The development of an online intervention for post-treatment cancer survivors with cancer-related fatigue

Background The number of post-treatment cancer survivors in Ireland is set to increase in coming years, due to advances in screening and treatment. This group will require ongoing supportive care as many will experience persistent negative side-effects that can impair quality of life. Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. Fatigue is extremely complex, and likely to involve the interaction of several physiologic and psychological mechanisms. Current evidence supports the use of nonpharmacological treatment strategies for reducing CrF. In order to develop evidence-based psychological interventions there is a need to understand the biological, psychological, and social contributors to positive adjustment in post-treatment cancer survivors. Online interventions have been shown to be an effective mode of delivery and can facilitate selfmanagement of long-term conditions. Aim This thesis will outline the rationale, decision-making processes, methods, and findings which led to the development of an online intervention that was tested in a feasibility trial. This theory-based intervention aimed to facilitate self-management and enhance coping with fatigue following cancer treatment. Methods The studies conducted in this research were based on the development phase of the UK Medical Research Council Framework for developing complex interventions. In the first study a systematic review and meta-analysis was conducted to identify the evidence base related psychological interventions for cancer-related fatigue in post-treatment cancer survivors. A qualitative study involving fatigued cancer survivors was then conducted to establish a theoretical basis for the intervention. The findings of the preparatory deductive and inductive research were collated to create a draft content manual and plan for the structure of the website. An iterative review process then took place to assess and improve usability of the website. Finally, a feasibility study was conducted to test the processes and potential of carrying out a larger trial. Findings The findings of the systematic review suggested there is some tentative support for psychological interventions for fatigue after cancer treatment. However, the RCTs were very heterogeneous in nature and the number of high quality studies was limited. The majority of the interventions were based on the principles of cognitive-behavioural therapy (CBT). Current guidelines recommend the use CBT for the treatment of fatigue. Qualitative research indicated that using the Self-regulation Model to describe fatigue after cancer may provide an integrated theoretical model for developing interventions for fatigue based on cognitive– behavioural principles. An online intervention was developed based on this theoretical framework, as well as current guidelines and input from stakeholders. The feasibility study found that the website considered acceptable to users and findings suggested that the trial was feasible. The study led to recommendations for final refinements to the intervention before its effectiveness is tested in a fully powered RCT. Conclusion Despite being a complex and multifaceted intervention, transparency was sought by detailing the components of the intervention, the proposed mechanisms of change. This is the first intervention of its kind based on SRM theory, with the primary aim of targeting the representations of fatigue and enhancing self-management of CrF specifically. The results from this trial indicated that the website was considered feasible. However, improvements can be made to enhance the website for participants. Further research is needed in order to establish if the intervention could have an impact on clinical, psychological, and behavioural outcomes