{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:16:34Z","timestamp":1787912194750,"version":"build-2784847793"},"reference-count":40,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R21CA235788"],"award-info":[{"award-number":["R21CA235788"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Support Palliat Care"],"accepted":{"date-parts":[[2025,4,23]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Acceptance and commitment therapy (ACT) is a promising behavioural intervention to improve quality of life in patients with advanced cancer and their family caregivers. Little qualitative research has examined the effects of ACT in cancer populations. Thus, this qualitative study examined the perceived impact of ACT, including mindfulness practice and values-based action, on patients with advanced gastrointestinal (GI) cancer and their family caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Individual, semistructured qualitative interviews were conducted with 13 patients with stage IV GI cancer and 14 family caregivers following their participation in a six-session ACT intervention. Data were analysed using an immersion\/crystallisation approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most participants identified benefits of ACT that facilitated their adjustment to cancer or caregiving. Patients and caregivers described several effects of mindfulness, including improved management of fatigue and other symptoms, improved emotion regulation skills and an ability to savour the present moment. Some participants reported misperceptions of the purpose of mindfulness, such as emptying the mind of thoughts or relaxing. In addition, engaging in actions based on personal values often led to patient empowerment (eg, renewed sense of purpose in life), improved caregiver self-care and better relationship quality between patients and caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Results raise hypotheses about potential mechanisms and outcomes of ACT interventions that warrant examination. Findings also suggest that enhancing education on mindfulness in ACT interventions may reduce conceptual misunderstandings. Finally, results suggest that a dyadic ACT intervention may improve relationship functioning between family members.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/spcare-2025-005548","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T13:20:24Z","timestamp":1746796824000},"page":"1250-1258","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Acceptance and commitment therapy in metastatic gastrointestinal cancer: patient and caregiver qualitative study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04010227","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9689-5392","authenticated-orcid":false,"given":"Catherine E","family":"Mosher","sequence":"first","affiliation":[{"name":"Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley B","family":"Lewson","sequence":"additional","affiliation":[{"name":"Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Austin-Wright","sequence":"additional","affiliation":[{"name":"Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne S","family":"Matthias","sequence":"additional","affiliation":[{"name":"VA Center for Health Information and Communication, Indianapolis, Indiana, USA"},{"name":"Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA"},{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R","family":"Helft","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita A","family":"Turk","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Sr","given":"Patrick J","family":"Loehrer","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amikar","family":"Sehdev","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad A","family":"Al-Hader","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley A","family":"Johns","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA"},{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"2026082802200676000_16.5.1250.1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2008.0036"},{"key":"2026082802200676000_16.5.1250.2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35060"},{"key":"2026082802200676000_16.5.1250.3","doi-asserted-by":"publisher","DOI":"10.1177\/1049909115603055"},{"key":"2026082802200676000_16.5.1250.4","doi-asserted-by":"publisher","DOI":"10.3322\/CAAC.21834"},{"key":"2026082802200676000_16.5.1250.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.02.068"},{"key":"2026082802200676000_16.5.1250.6","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1703"},{"key":"2026082802200676000_16.5.1250.7","article-title":"Understanding burden in caregivers of colorectal cancer survivors: what role do patient and caregiver factors play?","volume":"27","author":"Maguire","year":"2018","journal-title":"Eur J Cancer Care"},{"key":"2026082802200676000_16.5.1250.8","first-page":"1941","article-title":"Examining the role of subjective and objective burden in carer health-related quality of life: the case of colorectal cancer","volume":"23","author":"Hanly","year":"2015","journal-title":"Support Care Cancer"},{"key":"2026082802200676000_16.5.1250.9","first-page":"CD006788","article-title":"Pharmacological treatments for fatigue associated with palliative care","volume":"2015","author":"M\u00fccke","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2026082802200676000_16.5.1250.10","first-page":"CD012030","article-title":"Psychosocial interventions for fatigue during cancer treatment with palliative intent","volume":"7","author":"Poort","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2026082802200676000_16.5.1250.11","doi-asserted-by":"crossref","first-page":"102237","DOI":"10.1016\/j.cpr.2022.102237","article-title":"The efficacy of psychosocial interventions for cancer caregiver burden: A systematic review and meta-analysis of randomized controlled trials","volume":"99","author":"Secinti","year":"2023","journal-title":"Clin Psychol Rev"},{"key":"2026082802200676000_16.5.1250.12","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/jan.15543","article-title":"Effectiveness of Acceptance and Commitment Therapy for people with advanced cancer: A systematic review and meta-analysis of randomized controlled trials","volume":"79","author":"Fang","year":"2023","journal-title":"J Adv Nurs"},{"key":"2026082802200676000_16.5.1250.13","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1177\/02692163221099610","article-title":"Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial","volume":"36","author":"Mosher","year":"2022","journal-title":"Palliat Med"},{"key":"2026082802200676000_16.5.1250.14","doi-asserted-by":"crossref","unstructured":"Hayes SC , Strosahl KD , Wilson KG . Acceptance and commitment therapy: the process and practice of mindful change. 