title: Self-administered Acupressure for Persistent Cancer-related Fatigue: Fidelity Considerations.
abstract: BACKGROUND
  Complementary therapies are frequently used by breast cancer patients for symptom management; however, documentation of the components of intervention fidelity for studies is not widely available.
  
  
  OBJECTIVE
  This report examines the components of intervention fidelity, as put forth by the Treatment Fidelity Workgroup of the Behavior Change Consortium at the National Institutes for Health (NIH-BCC Workgroup), within an ongoing acupressure study of breast cancer survivors with persistent cancer-related fatigue (PCRF).
  
  
  METHODS
  For the acupressure study, the research team designed a randomized, controlled trial (RCT) with 3 parallel groups: (1) stimulating acupressure (intervention group); (2) relaxing acupressure (intervention group); and (3) standard care (control group).
  
  
  METHODS
  At baseline and at wk 3 and wk 6 of the study, women in the acupressure study attended sessions for training and data collection at clinics in the counties of Michigan where they lived. The self-administration of acupressure occurred in participants' homes.
  
  
  METHODS
  Targeted enrollment for the acupressure study is 300 breast cancer survivors who had experienced moderate-to-severe PCRF lasting longer than 1 y beyond treatment. The women are being recruited from 5 counties in Michigan, using the Michigan Tumor Registry to identify potential participants. The subsample report includes 183 participants who have completed all 10 wk of the acupressure study. Most participants in the acupressure study are Caucasian, are married, and have some college education.
  
  
  METHODS
  The acupressure study's educators teach participants in the intervention groups to self-administer either relaxing or stimulating acupressure for a 30-min period on a daily basis for 6 wk. All 3 groups receive the usual care for breast cancer survivors.
  
  
  METHODS
  For the acupressure study, the participants log the frequency of the self-administered acupressure sessions and their fatigue levels. Symptom assessments are made for all groups by telephone in the acupressure study at wk 2 through wk 5 to assess fatigue. A competency checklist is used at each session of training and retraining of both acupressure educators and participants. For this report, the 5 recommended fidelity components for interventions are (1) dose, (2) training, (3) intervention delivery, (4) intervention receipt, and (5) enactment of the intervention.
  
  
  RESULTS
  The ongoing RCT incorporated all 5 components of fidelity and can serve as a model for future work in this area.
  
  
  CONCLUSIONS
  Research protocols that address intervention fidelity can provide results that support internal and external validity. Clinicians should consider recommending complementary interventions that have incorporated fidelity components into their efficacy testing.
authors.forename: Gwen Karilyn
authors.initials: GK
authors.lastname: Wyatt
authors.forename: Dawn Annette
authors.initials: DA
authors.lastname: Frambes
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: John Todd
authors.initials: JT
authors.lastname: Arnedt
authors.forename: Susan L
authors.initials: SL
authors.lastname: Murphy
authors.forename: Suzanna M
authors.initials: SM
authors.lastname: Zick
mesh_terms: D019050:Acupressure / Q000379:methods*; D001943:Breast Neoplasms / Q000150:complications* / Q000628:therapy*; D005221:Fatigue / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D012648:Self Care / Q000379:methods*