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

The CARE intervention resources resonated with older Australian participants and a telephone-delivered format was acceptable.

• 20 cognitive 'think aloud' interviews were completed with older Australians aged 70 years and over diagnosed with cancer.
• Participants had a mean age of 74 years (range 70-79).
• Most participants had a diagnosis of blood cancer (55%, n=11) or breast cancer (45%, n=9) within 10 years.
• Participants reviewed intervention resources for each session and provided feedback on content relevance and understandability.
• Content analysis was used to analyse the interviews.

Participants identified a need to simplify wording and modify language to reflect Australian culture.

• Despite both being English-speaking countries, language differences between the USA-developed materials and Australian usage were noted.
• Participants provided specific feedback on understandability during cognitive interviews.
• This finding indicates that even within English-speaking countries, language adaptation is necessary for psycho-oncology interventions.

The term 'Elders' in the intervention title was identified as culturally inappropriate for the Australian context.

• In Australia, 'elders' is a cultural term used by First Nations peoples to identify a custodian of knowledge.
• Most participants suggested changing the term 'elders' in the intervention name.
• This represents a key cultural difference from the USA, where the term carries different connotations.

The analogy of ageism to racism used in the CARE intervention felt unfamiliar to some Australian participants.

• Some participants reported that the ageism-racism analogy used in the original USA intervention was not culturally familiar to them.
• This finding suggests that conceptual frameworks embedded in psychotherapy content may not translate directly across cultural contexts.
• This was identified as a component requiring adaptation for the Australian version.

Cultural adaptation of psycho-oncology interventions is required even between English-speaking countries to ensure feasibility, acceptability, and uptake.

• The CARE intervention was originally developed in the USA and specifically targets older people aged 70 years and over navigating ageing, depression, and cancer.
• Depression is described as common among older adults with cancer.
• The study demonstrates that translation between English-speaking countries does not eliminate the need for cultural review and modification.
• Adaptations were needed to maximise uptake for older adults facing cancer and depression in Australia.