ABSTRACT
This study was supported by Scientific and Technological Research Council of Turkey (TUBITAK) under the Grant Number 223K032. The authors thank to TUBITAK for their support.
Background:
Fear of cancer recurrence (FCR) is a prevalent and distressing concern among breast cancer survivors in Türkiye, yet culturally tailored interventions remain scarce. This presentation details the systematic adaptation of the Fear of Recurrence Therapy (FORT) program for Turkish breast cancer survivors using Bernal’s Ecological Validity Model (EVM).
Methods:
The multi-phase process began with translation and back-translation of the FORT manual, followed by advisory panel review, cognitive interviews, and an adaptation workshop. Quantitative evaluations from professionals and survivors were analyzed using Gwet’s AC1 to assess inter-rater agreement across EVM domains, while qualitative data were analyzed thematically.
Results:
Key adaptations involved simplifying technical terms, clarifying cognitive-behavioral concepts, and replacing culturally discordant content (e.g., references to writing wills or imagining funerals) with more resonant metaphors such as reconnecting with life goals. Visual and structural improvements, including consistent language use, updated infographics, and a glossary of key terms, were also implemented. Focus groups with oncology professionals and survivors (n=4 sessions) ensured emotional appropriateness, linguistic clarity, and conceptual fit. The adaptation workshop consolidated feedback, resulting in a culturally aligned, six-session group therapy manual. Gwet’s AC1 scores showed moderate to very good agreement across components, with strong consensus on metaphors, content, and contextual relevance. The final version was rated as acceptable and relevant by all participant groups.
Conclusion:
This study offers one of the first structured, culturally adapted interventions targeting FCR in Türkiye and illustrates how participatory adaptation can enhance ecological validity and emotional safety. The findings support future implementation and evaluation through a randomized controlled trial.