Patients' experiences of cognitive behavioural therapy integrated with activity pacing: a qualitative study

Our previous trial integrating cognitive behavioural therapy with activity pacing (CBT-AP) demonstrated the efficacy of CBT-AP in reducing cancer-related fatigue and depression, as well as improving the quality of life for patients with breast cancer. However, the range of subjective patient experiences on the effect of CBT-AP, including its content, context, and approach, has not been fully explored. This study aimed to explore patients' experiences of CBT-AP among breast cancer patients.

Patients with breast cancer who attended CBT-AP sessions were interviewed. The interviews continued until data saturation was achieved, with no new findings emerging. A total of 20 women, aged 24 to 62, at various stages of cancer and undergoing chemotherapy were involved in the study. The collected data was transcribed, translated and coded following themes developed in line with the objective of the study, ensuring sensitivity to context, rigour, transparency, and impact throughout the research process.

The data identified six major themes: the content of the therapy, the context of the therapy, experiences with the implementation of the therapy, benefits of the therapy, the therapeutic approach, and recommendations. Findings revealed that participants described all components of CBT-AP as important, with the content addressing common symptoms related to the disease and its treatment. Participants reported positive effects on their physical, psychological, and social health following the therapy. While the majority preferred face-to-face sessions, a significant number favoured a combination of face-to-face and telephone sessions. The participant's manual was found to be easily understandable and clear.

The findings suggest that participants had positive experiences with the therapy. Based on these experiences, it is recommended that specific components and delivery methods of CBT-AP, such as patient-centered content and flexible delivery options, be considered key factors to enhance its acceptability and feasibility. While this study highlights CBT-AP's potential to improve quality of life of breast cancer patients, further research is needed to evaluate its broader application and long-term impact in various healthcare settings, particularly for diverse patient populations.