The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation.

Abstract

Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation. Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis. The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context. Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary. It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.