Planning and developing an intervention to promote social eating for patients living with and beyond head and neck cancer

Abstract
Background
After treatment for head and neck cancer (HNC) up to 90% of patients have difficulties eating and drinking. A growing body of evidence indicates the enormity of challenges explicitly relating to the social dimension of eating for patients following treatment [1]. Patients report social eating after treatment as a loss; consisting of a loss of events, loss of enjoyment, loss of confidence, and loss of togetherness [2]. Despite these challenges, there are limited extant interventions to specifically support the social dimension of eating nor any replicable for use in contemporary clinical practice. This research aimed to plan and develop a self-management intervention to
promote social eating for patients living with and beyond HNC.

Methods
The intervention development was guided by the Person-Based Approach (PBA) [3]. A systematic review of the social eating experiences of patients with HNC was conducted and published [2] followed by qualitative interviews with patients (n=14) [4], relatives (n=12) and healthcare professionals (n=13) and thematically analysed. Based on this research, an intervention prototype was developed, informed by literature and qualitative findings, reviewed by an expert group, and iteratively tested for usability and acceptability using think-aloud interviews.

Results
The systematic review and empirical qualitative research findings informed the development of a patient-centered, evidence-based, and theory-driven resource to promote social eating for patients with HNC. Using self management theory, key features were identified to reflect the impact of HNC on social eating, improve confidence and promote strategies to overcome social eating barriers.

Conclusion
Integrating the systematic and iterative PBA, relevant theory and stakeholder involvement can develop an acceptable social eating intervention. Additional mixed-methods evaluation is required to determine the feasibility and effectiveness of this intervention in clinical practice.