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.