Adapting a brief mindful breathing intervention for self-management of distress in advanced cancer patients: the RESOLVE-i study

Psychological distress is common among patients with advanced cancer and can be a barrier to effective symptom management. Despite national guidance, psychological support in UK palliative care remains limited. Existing interventions are frequently delivered by untrained staff lacking confidence. Adapting evidence-based interventions offers an efficient strategy to improve care. This study describes the adaptation of a brief mindful breathing intervention, originally developed in Malaysia, for self-management of distress by patients with advanced cancer in the UK.

Using Moore et al.'s ADAPT framework, we followed four stages: Step 1: A systematic review (PROSPERO: CRD42022311729) established a rationale for adapting a brief mindful breathing intervention for distress in advanced cancer. Step 2: Semi-structured interviews with healthcare professionals (HCPs) explored acceptability, perceived utility, and integration into routine care. Step 3: A series of interviews with patients and carers informed the cultural and contextual iterative adaptation of the mindful breathing intervention and the development of accessible self-management resources. Step 4: A feasibility study was designed to assess acceptability, implementation, and to generate pilot data.

The systematic review supported the effectiveness of mindful breathing, though evidence found was context-specific to Malaysian clinical settings. HCPs endorsed integration into routine care but noted time constraints and concerns about information accessibility. Feedback from patients and carers informed several adaptations for self-management, including simplified language, inclusive imagery, removal of prescriptive instructions (e.g., breathing through the nose), and development of low-literacy resources. A video animation, infographic, and HCP training package were created to support implementation.

This stakeholder-informed adaptation resulted in a self-management mindful breathing intervention tailored for patients with advanced cancer in the UK. The intervention is now ready for feasibility testing and represents a scalable, resource-efficient strategy to enhance psychological support in palliative care, in line with NHS goals for community-based self-management.