RECENTRE: Determining the Acceptability and Efficacy of The Enhancing Women's Recovery after Cancer Treatment Program

RECENTRE is a single-cohort implementation study; hence, all participants receive the intervention. The 12-week digital intervention targets health education and health promotion incorporating international recommendations for the core outcomes of physical activity, diet, and minimising alcohol and body weight management as well as evidence-based strategies to manage smoking cessation, sleep, stress, menopausal symptoms, and sexual health over a 12-week period. Physical activity recommendations align with Australia’s physical activity and exercise guidelines for all Australians whilst accounting for sedentary behaviour guidelines and World Cancer Research Fund cancer prevention guidelines. For example to be moderately physically active, equivalent to brisk walking, for greater than or equal to 30 minutes daily. As fitness improves, aim for greater than or equal to 60 minutes of moderate (or for greater than or equal to 30 minutes of vigorous) physical activity every day and to be as lean as possible within the healthy weight range. Dietary recommendations include: eat mostly foods of plant origin; limit consumption of energy dense foods; avoid sugary drinks; limit intake of red meat and avoid processed meat; and avoid alcohol consumption. These are based on several guidelines including those from the Australian Dietary Guidelines, World Cancer Research Fund and the American Institute for Cancer Research. All other recommendations have been clinically informed by experts in the field of cancer recovery. Participants are provided the content firstly on a day-to-day basis (weeks 1-3) and then weekly (weeks 4-12) to build on, expand, revisit and reflect on knowledge gained. The timing and application of these strategies reflect the life stage of these women and are personalized to meet their individual goals and functional capacities. A baseline needs assessment assists participants to identify areas of priority and focus whilst working through the intervention content (accessing or omitting content relevant to personal preference and at a frequency of their choosing). Time taken to complete each section will vary from person to person depending on the content they choose, but we anticipate on average participants will spend an average of one-2 hours per week over the course of the 12 weeks to complete the full content available including completion of their RECENTRE Wellbeing Journal and RECENTRE thermometer. Reflections and a mid-program needs assessment helps to realign goals and priorities with the aim to build self-efficacy for personalised long-term health management. Additional customisation is offered to participants assessed as requiring additional support (i.e. advancer cancer, distressed) and by way of personalised virtual nurse specialist consultations. The content (covering but not limited to topics noted above) will be delivered individually via a self-directed interactive online platform. Participants flagged as requiring additional in-person support will be identified the needs assessments as well as via completion of three-weekly RECENTRE thermometers embedded in the intervention Wellbeing Journal. The RECENTRE thermometer is a single visual analogue scale (scores range 0 – 10) that essentially ‘flags’ if the participant is experiencing distress and or need, and therefore requires additional support from a clinical team member. Any participant identified as having advanced cancer at baseline will be offered additional clinical support for the duration of the intervention (maximum three consultations) and referral to appropriate clinical Associate Investigators based at Mater, if required. Each participant requiring additional in-person support will be offered individual virtual clinical consultations with trained clinicians via Zoom, Teams, FaceTime, or telephone to tailor their lifestyle program, and motivate them towards goal achievement, self-management, and a sustainably healthy lifestyle. The RECENTRE program provides all necessary health promotion content and supports participants to log relevant health and lifestyle information into the Wellbeing Journal, which is populated with responses to activities over time. The participant start date triggers a progression bar which is also displayed within the Wellbeing Journal. A weekly physical activity planner encourages participants to plan for their physical activity in the following week. The intervention platform incorporates news and announcements; new evidence; an overview of the program; and an online moderated ‘community’, programmed and monitored by RECENTRE clinical and technical teams, that allows participants to communicate with each other and ask basic questions relating to RECENTRE. Security of information entered by participants is ensured through encrypted data transmission and secure storage. The website and digital intervention is adapted for all computing platforms, including mobile phones however for ease of use the module content and updating of the Wellbeing Journal is best completed using a larger screen. Consultations (if required) with a nurse specialist trained in the intervention and with expertise in supportive cancer care will be conducted via video- or teleconferencing and will last approximately one hour. Therefore participants can undertake this study from their own homes or anywhere comfortable to them where they can access a Wi-Fi connection and privacy. In keeping with privacy guidelines, no recording of the consultations is undertaken.