Self-Management of Comorbidity and Recovery after Colorectal Cancer: A Phase I/II Study (#129)
Background: Many colorectal cancer survivors experience chronic side-effects and comorbidities but do not receive recommended support, treatment and follow-up nor appropriate post-cancer preventive care. Effective interventions are needed to support people affected by colorectal cancer with managing the physical and psychosocial impacts of cancer and comorbidity. Self-management is established as an effective management strategy for patients with chronic illness but its utility in cancer has not been adequately explored.
Methods: The study design follows the UK Medical Research Council’s (MRC) guidance on complex interventions with a theory-driven preclinical phase leading to phase I modelling and a phase II exploratory trial.
We have used the Flinders Program, an evidence-based chronic condition self-management support care-planning tool. The Program integrates collaborative problem-solving, goal-setting, drawing on community resources and motivational interviewing to support individual and family decision-making and activation.
Phase I modeling incorporated focus groups and key informant interviews to qualitatively explore self-management support acceptability, feasibility and perceived utility. A phase II pilot is currently underway recruiting people receiving active treatment for colorectal cancer. Outcomes measured include patient-reported self-management competency, resilience (CD-RISC), chronic disease self-efficacy, quality of life (SF12v2), cancer distress (Distress Thermometer), patient activation status (PAM), and patient experience for intervention and control groups pre- and post-assessment.
Results: Thematic analysis results suggest a need for more support in the five self-management core skill areas: decision-making, problem-solving, resource utilisation, health care partnerships and taking action in order to manage health complexity. The data indicate that colorectal cancer, although routinely treated as an acute condition, has long-lasting and chronic impacts on individual and family identity, life roles and day-to-day life.
To date the intervention appears feasible for routine application in the clinical setting.
Conclusions: Self-management support interventions improve outcomes for patients with chronic disease. The Flinders Program has potential applicability in cancer settings and further research is warranted.