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
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".