Acceptance and commitment therapy in metastatic gastrointestinal cancer: patient and caregiver qualitative study

Acceptance and commitment therapy (ACT) is a promising behavioural intervention to improve quality of life in patients with advanced cancer and their family caregivers. Little qualitative research has examined the effects of ACT in cancer populations. Thus, this qualitative study examined the perceived impact of ACT, including mindfulness practice and values-based action, on patients with advanced gastrointestinal (GI) cancer and their family caregivers.

Individual, semistructured qualitative interviews were conducted with 13 patients with stage IV GI cancer and 14 family caregivers following their participation in a six-session ACT intervention. Data were analysed using an immersion/crystallisation approach.

Most participants identified benefits of ACT that facilitated their adjustment to cancer or caregiving. Patients and caregivers described several effects of mindfulness, including improved management of fatigue and other symptoms, improved emotion regulation skills and an ability to savour the present moment. Some participants reported misperceptions of the purpose of mindfulness, such as emptying the mind of thoughts or relaxing. In addition, engaging in actions based on personal values often led to patient empowerment (eg, renewed sense of purpose in life), improved caregiver self-care and better relationship quality between patients and caregivers.

Results raise hypotheses about potential mechanisms and outcomes of ACT interventions that warrant examination. Findings also suggest that enhancing education on mindfulness in ACT interventions may reduce conceptual misunderstandings. Finally, results suggest that a dyadic ACT intervention may improve relationship functioning between family members.