Oral Presentation 2025 National Cancer Survivorship Conference

Addressing fear of cancer recurrence in routine care: Feasibility of implementing a clinical pathway (#9)

Ben Smith 1 2 3 4 , Joanne Shaw 4 5 , Alison Pearce 1 6 , Jia (Jenny) Liu 7 8 , Heather Shepherd 9 , Verena Wu 1 2 3 , Afaf Girgis 2 , Gail Garvey 10 , Laura Kirsten 4 11 , Iman Zakhary 12 , Carolyn Ee 13 14 15 , Dan Ewald 16 , Annie Miller 17 , Natalie Taylor 2 18
  1. The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
  2. UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
  3. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  4. Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia
  5. School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
  6. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  7. The Kinghorn Cancer Centre, St Vincent’s Hospital, Sydney, NSW, Australia
  8. St Vincent’s Clinical School, UNSW Sydney, Darlinghurst, NSW, Australia
  9. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  10. School of Public Health, The University of Queensland, Herston, Queensland, Australia
  11. Nepean Cancer Services, Nepean Blue Mountains Local Health District, Kingswood, NSW, Australia
  12. Multicultural Services, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
  13. NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
  14. Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
  15. Chris O’Brien Lifehouse Cancer Centre, Camperdown, NSW, Australia
  16. Sydney University Medical School, Northern Rivers University Centre for Rural Health, Lismore, NSW, Australia
  17. Cancer Council NSW, Woolloomooloo, NSW, Australia
  18. School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia

Background

Getting help with fear of cancer recurrence (FCR) is the most reported unmet need by people living with and beyond cancer. We established an evidence and consensus-based clinical pathway to enable health professionals to address FCR in routine care.

Aim

This study evaluated the feasibility and barriers/enablers of FCR clinical pathway implementation.

Methods

Australian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study. Thirty-eight items regarding FCR screening, assessment, and triage to stepped care (i.e., staged care tailored to FCR severity), were derived from a literature review, related pathways/guidelines, and expert input. Participants rated how feasible (i.e., able to be implemented) items were on a 5-point scale (strongly disagree–strongly agree), with optional qualitative feedback. Quantitative data was descriptively analysed. Qualitative feedback was content analysed guided by updated Consolidated Framework for Implementation Research domains (i.e., Innovation, Outer Setting, Inner Setting, Individuals).

Results

On average, 64.1% of participants strongly/agreed pathway items were feasible. The most feasible items were: validation and normalization of FCR by all health professionals (90% agreement), patient education to encourage FCR treatment uptake (85% agreement), FCR screening using a brief validated tool (84%). The least feasible elements were: training all health professionals in FCR screening (49%), moderate FCR intervention delivery by non-mental health specialists (51%), booster treatment sessions for moderate FCR (53%). Implementation barriers primarily related to Inner Setting characteristics (e.g., available resources, access to knowledge/training). Implementation enablers primarily related to characteristics of the Innovation (e.g., clinical pathway design/adaptability) and Individuals (e.g., innovation deliverer capability).

Conclusion

Some clinical pathway elements, such as delivery of moderate FCR interventions, are more challenging to implement than others. Given identified Inner Setting resource constraints, integrating the pathway into existing workflows, and training to enhance health professional capability to address FCR may aid implementation.