Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Cancer Med. 2024 Sep;13(17):e70187. doi: 10.1002/cam4.70187.
Rural cancer caregivers experience obstacles in accessing services, obtaining respite, and ensuring their care recipients receive quality care. These challenges warrant opportunities to participate in evidence-based behavioral intervention trials to fill support gaps. Adaptation to rural settings can facilitate appropriate fit, given higher caregiver service needs and unique challenges. We present findings from the adaptation process of a psychoeducational intervention designed to support cancer caregivers in rural settings.
We adapted Reblin's CARING intervention, designed for neuro-oncology, to target caregivers of rural cancer patients across cancer sites. First, we conducted formative work to determine the unmet social and supportive care needs rural cancer caregivers faced. We used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to guide the modifications. To conduct the adaptation, we elicited feedback through qualitative interviews of seven caregivers and three cancer hospital staff and thematic analysis to inform intervention modifications. Our qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Interviews revealed that service access was a pressing need, along with financial (e.g., treatment costs, employment challenges) and geographic barriers (e.g., distance to treatment, road conditions). We modified content, training, and context using the FRAME-IS steps. Changes enhanced fit through the following adaptations: changes to social support domains, session content, interventionist training, resource offerings, screening and recruitment processes, and virtual delivery.
Challenges to establishing successful psychosocial oncology interventions may be improved through participant-centered approaches and implementation science. Additional systemic challenges, including lack of systematic documentation of caregivers, persist and may especially disadvantage under-represented and underserved groups, such as rural dwellers. The enCompass intervention is undergoing ongoing single-arm pilot of rural cancer patient/caregiver dyads targeting caregiver coping self-efficacy and patient/caregiver distress (Clinical Trials #NCT05828927).
农村癌症护理人员在获得服务、获得喘息机会以及确保其护理对象获得高质量护理方面存在障碍。这些挑战需要有机会参与基于证据的行为干预试验，以填补支持空白。适应农村环境可以为满足更高的护理人员服务需求和独特挑战提供适当的契合。我们介绍了针对农村环境中癌症护理人员的心理教育干预措施的改编过程中的发现。
我们改编了 Reblin 的 CARING 干预措施，该干预措施针对神经肿瘤学，旨在针对农村癌症患者的护理人员。首先，我们进行了形成性工作，以确定农村癌症护理人员面临的未满足的社会和支持性护理需求。我们使用报告适应和修改证据基础实施策略的框架 (FRAME-IS) 来指导修改。为了进行改编，我们通过对七名护理人员和三名癌症医院工作人员进行定性访谈以及主题分析来征求反馈意见，以告知干预措施的修改。我们的定性研究遵循了定性研究报告的综合标准 (COREQ)。
访谈显示，服务获取是一个紧迫的需求，此外还有经济（例如治疗费用、就业挑战）和地理障碍（例如治疗距离、道路状况）。我们使用 FRAME-IS 步骤修改了内容、培训和背景。通过以下改编来增强适应性：对社会支持领域、课程内容、干预培训师、资源提供、筛选和招募流程以及虚拟交付的更改。
通过以参与者为中心的方法和实施科学，可能会改善建立成功心理肿瘤学干预措施的挑战。其他系统挑战，包括缺乏对护理人员的系统记录，仍然存在，并且可能特别不利于代表性不足和服务不足的群体，例如农村居民。EnCompass 干预措施正在对农村癌症患者/护理人员对进行单臂试验，针对护理人员应对自我效能和患者/护理人员的困扰（临床试验 #NCT05828927）。
