Evaluating the feasibility of adding brief telephone guidance to an online healthy living program for post-treatment cancer survivors.

Healthy Living after Cancer Online (HLaC Online) is an online delivered intervention aimed at supporting those who have completed cancer treatment achieve their healthy living goals. The development of HLaC Online was informed by the previous telephone-delivered Healthy Living after Cancer program and by stakeholder engagement conducted in 2019 and 2020. HLaC Online takes a holistic view of health and targets physical activity, healthy eating, maintaining a healthy weight, mental health, finding the new normal after cancer treatment, and fatigue management. It is recommended that participants access the program for 12 weeks, complete at least three modules, and log in once per week to utilise the trackers provided to track their progress. Adherence to the program will be monitored using website and google analytics, a questionnaire, and a post-program interview. Below is a brief description of each of the sections and some example exercises. My goals: involves participant’s aims, SMART goal setting, and action plans [1]. Physical activity: involves information about aerobic activity, flexibility/stretching, strength training, incidental physical activity, and reducing sitting time. Includes videos of example exercises [1,2]. An online exercise tracker is also provided in the program. Healthy eating: includes information on food guidelines, portion control, and incorporating ‘fun foods’ [1, 3]. An example exercise for this section involves asking participants to reflect on their own diet and to identify where they can make changes, such as reducing fat or sugar intake or making healthy food swaps. An online meal tracker is also provided in the program. Maintaining a healthy weight: includes information about what a healthy weight looks like and information about weight management [1,4]. An online weight tracker is provided in the program. Mental Health: involves information about mindfulness, connecting how we think, act and feel, and where to find support [5,6]. An example exercise for this section involves asking participants to complete a thought record. In this exercise, the participant is asked to write a down a situation where they felt distressed and to identify what their thoughts, feelings, and behaviours were in that situation. Participants will also be asked to identify an alternative thought and asked how this might have changed how they felt in that situation. Finding the new normal: includes stories about how other cancer survivors established their new normal and myths about completing treatment [7]. Fatigue management: Information about what causes fatigue, long-term fatigue management, and the ‘three P’s: plan, prioritise, and pace” for daily energy management [8]. An online fatigue and mood tracker is provided in the program. Peer support: Information about different peer support avenues, including support groups, Cancer Connect, and Cancer Council Online Community [9]. Staying on track: includes information about habit formation, getting back after a slip, planning ahead, getting support from others, and celebrating success [1]. An example exercise for this section asks participants to identify situations where they may find it challenging to meet their goals (e.g., while on holiday) and to problem-solve ways to help them stay on track with their goals. Participants will also be offered two 15-minute telephone guidance calls with a Provisional Psychologist in week 1 and week 4. For each phone call, the participants will be asked to have the program available in front of them. The first phone call will involve orientation to the Healthy Living after Cancer Online website, discussing the establishing the participant's aims in using the program, and establishing one relevant SMART goal and action plan using the My Goals module. Participants will be recommended three modules to use based on their aims for the program. Participants will be asked to access these modules and establish two more SMART goals prior to the next phone call. The second phone call will involve checking in with the participant to review their SMART goals and action plans, discuss the modules they have completed, and answer any questions they have regarding the program. [1] Information supplied by the telephone-delivered Healthy Living after Cancer Program [2] Exercise videos supplied by Cancer Council NSW [3] Information about reading a food label supplied by the National Health and Medical Research Council (representing the Commonwealth of Australia) [4] Information about gaining weight derived from the Nutrition and Cancer booklet, Cancer Council Australia [5] Information regarding thoughts, feelings, and behaviour developed for Finding My Way, supplied by A/Prof Lisa Beatty. [6] Information regarding mindfulness derived from Mindfulness-based cognitive therapy for cancer: Gently turning towards by Trish Bartley. [7] Information derived from Life after Cancer booklet, Cancer Council Australia. [8] Information derived from Fatigue and Cancer, Cancer Council Australia [9]Information was provided by stakeholder focus groups and interviews, and various Cancer Council websites regarding support groups they are associated with.