2nd edn. New York: Guilford Press, 2012.","DOI":"10.1037\/17335-000"},{"key":"2026082802200676000_16.5.1250.15","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1200\/JCO.24.00965","article-title":"Randomized controlled trial of acceptance and commitment therapy for fatigue interference with functioning in metastatic breast cancer","volume":"43","author":"Mosher","year":"2025","journal-title":"J Clin Oncol"},{"key":"2026082802200676000_16.5.1250.16","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1089\/jpm.2019.0398","article-title":"Acceptability, feasibility, and efficacy potential of a multimodal acceptance and commitment therapy intervention to address psychosocial and advance care planning needs among anxious and depressed adults with metastatic cancer","volume":"23","author":"Arch","year":"2020","journal-title":"J Palliat Med"},{"key":"2026082802200676000_16.5.1250.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbpra.2012.01.003"},{"key":"2026082802200676000_16.5.1250.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.06.021"},{"key":"2026082802200676000_16.5.1250.19","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jcbs.2023.01.001","article-title":"Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial","volume":"27","author":"Burns","year":"2023","journal-title":"J Contextual Behav Sci"},{"key":"2026082802200676000_16.5.1250.20","doi-asserted-by":"crossref","first-page":"2210","DOI":"10.1002\/pon.5209","article-title":"A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain","volume":"28","author":"Hadlandsmyth","year":"2019","journal-title":"Psychooncology"},{"key":"2026082802200676000_16.5.1250.21","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1186\/s12889-017-4121-2","article-title":"User-experiences with a web-based self-help intervention for partners of cancer patients based on acceptance and commitment therapy and self-compassion: a qualitative study","volume":"17","author":"K\u00f6hle","year":"2017","journal-title":"BMC Public Health"},{"key":"2026082802200676000_16.5.1250.22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s40814-021-00837-9","article-title":"Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial","volume":"7","author":"Mosher","year":"2021","journal-title":"Pilot Feasibility Stud"},{"key":"2026082802200676000_16.5.1250.23","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008900413113"},{"key":"2026082802200676000_16.5.1250.24","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008842517972"},{"key":"2026082802200676000_16.5.1250.25","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200209000-00007"},{"key":"2026082802200676000_16.5.1250.26","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1601412"},{"key":"2026082802200676000_16.5.1250.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.014"},{"key":"2026082802200676000_16.5.1250.28","doi-asserted-by":"publisher","DOI":"10.1177\/1073191111411667"},{"key":"2026082802200676000_16.5.1250.29","unstructured":"Borkan J . Immersion\/crystallization. In: Crabtree BF , Miller WL , eds. Doing qualitative research. 2nd edn. Thousand Oaks, CA: Sage, 1999: 179\u201394."},{"key":"2026082802200676000_16.5.1250.30","unstructured":"Lindlof TR , Taylor BC . Qualitative communication research methods. 2nd edn. Thousand Oaks, CA: Sage, 2002."},{"key":"2026082802200676000_16.5.1250.31","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X05279903"},{"key":"2026082802200676000_16.5.1250.32","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s10865-021-00200-6","article-title":"The association between psychological functioning and social support and social constraint after cancer diagnosis: a 30-day daily diary study","volume":"44","author":"Rivera-Rivera","year":"2021","journal-title":"J Behav Med"},{"key":"2026082802200676000_16.5.1250.33","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.24.6.635"},{"key":"2026082802200676000_16.5.1250.34","doi-asserted-by":"publisher","DOI":"10.1002\/pon.996"},{"key":"2026082802200676000_16.5.1250.35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/13284207.2023.2285803","article-title":"A qualitative study exploring experiences of female family caregivers of people with dementia in acceptance and commitment therapy","volume":"28","author":"Han","year":"2024","journal-title":"Clin Psychol"},{"key":"2026082802200676000_16.5.1250.36","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.copsyc.2018.12.004","article-title":"Mindfulness, acceptance, and emotion regulation: perspectives from Monitor and Acceptance Theory (MAT)","volume":"28","author":"Lindsay","year":"2019","journal-title":"Curr Opin Psychol"},{"key":"2026082802200676000_16.5.1250.37","doi-asserted-by":"crossref","first-page":"102085","DOI":"10.1016\/j.cpr.2021.102085","article-title":"What do people mean when they talk about mindfulness?","volume":"89","author":"Choi","year":"2021","journal-title":"Clin Psychol Rev"},{"key":"2026082802200676000_16.5.1250.38","doi-asserted-by":"crossref","first-page":"1233526","DOI":"10.3389\/fpsyg.2023.1233526","article-title":"Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease: a nested qualitative study within the ACTMus randomized controlled trial","volume":"14","author":"Edwards","year":"2023","journal-title":"Front Psychol"},{"key":"2026082802200676000_16.5.1250.39","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1080\/09602011.2019.1589531","article-title":"A changed reality: Experience of an acceptance and commitment therapy (ACT) group after stroke","volume":"30","author":"Large","year":"2020","journal-title":"Neuropsychol Rehabil"},{"key":"2026082802200676000_16.5.1250.40","doi-asserted-by":"crossref","first-page":"829","DOI":"10.6004\/jnccn.2020.7657","article-title":"Mental health and chemical dependency services at US cancer centers","volume":"19","author":"Niazi","year":"2021","journal-title":"J Natl Compr Canc Netw"}],"container-title":["BMJ Supportive &amp; Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/spcare-2025-005548","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:20:36Z","timestamp":1787908836000},"score":1,"resource":{"primary":{"URL":"https:\/\/spcare.bmj.com\/lookup\/doi\/10.1136\/spcare-2025-005548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,9]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8,28]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/spcare-2025-005548"],"URL":"https:\/\/doi.org\/10.1136\/spcare-2025-005548","relation":{},"ISSN":["2045-435X","2045-4368"],"issn-type":[{"value":"2045-435X","type":"print"},{"value":"2045-4368","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,9]]}}}