Implementing a Stepped Care Model to Address Fear of Cancer Recurrence in Early Stage (0-II) Melanoma Patients - A Pilot Study

In this pilot-study, we aim to trial the implementation of the Melanoma Care Program into routine practice. The Melanoma Care Program provided a psycho-educational intervention to early-stage high-risk melanoma patients experiencing fear of cancer recurrence (FCR). This intervention included the provision of a psycho-educational booklet titled ‘Melanoma: Questions and Answers’ and three psychotherapeutic telehealth sessions. This intervention significantly reduced patient FCR 12-months post-intervention. We aim to evaluate both the effectiveness and sustainability of implementing FCR screening and the Melanoma Care Program into routine practice at Melanoma Institute Australia and Royal Prince Alfred Hospital. Early-stage (0-II) melanoma patients who attend either study site will complete FCR screening using the Fear of Cancer Recurrence Inventory 9-item Short-Form between 4-weeks before and 1 week after their upcoming appointment. Based on these screening results, patients will be placed into a stepped-care model, determining the level of intervention they receive. This stepped-care model is outlined below. Step 1 - No/Low FCR Patients who score below 13/36 will continue to receive standard care. Step 2 - Moderate FCR Patients who score 13-21/36 will continue to receive standard care, as well as the Melanoma: Questions and Answers booklet and three psychotherapeutic telehealth sessions. Step 3 - Severe FCR Patients who score above 21/36 will continue to receive standard care, as well as the Melanoma: Questions and Answers booklet and five psychotherapeutic telehealth sessions Step 4 – Significant co-morbid mental health condition, regardless of FCR score Patients identified to have a significant co-morbid mental health condition will be referred to a community mental health specialist to better address their needs. Standard care involves patient education and support as per usual clinical practice. Furthermore, standard care involves offering Melanoma Institute Australia’s ‘Early Melanoma Guide’ booklet to any participant that do not already possess one. This booklet provides patients with information on diagnosis, treatments and common questions, and is provided to patients at Melanoma Institute Australia as a part of standard practice. The ‘Melanoma: Questions and Answers’ booklet in the Melanoma Care Program was created to provide comprehensive information on a range of topics for patients diagnosed with early-stage (0-II) melanoma. This booklet has been reviewed for this study to include up to date information and to be complimentary to the 'Early Melanoma Guide' developed by Melanoma Institute Australia. Both booklets will be available to patients online and in paper. The psychotherapeutic telehealth sessions are anticipated to be 30-90 minutes in duration and aim to provide empathetic, active listening in order to understand patient experiences and assist them in developing effective coping strategies. A session manual was created for use in the Melanoma Care Program, which will also be used in the present study. This intervention is based on psychodynamically-oriented psychotherapy and cognitive-behavioural therapy. Psychologist(s) delivering the intervention will be trained and supervised by The Lead Investigator (Dr. Iris Bartula) and the psychologist who developed the intervention (Prof Nadine Kasparian). The telehealth sessions will be conducted via telephone or videoconferencing at times convenient to the patient. The first session will take place as soon as possible after the patient completes screening, with each subsequent session taking place 2 weeks after. Session content interventions delivered and the adherence to strategies previously discussed will be monitored using a Telehealth Session Record From adapted from the original Melanoma Care Program. This intervention is anticipated to be implemented for 18 months