title: Fatigue in chronic hepatitis C infection: Understanding patients' experience from a cognitive-behavioural perspective.
abstract: OBJECTIVE
  Fatigue is a leading concern of patients with chronic hepatitis C virus (HCV) infection. Despite its clinical significance, fatigue in HCV is poorly understood and therefore invariably under-treated. A cognitive-behavioural approach offers a framework to understand and treat fatigue, but the characteristics of fatigue in chronic HCV infection have not been documented from a cognitive-behavioural perspective. This study captured the common and unique aspects of fatigue from a cognitive-behavioural perspective in individuals with HCV infection and clinically significant fatigue.
  
  
  METHODS
  Cross-sectional, qualitative using a critical realism approach.
  
  
  METHODS
  Fourteen individuals (64% women; age >18 years) participated in semi-structured interviews. The interviews documented the features, course, and perceived antecedents of fatigue; fatigue-specific cognitions; fatigue management behaviours; and the functional impact of fatigue.
  
  
  RESULTS
  Participants' descriptions included the aspects of fatigue that have been targets of cognitive-behavioural therapy in other medical conditions, including attributing fatigue to the illness; expectation of chronicity; low control; and fatigue-driven coping. There were also components of fatigue experience that appear to be unique characteristics of fatigue related to HCV, including predominantly physical fatigue; high acceptance of fatigue; and liver-protective diet as a fatigue management behaviour.
  
  
  CONCLUSIONS
  This was the first study to document the experience of fatigue in chronic HCV infection in a cognitive-behavioural framework. The findings suggest that the cognitive-behavioural approach can be applied to fatigue in chronic HCV infection. This would open an avenue to alleviate fatigue and thus improve the primary patient-reported outcome of the disease.
  What is already known on this subject? Fatigue is a key patient-reported outcome measure of chronic hepatitis C virus (HCV) infection. Fatigue management is not part of the standard care, because fatigue is poorly characterized in this population. What does this study add? A cognitive-behavioural approach can be applied to understand fatigue in HCV infection. Identified aspects of fatigue (antecedents, consequences, cognitions, behaviours) that can be treatment targets. Cognitive-behavioural therapy would open a new treatment avenue to alleviate fatigue in HCV infection.
authors.affiliation: Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Dora
authors.initials: D
authors.lastname: Zalai
authors.affiliation: Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Carney
authors.affiliation: Department of Gastroenterology, University Health Network, University of Toronto, Canada.
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.affiliation: Department of Psychiatry, University Health Network, University of Toronto, Canada.|Department of Ophthalmology, University Health Network, University of Toronto, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.affiliation: Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: McShane
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D003071:Cognition; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology* / Q000523:psychology; D005260:Female; D015438:Health Behavior; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: behaviour; chronic hepatitis C infection; cognition; cognitive behavioural therapy; fatigue