not a substantial claim: may not pass S2 (checkable).

A carefully designed sustainability strategy incorporating adequate training and support that elicits and addresses therapists' concerns, tailoring of intervention content and format to local needs, and communication of both objective and subjective evidence of the efficacy of interventions, is required to ensure their uptake into routine care.

“Our results suggest that a carefully designed sustainability strategy incorporating adequate training and support that elicits and addresses therapists' concerns, tailoring of intervention content and format to local needs, and communication of both objective and subjective evidence of the efficacy of interventions, is required to ensure their uptake into routine care.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There were no differences between participants and non-participants on age, gender and years of experience.

“There were no differences between participants and non-participants on age, gender and years of experience, and saturation was achieved within the included interviews.”