Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer

Abstract

Context: Patients with advanced cancer face a life-limiting condition that brings a high symptom burden that often includes pain, fatigue, and psychological distress. Psychosocial interventions have promise for managing symptoms, but need additional tailoring for these patients' specific needs. Patients with advanced cancer in the community also face persistent barriers -availability of interventions in community clinics, financial and illness-related factors -to accessing psychosocial interventions. Objectives:The aim of the current study was to assess the feasibility and acceptability of telephone implementation of Engage, a novel, brief combined Coping Skills Training and Acceptance and Commitment Therapy protocol, for reducing symptoms and increasing quality of life in community patients with advanced cancer.Methods: Adult patients with advanced cancer receiving care in the community received Engage, four, sixty-minute manualized telephone sessions delivered by a trained psychotherapist and completed pre-and post-treatment assessments.Results: Engage was feasible, achieving 100% accrual (N=24) of a heterogeneous sample of patients with advanced cancer, with good retention (88% completed). Acceptability was demonstrated via satisfaction (mean=29 out of 32, SD=2), engagement (95% attendance) and use of skills. Secondary analyses pointed to reductions in pain interference, fatigue, psychological distress, and improvements in psychological acceptance and engagement in value-guided activity at post treatment. Conclusion: Engage, our brief novel combined Coping Skills and Acceptance and CommitmentTherapy intervention, demonstrated initial feasibility and acceptability when delivered over the

Symptom experiences in advanced cancer: Relationships to acceptance and commitment therapy constructs

“…Many advanced cancer patients have symptoms that interfere with functioning 1–3 . Our results in combination with prior research 10–13 provide a strong rationale for large‐scale trials of ACT to reduce symptom interference in advanced cancer and promote feasible engagement in activities that enrich quality of life. If found to be efficacious, ACT could be widely disseminated to clinicians caring for advanced cancer patients, addressing a critical gap in the evidence‐based care of this population.…”

“…Based on the current findings and promising pilot trials in advanced cancer, 10–13 mindfulness and acceptance may be targeted in interventions to reduce symptom interference with functioning. Mindfulness may be increased through meditation or purposeful attention during activities.…”

“…ACT has produced promising results in pilot trials with advanced cancer patients 10–13 . In a pilot randomized controlled trial (RCT) with late‐stage ovarian cancer patients, ACT had large effects on anxiety and depressive symptoms and global quality of life compared to cognitive‐behavioral therapy 11 .…”

“…Although ACT has been tested in a few pilots with advanced cancer patients, 10–13 establishing relationships between ACT constructs and symptoms would bolster the theoretical foundation for large‐scale trials. To date, one study of metastatic breast cancer patients linked higher symptom burden to disengagement from valued activities and psychological inflexibility, 14 and another study found that mindfulness facets were negatively correlated with physical and psychological symptoms in this population 15 .…”

Why are some drought‐affected farmers less distressed than others? The association between stress, psychological distress, acceptance, behavioural disengagement and neuroticism

“…The principles of ACT are teachable, transdiagnostic and therefore broadly applicable, with an increasing body of research demonstrating the effectiveness of ACT for addressing a range of psychological conditions and lifestyle factors 44‐47 . There is also evidence that ACT can help to build resilience for managing challenging work environments 48 and improve coping in the general population, 49 as well as being useful in helping people cope with situations beyond their control, for example advanced cancer 50 and end of life care 51 . While this approach offers promise, it is vital that any such new interventions are adapted to carefully take into account farmers' unique stressors, preferences, attitudes, barriers to using existing sources of help and technology requirements, to ensure that strategies are perceived as relevant and acceptable, and are therefore adopted 52 …”