Cancer and Ageing Reflections for Elders (CARE): Australian Adaptation of a Psychotherapy for Older Adults With Cancer

TL;DR

This study adapts a US psychotherapy program for older adults with cancer to better suit Australian cultural norms and improve its effectiveness.

Contribution

The study provides a culturally adapted version of the CARE psychotherapy program for Australian older adults with cancer.

Findings

Participants found the intervention resources relevant but suggested simplifying language and adapting cultural terms.

The telephone-delivered format was acceptable to most participants.

The analogy of ageism to racism was unfamiliar to some, highlighting the need for cultural sensitivity.

Abstract

Depression is common among older adults with cancer. The USA‐developed CARE (Cancer and Ageing: Reflection for Elders) psychotherapy intervention, specifically addresses the unique needs of older people (≥ 70 years) navigating the challenges of ageing, depression, and cancer.

To review and tailor the CARE resources to ensure they are culturally appropriate and acceptable for older Australians.

Semi‐structured cognitive ‘think aloud’ interviews were conducted with older Australians (≥ 70 years) diagnosed with cancer. Participants reviewed the intervention resources for each session providing feedback on content relevance and understandability. Content analysis was used to analyse the interviews.

We completed 20 cognitive interviews. Participants had a mean age of 74 years (range 70–79) and most with a diagnosis of blood (55% n = 11) or breast cancer (45%, n = 9) within 10 years. Resource content resonated with participants and a telephone‐delivered intervention was acceptable. Participants emphasised the need to simplify wording and modify language to reflect Australian culture. In Australia ‘elders’ is a cultural term used by First Nations peoples to identify a custodian of knowledge; most participants suggested changing this. For some participants, the analogy of ageism to racism used felt unfamiliar.

This study highlights that cultural adaptation of psycho‐oncology interventions is required, even between English‐speaking countries, to ensure cultural appropriateness and enhance feasibility, acceptability and to maximise uptake for older adults facing cancer and depression.