Implementation and Evaluation of a Fear of Cancer Recurrence Screening, Referral and Management Program for Chinese Cancer Survivors A Stepped Wedge and Cluster Randomized Trial

What this Trial Is About

Researchers are evaluating a program designed to implement screening, referral, and management of fear of cancer recurrence into routine cancer care clinics. This study uses a stepped-wedge cluster randomized controlled trial to assess whether a systematic fear of cancer screening program that includes training, reflecting, evaluating, facilitating, and adapting improves the screening and referral rates compared to usual care without these implementation strategies. The goal is to increase the proportion of eligible patients screened and referred for psychosocial support, while also understanding patient and provider experiences and factors affecting the program's adoption and sustainability. The program involves five implementation strategies carried out at each study unit when it is randomly assigned to the intervention phase. Nurses receive a half-day training, and each unit under implementation gets weekly audit and feedback reports on eligible patients screened and referrals made. A senior research assistant trained and mentored by the principal investigator acts as a guided facilitator, conducting weekly site visits to address issues. While symptom assessment tools and referral criteria are standardized, routine workflows can be adapted to suit each unit's context and resources. Participants with non-metastatic breast, gynecological, or colorectal cancer who have completed primary and adjuvant treatments within the past two years are eligible for screening. Researchers will measure changes in the number of eligible patients screened and referred over a 24-month period before and after implementing the program. The study also includes qualitative assessments to explore experiences and contextual factors influencing the program's success. Participants will be monitored throughout this period to evaluate the program's impact on cancer care clinics.

Implementation and Evaluation of a Fear of Cancer Recurrence Screening, Referral and Management Program