Iris Kanera

62 Chapter 3 PST comprises five steps in which the patient (1) needs to adopt a positive attitude towards facing the problem, (2) defines what the problem exactly is, (3) makes a list of alternatives to tackle the problem, (4) predicts the benefits and consequences of each alternative, and (5) implements the best alternative in daily life and evaluates the result (D’Zurilla & Nezu, 2007). In the KNW, each problem area is addressed following the structure of PST; that is, identifying the problemand selecting a goal, getting informed of different solutions, making a personalized action plan, and trying out the action plan and evaluating the progress. The basic principles of CBT are covered by providing psycho-education and giving assignments, such as monitoring behavior or thoughts, challenging dysfunctional cognitions, and encouraging patients to set new goals. In addition, elements were used from a treatment protocol proven effective for treating cancer-related fatigue among cancer survivors (Gielissen, 2007). The protocol links six factors to fatigue: (1) poor coping with cancer, (2) fear of cancer recurrence, (3) dysfunctional cognitions (4) dysregulation of sleep, (5) dysregulation of activity, and (6) low social support. All these factors are addressed in the KNW. Step 4: Producing program components and materials With the end products of the previous steps, the program components and materials were produced. This included describing the program scope and sequence, preparing design documents, reviewing available materials, and developing and testing the program materials (Bartholomew et al., 2011). Scope and sequence The KNW (http://www.kankernazorgwijzer.nl ) covers seven self-management training modules. The modules Fatigue, Return to Work, Mood (i.e., anxiety and depression), and Relationships mainly cover psychosocial and mental health related issues, while the modules Physical Activity (PA), Diet, and Smoking cover lifestyle-related issues. The modules are interrelated. For example, within the Fatigue module, participants receive the advice to also visit the PA module if there is an indication that the participant is getting too little PA. As discussed in Step 3, the sequence within the modules is based on PST (D’Zurilla & Nezu, 2007). In general, the modules consist of four components divided over two sessions. In the first session, participants identify their problem, select a goal and receive psycho-education and assignments on how to deal with their problem, and personalize their goal through action plans. After 30 days, participants are invited for a second session in which they can evaluate the progress of their goal. If successful, participants are encouraged to maintain their behavior. Otherwise, participants are encouraged to try again, try another solution, or adjust their goal and receive additional advice on how to deal with difficult situations. Furthermore, all modules provide links to other relevant and reliable websites.