Appendix for: A guided online Cognitive Behavioral Intervention to prevent persistent pain after breast cancer surgery_a feasibility and acceptability study

Aim: This study looked at whether an online therapy program (based on cognitive behavioral therapy, or CBT) is feasible and acceptable for women preparing for breast cancer surgery. It also tested whether this program reduces anxiety and worries about pain more than a basic health education program. Methods: Patients were randomly assigned to one of two groups: an online CBT program or an online health education program, both having five sessions and three video calls with a therapist. Feasibility was determined by recruitment and retention rate, attendance and treatment fidelity. Acceptability was assessed with evaluation forms completed by both patients and therapists. Changes in anxiety and pain worry after the intervention were compared between the groups. Results: The program was feasible overall. About 40% of eligible patients joined the study, and most of those in the CBT group completed all sessions. Participants generally liked the program and felt it helped them. However, some found it hard to fully participate because of their illness, treatment side effects, or personal situations. Both groups showed less anxiety and fewer worries about pain after the program. However, the CBT program did not reduce these problems more than the health education program. Conclusion: The online CBT program is feasible and well accepted.