Background: Although cancer-related fatigue (CRF) has gained
increased attention in the past decade, it remains difficult to treat. An
integrative approach combining conventional and complementary medicine
interventions seems highly promising. Treatment programs are more likely to be
effective if the needs and interests of the people involved are well
represented. This can be achieved through stakeholder engagement.
Objectives: The aim of the study was to develop an integrative
CRF treatment program using stakeholder engagement and to compare it to an
expert version. Method: In a qualitative study, a total of 22
stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5
nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a
local Swiss Cancer League) were interviewed either face-to-face or in a focus
group setting. For data analysis, qualitative content analysis was used.
Results: With stakeholder engagement, the integrative CRF
treatment program was adapted to usual care using a prioritizing approach and
allowing more patient choice. Unlike the expert version, in which all
intervention options were on the same level, the stakeholder engagement process
resulted in a program with 3 different levels. The first level includes
mandatory nonpharmacological interventions, the second includes
nonpharmacological choice-based interventions, and the third includes
pharmacological interventions for severe CRF. The resulting stakeholder based
integrative CRF treatment program was implemented as clinical practice guideline
at our clinic (Institute for Complementary and Integrative Medicine, University
Hospital Zurich). Conclusion: Through the stakeholder engagement
approach, we integrated the needs and preferences of people who are directly
affected by CRF. This resulted in an integrative CRF treatment program with
graded recommendations for interventions and therefore potentially greater
sustainability in a usual care setting.