# Development of ACT+: A Novel, Person‐Centred Psychological Intervention Based on Acceptance and Commitment Therapy (ACT) to Improve Quality of Life in Patients Living With and Beyond Cancer

## TL;DR

Researchers developed ACT+, a new psychological therapy combining acceptance and commitment therapy with exercise and work support, to improve quality of life for cancer survivors.

## Contribution

ACT+ integrates acceptance and commitment therapy with lifestyle support options, developed through iterative stakeholder and patient input.

## Key findings

- ACT+ was refined using insights from qualitative research, stakeholder input, and pre-pilot testing.
- The intervention received support from cancer patients and healthcare professionals.
- Patient and public involvement significantly shaped the cultural acceptability and delivery of ACT+.

## Abstract

The need to improve the quality of life (QoL) and well‐being of people living with and beyond cancer is well recognised. SURECAN (SUrvivors' Rehabilitation Evaluation after CANcer) is a multiphase study developing and evaluating a psychological intervention based on acceptance and commitment therapy (ACT) for people who have completed hospital‐based treatment for cancer but have low QoL. We describe the process by which we iteratively developed and refined ACT+, an intervention in which ACT is integrated with options to support exercise and work.

ACT+ development was guided by the theory of ACT while Normalisation Process Theory (NPT) was used as a sensitising tool at all stages. Evidence from several strands of research comprising a qualitative meta‐synthesis, a qualitative study with stakeholders and pre‐pilot testing was brought together to refine ACT+. Insights from patient and public involvement (PPI) consultations supported the development and refinement of ACT+ resources throughout.

The qualitative study with stakeholders shed light on the ‘real world’ contexts in which the ACT+ intervention would be offered and accessed, as well as the appeal of ACT+ as a therapy for people living with and beyond cancer. People who had treatment for cancer (n = 31) and healthcare professionals (n = 16) provided overall support for the intervention. Subsequent pre‐pilot testing of the intervention and qualitative work with cancer patients (n = 6) and therapists (n = 7) led to further refinements. Evidence collected from all strands of research and PPI was integrated in an iterative way to produce an intervention that was acceptable to all.

We adopted an iterative and evidence‐based approach to the development of the ACT+ intervention, which was acceptable to patients and healthcare professionals. Future work will examine the effectiveness of ACT+.

This intervention was developed and refined with substantial involvement from the study's patient and public involvement group and others accessed via community/patient groups to discuss and gain feedback on patient‐facing materials. For example, the ACT+ participant handbook underwent four consultation rounds with patient representatives, including a consultation specifically focused on its cultural acceptability. Therefore, emerging insights from PPI were also used to optimise ACT+ components and delivery. Their input was integrated throughout all three strands of the research.