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Abstract
Objective
Adolescents and young adults with cancer have poorer psychological outcomes relative to both younger and older patients. Their distress often peaks at the completion of cancer treatment, as they return to their normal lives while hospital‐based support is reduced. Telepsychology has the potential to reduce help‐seeking barriers in this group; nevertheless, other challenges remain. This article discusses the Recapture Life randomised controlled trial, which involved online, videoconferencing‐based delivery of group‐based cognitive‐behavioural therapy to adolescents and young adults aged 15–25 years in the first year post‐treatment.
Methods
A case series (n = 11, 53% females, mean age = 21.1 years) is presented to illustrate ethical and clinical considerations in delivering cognitive‐behavioural therapy in the online environment.
Results
Across the study trajectory, ethical/clinical issues were documented among between 3.0–14.3% of participants. Almost half of the incidents (45%) were identified through routine safeguards built into the intake protocol. Challenges described include: (a) managing mental health risks without face‐to‐face contact; (b) facilitating discussion about potentially distressing cancer‐related experiences in a group setting; (c) responding appropriately to participants’ health changes (e.g., cancer relapse) during the trial; and (d) the need to be mindful of a range of ‘survivorship’ experiences and outlooks.
Conclusions
We conclude by reflecting on the clinical ‘trade‐offs’ that exist when the provision of therapy reliant on human interaction is transferred to an electronic realm. Despite the potential challenges, we argue that telepsychology is critical to broadening access to timely, evidence‐based therapy among vulnerable groups, such as young people with cancer.
Acknowledgements
The authors wish to thank all the young people who have participated in the Recapture Life study. We acknowledge the contribution of Sarah Ellis, Eden Robertson, Emma Doolan, Helen Wilson, and Sanaa Mathur, as well as the support of the wider Recapture Life‐AYA Working Party, including A/Prof. Richard Cohn, Prof. Phyllis Butow, Prof. Richard Bryant, Dr Antoinette Anazodo, Ms Kate Thompson, Ms Lucy Holland, Prof. Susan Sawyer, Dr Belinda Barton, Ms Belinda Matigian, Ms Lyndal Gray, Dr Michael Osborn, Ms Meg Plaster, and Dr Marianne Phillips. The Recapture Life study was co‐funded by a beyond blue and Cancer Australia project grant (ID: 1022868). Ursula Sansom‐Daly is supported by an Early Career Fellowship from the Cancer Institute of New South Wales (ID: 14/ECF/1‐11). Claire Wakefield is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia (APP1067501) and an Early Career Development fellowship from the Cancer Institute of NSW (ID: 11/ECF/3–43). The Behavioural Sciences Unit is supported by the Kids with Cancer Foundation.