Feasibility of Systems Support Mapping to guide patient-driven health self-management in colorectal cancer survivors

Abstract

Objective: To evaluate feasibility of System Support Mapping (MAP), a systems thinking activity that involves creating a diagram of existing self-management activities (e.g. symptom management, health behaviors) to facilitate autonomous engagement in optimal self-management.

Design: One-arm pilot study of MAP in colorectal cancer survivors (NCT03520283).

Main outcome measures: Feasibility of recruitment and retention (primary outcome), acceptability, and outcome variability over time.

Results: We enrolled 24 of 66 cancer survivors approached (36%) and 20 completed follow-up (83%). Key reasons for declining participation included: not interested (n = 18), did not perceive a need (n = 9), and emotional distress/overwhelmed (n = 7). Most participants reported that MAP was acceptable (e.g. 80% liked MAP quite a bit/very much). Exploratory analyses revealed a -4.68 point reduction in fatigue from before to 2 weeks after MAP exceeding a minimally important difference (d = -0.68). There were also improvements in patient autonomy (d = 0.63), self-efficacy (for managing symptoms: d = 0.56, for managing chronic disease: d = 0.44), psychological stress (d = -0.45), anxiety (d = -0.34), sleep disturbance (d = -0.29) and pain (d = -0.32). Qualitative feedback enhanced interpretation of results.

Conclusions: MAP feasibility in colorectal cancer survivors was mixed, predominantly because many patients did not perceive a need for this approach. MAP was acceptable among participants and showed promise for improving health outcomes.

Keywords: Cancer survivors; autonomy; distress; fatigue; self-efficacy; self-management.

Conflict of interest statement

Competing Interests

The other authors have no conflicts of interest to report relevant to the content of this article.

Figures

Figure 1.

Key for guiding the System Support Mapping (MAP) intervention

Figure 2.

Study Flow Diagram