Using SMART Design to Improve Symptom Management Strategies Among Cancer Patients

First, dyads were randomized to receive caregiver-delivered reflexology or meditative practice. Fatigue severity was assesses weekly via phone calls to the cancer patients during weeks 1-4 of the intervention. For patients who did not respond to the intervention during the first 4 weeks, those dyads were referred to as non-responder and re-randomized. A non-responder was determined if the level of reported fatigue remained the same or increased from the first week of the intervention.

The re-randomization placed the non-responders in either a group that received a higher dose (more time) with the first intervention or to the alternate practice (meditative practice to those randomized to reflexology and vice versa) for weeks 5-8. Those who did respond during weeks 1-4 continued the same therapy they began with.

Inclusion criteria

• 21 year of age or older
• Solid tumor cancer diagnosis
• Able to perform basic activities of daily living (ADLs)
• Undergoing chemotherapy, hormonal therapy, or targeted therapy
• Able to speak and understand English
• Have access to a telephone
• Able to hear normal conversation
• Reporting a severity of 3 or higher on fatigue using a 0-10 standardized scale at intake.

Exclusion criteria

• Diagnosis of major mental illness on the medical record (verified by the recruiter)
• Residing in a nursing home
• Bedridden
• Currently receiving reflexology or meditative practices
• Suspected or diagnosed deep vein thrombosis or painful foot neuropathy.