A stepped-care approach to self-management: a qualitative study among individuals with cancer and their caregivers...

Patients and their caregivers (dyads) face 24/7 responsibility for managing cancer-related challenges. We explored the experience of patient-caregiver dyads using Coping-Together, a self-directed intervention designed to enhance access to the self-management information dyads needs, whereby types of guidance (lay vs clinician guidance) to use the materials varied over time.

This descriptive qualitative study analyzed 19 semi-structured telephone interviews with patients and/or caregivers completing a pilot sequential multiple assignment randomized trial (SMART) of Coping-Together, where level of guidance varied according to a stepped care approach. The interviews explored participants' satisfaction with Coping-Together, including of the different types of guidance offered, and the self-management skills acquired. Audio-recorded and transcribed interviews were analyzed using thematic analysis.

Four themes were identified: (1) knowing what you need and when you need it; (2) dyadic approach: not always together (dyadic interventions best seen on a continuum instead of a dichotomy); (3) putting theory into practice: learning new self-management strategies (dyads focused on 3/6 booklets); and (4) lay versus healthcare professional guidance: benefits and challenges on use of Coping-Together. Participants generally found added guidance helpful, with those receiving both lay and clinician-led guidance expressing no clear preference between them.

As healthcare transitions to community-based care, programs like Coping-Together play a critical role in supporting self-management for patients and their caregivers. Findings support the acceptance of lay guidance among participants, which can potentially be a cost-effective option to enhance intervention engagement; this will be examined in future studies.

NCT04255030.