# Qualitative study of experience of acceptance and commitment therapy (ACT+) amongst Survivors' Rehabilitation Evaluation after Cancer (SURECAN) trial participants and therapists: A protocol

## TL;DR

This study explores how cancer survivors and therapists experience a new therapy called ACT+ and how it could be used in NHS care.

## Contribution

The study introduces a qualitative protocol to evaluate the implementation and effectiveness of ACT+ in cancer rehabilitation.

## Key findings

- The study will interview participants and therapists to understand how ACT+ is experienced and perceived.
- It will compare experiences of participants who improved versus those who did not following ACT+.
- Findings will inform how to optimize ACT+ for routine NHS care.

## Abstract

This interview study forms part of a mixed methods process evaluation of the Survivors’ Rehabilitation Evaluation after Cancer (SURECAN) trial to understand the experiences of participants (who are living with and beyond cancer) in receiving a form of acceptance and commitment therapy, and therapists providing the intervention. SURECAN is a multi-centre, pragmatic, individual participant randomised controlled trial of an intervention based on acceptance and commitment therapy supplemented by support for return to meaningful work and/or physical activity (ACT+). This qualitative study addresses the ways in which participants believe they benefit from ACT+ (or not), and how the ACT+ intervention might best be implemented into routine National Health Service (NHS) care.

The study investigates experiences of ACT+ by different participants to understand how we can optimise the ACT+ intervention and its delivery (assuming the intervention is successful). We will conduct individual interviews with participants who have taken part in the active arm of the SURECAN trial to understand their experiences of engaging with and receiving ACT+, their perceptions of the impact of the therapy, and relevant contextual factors influencing these experiences. In particular, we will focus on comparing our interview findings between those trial participants who improved and those who failed to improve (or worsened), in terms of quality of life following ACT+. Additionally, we will conduct individual interviews with therapists who have delivered ACT+ as part of the SURECAN trial, to understand their experiences of delivering ACT+.

Consistent with other qualitative protocols, this protocol is not registered. Instead, it is shared as a means of documenting ahead of time, how we are endeavouring to understand the ways in which a newly trialled talking therapy is received by patients and therapists, and how (if successful) it might be incorporated into the NHS.

Our study looks at experiences of the SURECAN trial for people who are living with and beyond cancer. SURECAN is a trial of a kind of talking therapy called 'acceptance and commitment therapy'. Acceptance and commitment therapy (ACT) helps people to embrace their feelings and thoughts (and live according to their values) rather than fighting against them. Our therapists also talk to patients about their work life and levels of physical activity to help them get a balance (so we call it ACT+). Our study will interview participants (patients and therapists) on the trial about the benefits of ACT+ (or not), and how ACT+ therapy could become part of everyday NHS care. The study aims to work out how we can optimise the ACT+ therapy for the NHS. We will conduct individual interviews with participants who have received ACT+ in the SURECAN trial, to understand their experiences of ACT+, their perceptions of the talking therapy, and whether anything else going on in their lives at the time could explain their experiences of ACT+. In particular, we will compare trial participants whose quality of life improved with those who did not improve (or worsened). Additionally, we will talk with the ACT+ talking therapists to understand their experiences of delivering ACT+ to people who are living with and beyond cancer.