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

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 ( = 18), did not perceive a need ( = 9), and emotional distress/overwhelmed ( = 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 ( = -0.68). There were also improvements in patient autonomy ( = 0.63), self-efficacy (for managing symptoms:  = 0.56, for managing chronic disease:  = 0.44), psychological stress ( = -0.45), anxiety ( = -0.34), sleep disturbance ( = -0.29) and pain ( = -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.