Using co-design to transform an established cancer patient iCBT intervention to meet the needs of family carers - Developing the CarersCanADAPT web-based intervention

Abstract

Aims: Cancer carers experience high rates of anxiety and depression, yet limited targeted support exists. We aimed to transform an existing established internet Cognitive Behavioural Therapy (iCBT) program for cancer patients (iCanADAPT) to target the unique needs of family/friend carers.   Methods: Yardley et al’s (2015) Person-Based Co-design Approach was used to ensure iCBT content and design was grounded in end-user needs/preferences. Psychologists, social workers, and cancer carers participated in individual cognitive interviews to discuss carer-relevant adaptations needed for the iCanADAPT program. Carers completed follow up interviews 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. Participants stressed that iCBT content should address unique carer challenges such as juggling multiple roles, relationship changes, caregiving overwhelm, and guilt. Carers proposed technical and practical revisions to facilitate more widespread uptake, completion, and implementation.   Clinicians endorsed existing CBT strategies, and many suggested incorporating other therapeutic approaches such as cognitive defusion. Clinicians noted key barriers/facilitators to carer uptake and discussed implementation factors of scope, delivery and target audience. Seven carers completed a follow-up interview and reported high acceptability of the revised carer-relevant content.   Conclusions: Development of a carer-specific anxiety and depression program, CarersCanADAPT aims to 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