Exploring Barriers and Facilitators to Engagement of an Online Acceptance and Commitment Therapy Intervention for Cancer Survivors With Chronic Painful Chemotherapy-Induced Peripheral Neuropathy: Qualitative Interview Study.

Abstract

Background: Online self-management interventions for cancer survivors are increasingly being used, but engagement is often difficult for patients. Given the importance of engagement for intervention effectiveness, identifying patient-reported barriers and facilitators is essential.

Objective: The aim of this study was to qualitatively examine barriers and facilitators influencing engagement with an online self-management intervention, offered with or without guidance, for cancer survivors experiencing chronic painful chemotherapy-induced peripheral neuropathy (CIPN).

Methods: Patients who took part in the Embrace Pain randomized controlled trial, conducted between December 2021 and July 2024, were invited to participate in this study. Eligible participants were adults with chronic painful CIPN, based on criteria including pain, completion of chemotherapy, and European Organisation for Research and Treatment of Cancer QLQ-CIPN20 Questionnaire (ie, cancer-specific measure of sensory, motor, and autonomic neuropathy). The Embrace Pain randomized controlled trial involved evaluating an online self-management acceptance and commitment therapy intervention for pain interference in daily life, with some participants receiving email guidance and others not. Thereafter, 12 patients experiencing chronic painful CIPN participated in semistructured interviews. Data were analyzed using thematic analysis. An inductive coding approach was applied, and Atlas.ti (Lumivero) was used for coding.

Results: In total, 2 themes and 17 codes emerged from the data, namely 7 codes for barriers and 10 codes for facilitators. Barriers included program schedule, burden, lack of guidance, irrelevance, mindfulness exercises, usability, and missing content. Facilitators included usability, recognition, positive self-management, program schedule, symptom management, relevance, guidance, experiential exercises, mindfulness exercises, and value-based living. Program schedule, guidance, mindfulness exercises, and usability proved to be barriers for some, while others indicated that they were facilitators for their use.

Conclusions: Participants' perceptions of the intervention varied, with engagement influenced by individual circumstances. These variations highlight the importance of personal context in shaping both uptake and effectiveness, indicating a need for tailored approaches to address diverse needs and challenges faced by participants.