A pilot randomised controlled trial of Acceptance and Commitment Therapy for medication decision-making and quality of life in women with breast cancer : the ACTION trial

Graham, Christopher d. and Ellison, Rachel and Hall, Louise h. and Clark, Jane and Mcnaught, Emma and Green, Sophie m. c. and Wilkes, Hollie and Robson, Gita and Lorentz, Ian and Holmes, Lucy and Bould, Nicky and Hartley, Suzanne and Naik, Jay and Buckley, Sarah and Hirst, Charlotte and Hartup, Sue and Foy, Robbie and Neal, Richard d. and Velikova, Galina and Farrin, Amanda and Collinson, Michelle and Smith, Samuel g. (2024) A pilot randomised controlled trial of Acceptance and Commitment Therapy for medication decision-making and quality of life in women with breast cancer : the ACTION trial. Psycho-Oncology, 33 (5). e6349. ISSN 1099-1611 (https://doi.org/10.1002/pon.6349)

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Abstract

AbstractObjectiveNon‐adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side‐effects and distress. We co‐designed an Acceptance and Commitment Therapy intervention (ACTION) to enhance medication decision‐making and quality of life (QoL). We undertook a pilot trial of ACTION to inform the feasibility of a phase III trial, and to examine intervention acceptability.MethodsThis was a multi‐site, exploratory, two‐arm, individually randomised external pilot trial. Women with early breast cancer prescribed AET were randomised (1:1) to receive usual care (UC) or UC + ACTION. The ACTION intervention comprised a remotely delivered one‐to‐one ACT session followed by three group sessions delivered by clinical psychologists, alongside a website containing ideas for the self‐management of side effects.ResultsOf the 480 women screened for eligibility, 260 (54.2%) were approached and 79 (30.4%) randomised. 71 (89.9%) women provided data at 3‐month and 70 (88.6%) at 6‐month 40 women were randomised to receive UC + ACTION and 32 (80.0%) completed the intervention. Most (75.0%) accessed the website at least once. ACTION was acceptable to participants (Borkovec & Nau Scale: mean = 7.8 [SD = 2.7] out of 10). Signals of effectiveness in favour of the UC + ACTION arm were observed for medication adherence (Adherence Starts with Knowledge questionnaire‐12), QoL (work and social adjustment scale), health‐related QoL (functional assessment of cancer therapy[FACT] general and FACT‐ES‐19/23), distress (generalised anxiety disorder ‐7, patient health questionnaire‐9) and psychological flexibility (valuing questionnaire).ConclusionsThe ACTION intervention was acceptable to patients. There were promising signals for effectiveness on primary and secondary outcomes. A phase III randomised controlled trial is feasible.Trial RegistrationISRCTN12027752.

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