Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

iCanBlend: Blended Psychological Therapy for the treatment of anxiety and depression in adult patients with an experience of cancer – a qualitative interview study. (#383)

Kelly F Nunes-Zlotkowski 1 2 , Heather Shepherd 1 3 , Lisa Beatty 1 4 , Phyllis Butow 1 2 , Joanne Shaw 1 2
  1. School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, New South Wales, Australia
  2. School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia
  3. Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
  4. Clinical Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia

Background: Lifetime prevalence estimates of major depression (18%) and anxiety (24%) in patients1 with cancer are higher than those in the general population2,3. Despite availability of effective cancer-specific interventions for depression and anxiety, treatment uptake in psycho-oncology is low4,5. Reasons for low uptake include workforce issues and geographic barriers to access. Blended psychological therapy (BT) may help increase acceptability of and engagement with treatment in psycho-oncology as it combines patient-driven, online therapy with therapist-facilitated sessions6-8. BT may improve access to treatment; uptake and adherence; treatment maintenance; and therapy effects9-11. Research supports the acceptability and feasibility of different models of BT in non-cancer context but evidence in psycho-oncology is limited.

Aim: This study aimed to explore psycho-oncology stakeholders (service managers, psychologists) views on the feasibility and acceptability of BT models and barriers and facilitators to implementation into psycho-oncology care in Australia.

Method: Psychologists working clinically with cancer patients and psycho-oncology service managers were recruited to participate in qualitative, semi-structured telephone interviews to explore feasibility and acceptability of BT models and to identify barriers and facilitators to implementation. Interviews were analysed qualitatively using a Framework Analysis approach12.

Results: Twenty-two participants (psychologists, n=17; service managers, n=5) were interviewed. Thematic analysis identified three themes: (i) patient engagement; (ii) perception of control; (iii) system factors.  An overarching theme of trust underpins the themes. Specifically, the use of digital technology was perceived both as a barrier to patient engagement but also as providing flexibility for access. Clinicians voiced concerns regarding duty of care and lack of autonomy to deliver therapy but also noted BT could optimise clinician time and resources. Finally, there were concerns about service over-reliance on the digital component as a means of reducing dedicated psycho-oncology positions.

Conclusion: Overall BT was feasible and acceptable. Future research will incorporate healthcare professionals’ preferences for BT development and evaluation of a cancer-specific anxiety and depression BT intervention.

  1. Kuhnt S, Brähler E, Faller H, et al. Twelve-Month and Lifetime Prevalence of Mental Disorders in Cancer Patients. Psychotherapy and Psychosomatics. 2016;85(5):289-296.
  2. Waraich P, Goldner EM, Somers JM, Hsu L. Prevalence and Incidence Studies of Mood Disorders: A Systematic Review of the Literature. The Canadian Journal of Psychiatry. 2004;49(2):124-138.
  3. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine. 2013;43(5):897-910.
  4. Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psycho-oncology (Chichester, England). 2016;25(8):882-890.
  5. Singer S, Szalai C, Briest S, et al. Co-morbid mental health conditions in cancer patients at working age - prevalence, risk profiles, and care uptake. Psycho-oncology (Chichester, England). 2013;22(10):2291-2297.
  6. Kooistra LC, Ruwaard J, Wiersma JE, et al. Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care. Internet Interv. 2016;4:61-71.
  7. Van Der Vaart R, Witting M, Riper H, Kooistra L, Bohlmeijer ET, Van Gemert-Pijnen LJ. Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study. BMC Psychiatry. 2014;14(1).
  8. Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JEWC. Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care. JMIR Ment Health. 2016;3(1):e9-e9.
  9. Erbe D, Eichert HC, Riper H, Ebert DD. Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review. J Med Internet Res. 2017;19(9):e306.
  10. Fitzpatrick M, Nedeljkovic M, Abbott JA, Kyrios M, Moulding R. "Blended" therapy: The development and pilot evaluation of an internet-facilitated cognitive behavioral intervention to supplement face-to-face therapy for hoarding disorder. Internet Interv. 2018;12:16-25.
  11. Kooistra LC, Wiersma JE, Ruwaard J, et al. Cost and Effectiveness of Blended Versus Standard Cognitive Behavioral Therapy for Outpatients With Depression in Routine Specialized Mental Health Care: Pilot Randomized Controlled Trial. J Med Internet Res. 2019;21(10):e14261.
  12. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 2013;13(1):117.