A psychosocial group intervention to address fear of recurrence in women with cancer: a randomized controlled clinical trial

Fear of cancer recurrence will be measured using the Fear of Cancer Recurrence Inventory (FCRI) (Simard & Savard, 2009). The FCRI is a 42-item questionnaire that includes a global score as well as seven subscales including triggers, severity, psychological distress, functional impairment, insight, reassurance, and coping strategies. A score of 13 or greater on the nine-item severity subscale (range 0-36) indicates clinical level of FCR (54).

1. Cancer-specific distress with the Impact of Event Scale (IES) (Horowitz, Wilner, & Alvarez, 1979); The IES is a 15-item questionnaires that assesses cancer distress. It has two subscales, intrusive thoughts and avoidance, which provide a total score. Perceived risk of cancer recurrence will be assessed using a one-item question where respondents indicate their level of perceived personal risk for a cancer recurrence over the last two days (Bish et al., 2002).
2. Intolerance of uncertainty with be measured with the Intolerance of Uncertainty Scale (IUS) (Buhr & Dugas, 2002). The IUS is a 27-item four-factor questionnaire that represents uncertainty as stressful and upsetting, uncertainty as leading to the inability to act, uncertain events as being negative and to be avoided, and being uncertain as unfair (Buhr & Dugas, 2002).
3. Uncertainty in Illness will be measured by the Mishel Uncertainty in Illness Scale (MUIS-C) (Mishel, 1981). The MUIS-C consists of 23 items rated on a five-point Likert scale. Coping will be measured with the following three coping scales: (1) Cognitive Avoidance Questionnaire (Sexton & Dugas, 2008), that contains 25 items that measure avoidance coping; (2) the Reassurance-Seeking Behaviours subscale of the Health Anxiety Questionnaire (Lucock & Morley, 1996), that contains three items that pertain to body-checking and reassurance-seeking from loved ones; and 3) the Reassurance Questionnaire (Speckens, Spinhoven, Van Hemert, & Bolk, 2000), that contains 10 items that measure reassurance-seeking from physicians.
4. Quality of life will be measured with the SF-8 instrument (Ware, Kosinski, Dewey, & Gandek, 2001). The SF-8 is a health-related QoL measure that provides an assessment of general physical (PCS) and mental (MCS) health with a 4-week recall period..

Additional variables to control:
1. As group cohesion may influence the impact of our CE group intervention, we will measure this construct at the end of the 6-week intervention for both the intervention and the control group. Cohesion will be measured with the Group Cohesion Scale-Revised (GCS-R) (Treadwell, Laverture, Kumar, & Veeraraghavan, 2001). The GCS-R is a 25 item questionnaire measuring group cohesion in terms of interaction and communication among group members. An example of an item is 'group members usually feel free to share information'.
2. Group alliance: we will use the California Psychotherapy Alliance Scale (CALPAS) (Gaston, 1991). The CALPAS is a 24-item scale that has four theoretically derived alliance dimensions: (1) the 'therapeutic alliance'; (2) the 'working alliance'; (3) the therapist’s contribution to the alliance; (4) the agreement on goals and tasks of therapy.
3. Therapeutic working group alliance measurement will be taken immediately following the last session for both the intervention and the control group.
4. Satisfaction with therapy: will be measured using Satisfaction with Therapy and Therapist Scale Revised (STTS-R). The STTS-R is a 12-item scale measuring the patient’s level of satisfaction with both the group therapy and the therapist in the CBT group (Oei & Green, 2008).
5. Credibility of intervention will be measured using: Credibility Expectancy Questionnaire (CEQ) – Version II, a scale for measuring treatment expectancy (six items) and rationale credibility (two items) (Devilly & Borkovec, 2000).