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

BACKGROUND: 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. AIMS: To review and tailor the CARE resources to ensure they are culturally appropriate and acceptable for older Australians. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.