Self-management of comorbidity and recovery after colorectal cancer: A phase I/II study

Background: Many colorectal cancer survivors experience chronic side‐effects and comorbidities but do not receive recommended support, treatment and follow‐up nor appropriate post‐cancer preventive care. Effective interventions are needed to support people affected by colorectal cancer with managing the physical and psychosocial impacts of cancer and comorbidity. Self‐management is established as an effective management strategy for patients with chronic illness but its utility in cancer has not been adequately explored.

Methods: The study design follows the UK Medical Research Council's (MRC) guidance on complex interventions with a theory‐driven preclinical phase leading to phase I modelling and a phase II exploratory trial.

We have used the Flinders Program, an evidence‐based chronic condition self‐management support care‐planning tool. The Program integrates collaborative problem‐solving, goal‐setting, drawing on community resources and motivational interviewing to support individual and family decision‐making and activation.

Phase I modelling incorporated focus groups and key informant interviews to qualitatively explore self‐management support acceptability, feasibility and perceived utility. A phase II pilot is currently underway recruiting people receiving active treatment for colorectal cancer. Outcomes measured include patient‐reported self‐management competency, resilience (CD‐RISC), chronic disease self‐efficacy, quality of life (SF12v2), cancer distress (Distress Thermometer), patient activation status (PAM), and patient experience for intervention and control groups pre‐ and post‐assessment.

Results: Thematic analysis results suggest a need for more support in the five self‐management core skill areas: decision‐making, problem‐solving, resource utilisation, health care partnerships and taking action in order to manage health complexity. The data indicate that colorectal cancer, although routinely treated as an acute condition, has long‐lasting and chronic impacts on individual and family identity, life roles and day‐to‐day life.

To date the intervention appears feasible for routine application in the clinical setting.

Conclusions: Self‐management support interventions improve outcomes for patients with chronic disease. The Flinders Program has potential applicability in cancer settings and further research is warranted.