Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

The Therapists’ Role – Understanding Strategies and Techniques used in a guided digital psychological intervention for fear of cancer recurrence (TRUST) (126446)

Frederik Lynge Overgaard 1 , Ingrid Elin Johanna Swenne 1 , Lisbeth Frostholm 2 3 , Ben Smith 4 , Joanna Fardell 5 , Lisa Beatty 6 , Britt Klein 7 , Per Fink 8 , Phyllis Butow 8 , Lea Lund 9 10 , Johanne Lyhne 1
  1. Department of Oncology, University Hospital of Southern Denmark - Vejle, Vejle, Denmark
  2. Department for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
  3. Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
  4. The Daffodil centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
  5. Discipline of Pediatrics, School of Clinical Medicine, UNSW, Sydney, Australia
  6. Flinders University, College of Education, Psychology & Social Work, Flinders University Institute of Mental Health and Wellbeing, Adelaide, Australia
  7. Health Innovation & Transformation Centre, Federation University Australia, Ballarat, Australia
  8. School of Psychology, University of Sydney, Sydney, Australia
  9. Centre for Shared Decision Making, University Hospital of Southern Denmark - Vejle, Vejle, Denmark
  10. Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

Objectives/Purpose

Therapist-guided digital psychological interventions have consistently demonstrated greater engagement and efficacy than non-guided interventions. However, little is known about the specific mechanisms by which guidance contributes to these outcomes - particularly with regard to promoting participant adherence and engagement. This secondary analysis of data from a RCT of therapist-guided (TG)-iConquerFear - a digital fear of cancer recurrence (FCR) intervention - examines therapist-participant interactions to elucidate the therapist’s role in facilitating these outcomes.

Sample and Setting

Colorectal cancer survivors with severe FCR were enrolled in the intervention. Three therapists provided asynchronous written support. Data comprised messages exchanged between therapists and participants via the program’s messaging system and a focus group and individual interview with therapists providing the guidance to support the coding scheme. Therapists could access participants’ activity logs, diary entries, and performance data, which informed their feedback. Each therapist was responsible for multiple participants.

Procedures

The study employed a phenomenological-hermeneutic approach using an iterative, data-driven analysis combining both inductive and deductive strategies. Written communication from 44 participants was coded using a deductive coding scheme based on the themes from the messages from the participants and the interviews. The interviews were conducted based on initial coding of a limited number of therapist-participant conversations. Throughout the analysis, the coding scheme was continuously refined through an inductive approach to the data.

Results

The analysis unfolded three key themes in the dialogue: “trust building,” “facilitating meaning”, and “execution and implementation.” Common mechanisms included: “praise”, “unity”, and “encouragement,” highlighting the supportance and therapeutic alliance of the therapist guidance.

Conclusion and Clinical Implications

Therapists’ guidance fosters trust, a sense of shared purpose, and self-efficacy - factors instrumental in maintaining adherence and engagement in digital interventions by empowering the participant. The findings highlight the critical role of therapists in enhancing intervention engagement and efficacy.