Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence– results of a three round online Delphi consensus process with Australian health professionals and researchers

Abstract

Purpose Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR. Methods Australian health professionals and researchers working with adult cancer survivors participated in a 3-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree – strongly agree), with optional qualitative feedback. Consensus was defined as ≥80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented in two subsequent rounds with new items, derived from content analysis of qualitative feedback. Results From 94 participants in Round 1 (89% health professionals) 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations, and stepped care management were endorsed. However, timing of FCR screening/triage did not reach consensus. Conclusions This world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts. Implications for Cancer Survivors Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.