Feasibility and Acceptability of the Take Action Program for Breast Cancer Survivors

BACKGROUND AND PURPOSE: Breast cancer survivors often report persistent trouble with occupational engagement after cancer treatment (Lyons, Svensborn, Kornblith, & Hegel, 2015). Challenges in self-care, work, leisure, and social participation may be amplified in urban, safety net hospitals that do not have access to comprehensive cancer rehabilitation. The purpose of this study is to explore the feasibility, acceptability, and potential efficacy of Take Action, a 6-wk, occupation-based self-management program for women who have completed cancer treatment at an urban safety net hospital within the past 2 yr.

DESIGN AND METHOD: In a single-arm pilot study of the Take Action program, three cohorts of five Stage I–III breast cancer survivors will be enrolled. Take Action consists of six sessions informed by social learning theory (Bandura, 1986) and problem-solving therapy (D’Zurilla & Nezu, 2007). Participants attend two individual sessions and four 90-min group sessions focused on symptom management and occupational performance in the areas of self-care, work, leisure, and social participation. Feasibility will be assessed by examining descriptive statistics regarding participant recruitment flow and adherence to group sessions and to data collection procedures. Acceptability will be assessed by a patient satisfaction survey (rated on a 10-point scale, with higher scores indicating greater satisfaction) and interview transcripts of feedback. Potential efficacy will be explored with paired-samples t tests comparing pre- and postprogram assessments of activity level (Activity Card Sort; Baum & Edwards, 2008), occupational performance and satisfaction with occupational performance (Canadian Occupational Performance Measure; Law et al., 2014), and quality of life (Functional Assessment of Cancer Therapy–General; FACIT Measurement System, 2007).

INTERIM RESULTS: The initial cohort has completed the program, and the second cohort is under way. Data collection will be completed by October 2016. Regarding feasibility, 49 of the 146 women (34%) who were screened were eligible. Of the first 12 women invited to enroll, two declined, five joined the first cohort, and five joined the second cohort. Within the first cohort, one woman withdrew, and the other four women attended at least five of the six meetings and completed the pre and post assessments. Regarding acceptability, the first cohort found both the group and individual sessions to be highly beneficial (M scores = 9.75 and 9.25, respectively) and reported high satisfaction with the program (M = 10). Regarding efficacy, participants showed increases in activity level (M change = 18.0, t = 4.4, p = .02), occupational performance (M change = 0.95, t = .71, p = .52), satisfaction with occupational performance (M change = 1.6, t = 1.1, p = .36), quality of life (M change = 15, t = 1.3, p = .27). They also rated high confidence in their ability to problem solve and set goals independently (M scores = 9.50 and 9.75, respectively).

CONCLUSION: While recruitment and data collection is ongoing, these interim analyses suggest that Take Action is feasible to implement and acceptable to participants who have many unmet needs. Although this design and small sample do not allow us to determine efficacy of the program, the improvement in scores and the feasibility data suggest the program warrants further testing with larger samples and more rigorous designs.

IMPACT STATEMENT: The implementation of a client-centered self-management program at an urban safety net hospital fills an important gap in the expansion of rehabilitation programs for breast cancer survivors and demonstrates an important opportunity for occupational therapy for to meet the needs of this underserved population.

References

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Baum, C. M., & Edwards, D. (2008). Activity Card Sort (2nd ed.). Bethesda, MD: AOTA Press.

D’Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). New York: Springer.

FACIT Measurement System. (2007). FACT–G [instrument and administration manual]. Evanston, IL: Author.

Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2014). Canadian Occupational Performance Measure (5th ed.). Ottawa: CAOT Publications.

Lyons, K. D., Svensborn, I. A., Kornblith, A. B., & Hegel, M. T. (2015). A content analysis of functional recovery strategies of breast cancer survivors. OTJR: Occupation, Participation and Health, 35, 73–80. https://doi.org/10.1177/1539449214567306