The Medical Research Council Framework for Developing and Evaluating Complex Interventions (MRC Framework) will be utilized to develop and evaluate an evidence-based tai chi intervention for managing the symptom cluster of fatigue-sleep disturbance-depression in breast cancer patients.
The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is regarded as one of the most common symptom clusters among breast cancer (BC) patients. Considering the fact that no specific medications can be recommended to relieve symptom clusters, numerous non-pharmacological interventions have therefore been performed with medication as a combination intervention for the treatment of symptom clusters in cancer patients. Among these interventions, tai chi could be an optimal option for relieving the FSDSC. The overall aims are to develop an evidence-based traditional Chinese exercise (TCE) tai chi protocol, test the feasibility of the protocol, and preliminarily examine the effectiveness of tai chi on the FSDSC and quality of life (QoL) through a pilot randomized controlled trial (RCT). The MRC Framework will be used to develop and evaluate an evidence-based intervention for BC patients. In phase one, an evidence-based TCE tai chi intervention protocol will be developed. An expert panel will then be invited to assess the content validity of the intervention protocol. Testing the feasibility of the tai chi intervention protocol, and preliminarily examining the effects of tai chi on the FSDSC will be conducted in phase two. After completion of the pilot RCT, semi-structured interviews will be conducted to assess the participants' experience of participating in the pilot trial and performing the tai chi exercise. The evidence-based tai chi intervention protocol for managing the FSDSC in breast cancer patients will be developed. The feasibility and effects of utilizing the tai chi intervention for BC patients will be explored. A future multicentre large-scale RCT to further evaluate the effects of tai chi on the FSDSC in the BC population will benefit from the study results of this doctoral research project.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
72
A booklet on the self-management of cancer symptoms. After the pilot RCT is completed, if the participants allocated to the control group are interested in practising tai chi, the intervention will be provided
Around 60 minutes practising easy tai chi movements/postures twice per week
The Affiliated Hospital of Putian University
Putian, Fujian, China
The Affiliated Hospital Of Southwest Medical University
Luzhou, Sichuan, China
Time taken to recruit planned sample
the time that was taken to recruit the planned sample size of participants
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Referral rate
The number of referrals made by clinicians in different departments and hospitals divided by all referrals
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Recruitment rate
The number of subjects who enrolled in the study divided by all subjects eligible for enrolment
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Retention rate
The number of subjects who completed the study divided by all subjects who enrolled in the study
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Dropout rate
The number of subjects who dropped out after randomization divided by all subjects who enrolled in the study
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Reasons for dropping out
Feedback from the dropout subjects to identify their reasons for dropping out
Time frame: From baseline (T1) to the completion of the 8-week intervention (T2)
Feasibility of the questionnaires
The percentage of missing values for each item of the scales used, including the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Breast (FACT-B)
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Time frame: Baseline (T1), immediately after completion of the 8-week intervention (T2), and four weeks after completion of the intervention (T3)
Adherence rates
The adherence rates will be measured by the number of tai chi sessions performed divided by the total possible tai chi sessions
Time frame: Immediately after completion of the 8-week intervention (T2)
Participant feedback
Participants' feedback on and satisfaction with the intervention using a self-designed feedback form
Time frame: Immediately after completion of the 8-week intervention (T2)
Adverse events associated with the intervention
In each tai chi session, the subjects in the intervention group will record whether they had any uncomfortable feelings
Time frame: Immediately after completion of the 8-week intervention (T2)
Number of patients completed the exercise log
The participants in the tai chi group will be required to keep a diary to monitor their tai chi exercise after each tai chi session
Time frame: Immediately after completion of the 8-week intervention (T2)
Symptom cluster assessment: fatigue
Fatigue will be measured by the Brief Fatigue Inventory (BFI). The Brief Fatigue Inventory includes nine items using a 0- to 10-point Likert scale, where 0 = "no fatigue" and 10 = "fatigue as bad as you can imagine" . The global BFI score, with a range between 0 and 90, is calculated as the mean of the nine items, and higher scores correspond to more severe fatigue
Time frame: Baseline Assessments (T1); Immediately after completion of the 8-week intervention (T2); 4-week Follow-up (T3)
Symptom cluster assessment: sleep disturbance
Sleep disturbance will be measured by the Pittsburgh Sleep Quality Index (PSQI). This 19-item questionnaire consists of seven components: subjective sleep quality (one item), sleep latency (two items), sleep duration (one item), habitual sleep efficiency (three items), sleep disturbance (nine items), use of sleeping medications (one item), and daytime dysfunction (two items). Each of the seven component scores are identified based on scoring algorithms, with each item using a 4-point Likert response scale, ranging from 0 to 3. A global (total) score is obtained from the sum of the seven component scores, with a possible range of 0 to 21 points. A higher score on the global (total) score indicates poorer sleep quality.
Time frame: Baseline Assessments (T1); Immediately after completion of the 8-week intervention (T2); 4-week Follow-up (T3)
Symptom cluster assessment: depression
depression will be measured by the Hospital Anxiety and Depression Scale (HADS). The HADS is a 14-item, self-report scale that includes two subscales, namely, the Anxiety subscale (HADS-A) and the depression subscale (HADS-D), which has seven items per subscale. The scale uses a 4-point Likert scale, ranging from 0 to 3. The sum of the ratings of 14 items yields a total score; the sum of the ratings of seven items in each subscale yields separate scores for anxiety and depression. The score ranges between 0 and 42 for the total score and between 0 and 21 for each subscale. Higher scores indicate greater severity of anxiety and depression.
Time frame: Baseline Assessments (T1); Immediately after completion of the 8-week intervention (T2); 4-week Follow-up (T3)
Quality of life (QoL) assessment
Quality of life assessment will be measured by the Functional Assessment of Cancer Therapy-Breast (FACT-B). The FACT-B is subdivided into four primary QoL domains, namely, Physical Well-Being (seven items), Social Well-Being (seven items), Emotional Well-Being (six items), and Functional Well-Being (seven items), and contains additional concerns for Beast Cancer (10 items) . The FACT-B has a 5-point Likert-type response scale, ranging from 0 to 4, where 0 = "not at all" and 4 = "very much". A summing-up of each FACT-B subscale creates the FACT-B total score, ranging from 0 to 148. Moreover, a higher FACT-B score indicates a better QoL status.
Time frame: Baseline Assessments (T1); Immediately after completion of the 8-week intervention (T2); 4-week Follow-up (T3)