“ACT : A pilot study to assess the role of acceptance in rehabilitation at the end of life”

Background: Rehabilitation in palliative care aims to maximize physical and psychological functioning, but negative thoughts can hinder patients from attempting this approach. Acceptance Commitment Therapy (ACT), a form of talking psychotherapy which relies on psychological flexibility may support patients in managing negative emotions.. ACT has been used in many health related behavioural interventions, but not in palliative care rehabilitation. This study aimed to investigate the the relationship between acceptance (as conceptualised in ACT), psychological morbidity and physical outcomes.. Method: Cross-sectional study in which a consecutive sample of patients attending a specialist palliative care day therapy unit for rehabilitation completed (i) AAQ–II to measure acceptance; (ii) Kessler-10 to measure psychological morbidity. Physical function was assessed by (i) timed 2 minute walking test; (ii) a minute sit to stand test. Correlation statistics and multivariable regression analyses were used to determine the strength of relationship between acceptance and psychological morbidity and physical function with a sample of 100 patients calculated to achieve 90% power. Results: 101 patients were recruited, mainly white females with a mean age of 64 years. Correlation analysis showed a negative moderate association between acceptance and psychological morbidity (R=-0.59) and a weak positive association between acceptance and distance walked (R=0.21) and sit to stand (R=0.27). Further regression analysis identified that only the relationship between acceptance and psychological morbidity was statistically significant. Conclusions: In demonstrating a negative association between acceptance and psychological morbidity, it may be possible to reduce psychological morbidity by improving patients’ acceptance using an ACT-based intervention. Future work is needed to develop such an intervention in palliative care rehabilitation to test its acceptability and feasibility.