Aims: Cancer carers report high levels of anxiety, depression, and unmet emotional needs, however limited targeted support is available. We aimed to adapt an iCBT program with demonstrated efficacy among cancer patients (iCanADAPT) to target the unique psychological needs of carers.
Methods: To ensure iCBT content and design aligned with evidence-based psycho-oncology approaches and grounded in end-user experiences and needs, we applied Yardley et al’s (2015) Person-Based Co-design Approach. Psycho-oncology clinicians (psychologists, social workers) and cancer carers participated in individual cognitive interviews to discuss carer-relevant adaptations needed for the iCanADAPT program. Carers completed a follow up interview to provide feedback on iteratively adapted content. Qualitative data was analysed using interpretive description.
Results: 15 carers, 9 psychologists and 8 social workers completed cognitive interviews. All participants discussed the need for widely available and targeted psychological support for carers. Participants stressed that iCBT content should address unique carer challenges such as juggling multiple roles, relationship changes, caregiving responsibility and overwhelm, and carer guilt.
Carers engaged with CBT components of the existing module such as thought challenging, activity planning and mindfulness and suggested revisions to make content more relatable. Carers proposed technical and practical revisions to facilitate more widespread uptake, completion, and implementation.
Psycho-oncology clinicians endorsed existing CBT strategies, and many suggested incorporating Acceptance and Commitment Therapy approaches such as cognitive defusion and values clarification. Clinicians noted key barriers/facilitators to carer uptake and discussed implementation factors of scope, delivery and target audience. Eight carers completed a follow-up interview and reported high acceptability of the carer-relevant content.
Conclusions: Development of a carer-specific anxiety and depression program, CarersCanADAPT will improve carer psychological wellbeing. Co-design methodology will ensure it meets the unique needs of carers. Future research to evaluate the efficacy of CarersCanADAPT is planned.