Development of ACT+: A Novel, Person‐Centred Psychological Intervention Based on Acceptance and Commitment Therapy (ACT) to Improve Quality of Life in Patients Living With and Beyond Cancer

Introduction:

The need to improve the quality of life (QoL) and well‐being of people living with and beyond cancer is well recognised. SURECAN (SUrvivors' Rehabilitation Evaluation after CANcer) is a multiphase study developing and evaluating a psychological intervention based on acceptance and commitment therapy (ACT) for people who have completed hospital‐based treatment for cancer but have low QoL. We describe the process by which we iteratively developed and refined ACT+, an intervention in which ACT is integrated with options to support exercise and work.

Methods:

ACT+ development was guided by the theory of ACT while Normalisation Process Theory (NPT) was used as a sensitising tool at all stages. Evidence from several strands of research comprising a qualitative meta‐synthesis, a qualitative study with stakeholders and pre‐pilot testing was brought together to refine ACT+. Insights from patient and public involvement (PPI) consultations supported the development and refinement of ACT+ resources throughout.

Results:

The qualitative study with stakeholders shed light on the ‘real world’ contexts in which the ACT+ intervention would be offered and accessed, as well as the appeal of ACT+ as a therapy for people living with and beyond cancer. People who had treatment for cancer (n = 31) and healthcare professionals (n = 16) provided overall support for the intervention. Subsequent pre‐pilot testing of the intervention and qualitative work with cancer patients (n = 6) and therapists (n = 7) led to further refinements. Evidence collected from all strands of research and PPI was integrated in an iterative way to produce an intervention that was acceptable to all.

Conclusion:

We adopted an iterative and evidence‐based approach to the development of the ACT+ intervention, which was acceptable to patients and healthcare professionals. Future work will examine the effectiveness of ACT+.

Patient and Public Engagement:

This intervention was developed and refined with substantial involvement from the study's patient and public involvement group and others accessed via community/patient groups to discuss and gain feedback on patient‐facing materials. For example, the ACT+ participant handbook underwent four consultation rounds with patient representatives, including a consultation specifically focused on its cultural acceptability. Therefore, emerging insights from PPI were also used to optimise ACT+ components and delivery. Their input was integrated throughout all three strands of the research.

What is it about?

The study focused on developing and evaluating a psychological intervention called ACT+ for cancer survivors with low quality of life, integrating acceptance and commitment therapy with exercise and work support. It employed an iterative approach guided by ACT and Normalisation Process Theory, incorporating evidence from qualitative meta-synthesis, stakeholder studies, and pre-pilot testing. Patient and public involvement played a crucial role in refining the intervention, ensuring it was acceptable to both patients and healthcare professionals. The development process involved creating and refining patient-facing materials such as a participant handbook and therapist manual, with feedback from consultations and qualitative research. The study successfully produced an intervention deemed acceptable to key stakeholders, setting the stage for further examination of its effectiveness in a randomized controlled trial. The trial aims to assess the feasibility, acceptability, and effectiveness of ACT+ in aiding cancer survivors, with its protocol already published.

Why is it important?

This study is important as it addresses the critical need to improve the quality of life and well-being of individuals living with and beyond cancer. By developing ACT+—a psychological intervention based on acceptance and commitment therapy (ACT)—the research aims to specifically target and alleviate the low quality of life experienced by cancer survivors, which is often exacerbated by psychological distress and physical limitations. The study's novel approach integrates ACT with exercise and work support, offering a comprehensive and adaptable intervention that aligns with real-world contexts. This is particularly significant given the increasing number of cancer survivors and the associated challenges they face, such as psychological distress, fear of recurrence, and employment issues. The findings have implications for developing effective support strategies for cancer survivors, ultimately contributing to improved mental health and quality of life.

Key Takeaways:

1. Iterative Development: The study utilized an iterative, evidence-based approach to develop ACT+, incorporating patient and public involvement (PPI) insights, stakeholder feedback, and qualitative research findings to refine the intervention for acceptability among patients and healthcare professionals.

2. Integration with Real-World Contexts: The use of Normalisation Process Theory (NPT) as a sensitizing framework ensured that ACT+ was developed to be applicable and implementable in real-world settings, enhancing its potential for successful adoption if proven effective.

3. Stakeholder Engagement: Continuous engagement with patients, healthcare professionals, and PPI contributors during the development process ensured that ACT+ addressed the practical needs and preferences of cancer survivors, supporting its feasibility and relevance for the target population.