iACT: Information and acceptance and commitment therapy (ACT) based self-help intervention for carers of people with advanced cancer.

Participants will be recruited via online/social media advertising and within physical sites in Australia. Participants will be provided access to an information hub, an acceptance and commitment therapy (ACT) manual and an online support group for participants facilitated by the study psychologist. The information hub will be embedded within the study web page and will contain links to legitimate sources of written and video information that includes topics such as physical, psychological, spiritual and cultural, caring tips and information, patient and carer perspectives. The information hub will include video that outlines the resource links provided and also explains why some questions are difficult to answer and recommends carers seek support to manage distress that arises when dealing with the unknown. Participants will not be advised to spend any certain amount of time browsing these links; this will be determined by a participant's informational needs and their own preferences. Based on ACT, the self-help manual created by Davis et al (2020) is designed to help carers cope better with their situation through psychoeducation and experiential exercises. The manual has 66 pages including 9 modules and 14 exercises (including 4 accompanying audio recordings). It will be available to participants in hard copy and as an electronic version on the study website. A health professional (psychologist with at least introductory training in ACT) will contact participants within one week of recruitment/baseline assessment and offer up to four support check-ins (approximately 15 minutes in length via phone, video call, text or an email – depending on participant preference). The health professional and participant will establish a flexible schedule for these check-ins (over the course of one month). The purpose of the support check ins is to review participant progress and answer any questions about the information or exercises provided. The psychologist will respond with positive and encouraging feedback and offer advice and instruction. The intervention manual is designed to be taken at the participant's own pace. Instructions provided within state "Some people may prefer to review the whole booklet in one or two sittings. If so, we strongly recommend that you return to it and review the content and exercises again at a later date. This allows you to integrate the skills over a longer period of time. Others may choose to complete the booklet more slowly. The intervention period is considered to be 1 month (post baseline); support check-ins will be conducted within this timeframe and participants will be encouraged to complete the manual within this time frame. Participants will be offered the opportunity to join the study’s Facebook support group page. The group will be the ‘secret’ group setting from Facebook; a secret group that involves only those an administrator allows to participate. Participants are not required to post to the Facebook group page. Upon enrollment we will advise participants that if we become concerned about any one individual's need for additional counselling we will refer him or her to appropriate services. Approximately bi-weekly (depending on participant recruitment rate), material from the iACT manual and other relevant psychological support material (based on the observations of the discussions and clinical reasoning by the psychologist) will be posted on the group Facebook page, followed by a discussion question from the psychologist. The psychologist will review postings daily and respond when appropriate (clarifying, answering questions, offering encouragement, or asking additional facilitating questions). As part of the feasibility data to inform a future effectiveness trial, participants will be offered the option to engage in study components via internet, phone and traditional hard copy/mail out methods. The participant follow-up survey includes questions as to which components of the intervention the participant engaged in. Qualitative Interviews Following completion of the intervention and follow-up survey, participants who consent to be contacted will be contacted with an invitation to participate in a qualitative interview. Individual qualitative interviews will be conducted until informational redundancy is reached. The interviews will be guided by a semi-structured interview guide and be approximately 30 minutes in length. Participants will have the option of completing the interviews via telephone or video call– depending on their preference. Interviews will be audio recorded and transcribed.