Exploring the Acceptability of an Age-Specific Multidimensional Rehabilitation Program for Young Adult Cancer Survivors: A Qualitative Feasibility Study

Abstract

Purpose:

To explore the acceptability of the content and delivery of the age-specific cancer rehabilitation program Young Adults Taking Action (YATAC) from the perspective of young adult cancer survivors (YACSs).

Methods:

Nineteen YACSs (aged 18–39) participated. Program acceptability was explored through four focus groups. The Theoretical Framework of Acceptability guided data collection and analysis. Data from the focus groups were deductively analyzed using framework analysis.

Results:

The YACSs found the YATAC program acceptable and relevant to their needs. The participants reported enhanced physical self-efficacy, improved mood, greater acceptance of their condition, reduced loneliness, and increased confidence in managing daily life. Peer support, practical exercises, and tailored content were identified as particularly valuable. Referring to delivery acceptance, participants described the program format as engaging and supportive, though some found the intensive schedule burdensome. Few suggested removing content; instead, they recommended extending sessions and adding topics such as diet, fertility, and cognitive concerns. The participants also highlighted the need for clearer guidance on accessing resources after the program. Group discussions were generally beneficial; however, some participants expressed discomfort around discussing sensitive topics in mixed settings.

Conclusion:

The YATAC program was well received and perceived as beneficial by YACSs, particularly when sessions were practical, peer-supported, and individualized. The findings support the program’s continued development and refinement.

Implications for Cancer Survivors

: This study highlights the importance of peer interaction and personalized content and thoughtful delivery design in survivorship care for young adults. Future research should explore long-term and wider outcomes.

Keywords

young adults cancer survivors rehabilitation acceptability complex interventions

Introduction

Late effects and reduced participation in everyday life after cancer treatment among young adult cancer survivors (YACSs) aged 18–39 are major concerns for these individuals and for society.^1–4 Globally, approximately one million young adults are diagnosed with cancer every year, with 1600 cases in Denmark.^5–7 Due to advances in cancer detection and treatment, young adults with cancer have a high 5-year survival rate ranging from 83% to 86%.⁸ However, they face a high risk of severe, multiple, and age-specific late effects, which may persist or emerge decades beyond treatment.^4,9–12 In particular, this is due to the intensive, multimodal, and prolonged treatment that YACSs often undergo, combined with the disruption of key developmental milestones such as education, career, and family-building.^13,14

Specifically, YACSs often experience simultaneous physical and psychological challenges, including fatigue, sexual health issues, fertility concerns, fear of recurrence, depression, and anxiety, which hinder their participation in education, work, leisure, and social life.^4,15–20 In addition, studies show that YACSs lack confidence in managing life after treatment.^21,22 The literature emphasizes the need for age-specific programs to enhance self-efficacy in managing late effects and everyday participation.^4,21,23,24 Rehabilitation is an interdisciplinary approach that addresses complex problems by focusing on the dynamic interaction between biological, psychological, social, and existential factors. It aims to improve functioning and participation and has been shown to enhance self-efficacy and health-related quality of life.^25–28 Nevertheless, age-specific rehabilitation programs for YACSs remain limited.^4,24,29,30

To address the lack of rehabilitation programs tailored to the specific needs of YACSs, a comprehensive age-specific, goal-oriented, and peer-based rehabilitation program called Young Adults Taking Action (YATAC) was codeveloped with YACSs and other stakeholders.³¹ Before a full-scale feasibility study can be conducted, it is crucial to assess the program’s preliminary acceptability to identify areas for refinement and enhance sustainable implementation. This study explored the acceptability of the content and delivery of the YATAC program from the perspective of YACSs.

Method

Research design

This qualitative feasibility study explored the acceptability of the YATAC program. The study design, including the intervention structure and the evaluation plan, is described in detail in a previously published protocol³² and registered on clinicaltrials.gov (NCT05551286).

The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research Checklist,³³ which guided both study design and reporting to enhance transparency and methodological rigor. A completed COREQ checklist is provided as Supplementary Data.

Theoretical framework

The Theoretical Framework of Acceptability (TFA) was applied to assess the acceptability of the program’s content and delivery.³⁴ Developed by Sekhon et al.,³⁴ the TFA provides a comprehensive conceptual model for evaluating how individuals perceive health care interventions, based on their anticipated or experienced cognitive and emotional responses. The framework has been widely used in previous studies to guide data collection and analysis related to the acceptability of health care interventions.^35–38

In the TFA, acceptability is conceptualized as a multifaceted construct that can be assessed both prospectively, before an individual engages with an intervention, and retrospectively, after the intervention has been experienced. It defines acceptability as the extent to which an individual who receives or delivers an intervention considers the intervention appropriate based on anticipated or experienced cognitive and emotional responses to the intervention.³⁴

The framework comprises seven interrelated constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. These constructs capture participants’ emotional reactions, perceived effort, moral alignment, understanding, trade-offs, expected outcomes, and confidence in engaging with the intervention.³⁴ The constructs are described in detail in Table 1.

Table 1.

Description of the Constructs in the Theoretical Framework of Acceptability (TFA)

Construct	Description
Affective attitude	An individual’s^a feelings about the intervention
Burden	An individual’s perception of the required amount of effort to be able to engage in the intervention
Ethicality	To what extent the intervention is in accordance with an individual’s value system
Intervention coherence	To what extent an individual understands the intervention and how it works
Opportunity costs	To what extent an individual must give up benefits, profits, or values to engage in the intervention
Perceived effectiveness	To what extent the intervention is perceived as likely to achieve its purpose
Self-efficacy	An individual’s confidence in performing the behaviors required to engage in the intervention

An individual could be the person receiving or delivering the intervention.

In this study, the TFA guided both the development of the semistructured interview guide and the deductive analysis of the focus group data, which enabled a structured and theory-informed exploration of the participants’ experiences.

Setting and time frame

The study was conducted at REHPA, the Danish Knowledge Center for Rehabilitation and Palliative Care, in Nyborg, Denmark. REHPA is a publicly funded research clinic that offers free residential rehabilitation stays for individuals with life-threatening diseases.³⁹ The study was conducted between May and November 2022.

Participants and recruitment

The eligibility criteria were (1) aged 18–39 at the start of the program, (2) diagnosed with any type of cancer, (3) had completed primary/active cancer-directed treatment (cytotoxic chemotherapy, radiation therapy, and/or definitive surgical intervention; hormonal treatments or maintenance therapies were allowed), (4) independent in personal activities of daily living, (5) able to speak and understand Danish, (6) access to an internet-enabled device (e.g., smartphone or tablet), and (7) willing to provide written informed consent.

Participants were recruited between May and September 2022 through multiple channels. Information about the program was distributed to municipalities, relevant hospital departments, and the websites and social media platforms of REHPA and the nongovernmental organization Young Cancer at the Danish Cancer Society, and participants were referred to the program by their treating physician or a general practitioner.

The sampling strategy was purposive, aiming for diversity in gender, diagnosis, and time since treatment in order to capture a broad range of experiences. The recruitment goal was 20 participants, a fixed sample size based on REHPA’ capacity for each rehabilitation stay. Nineteen participants were ultimately included, which reflects full enrollment for the study period.

The program

The program aims to improve YACSs’ self-efficacy to manage everyday life and health-related quality of life.³¹ It builds on the Social Cognitive Theory and John Dewey’s learning theory.^40–42

The program includes 23 sessions delivered over the course of a five-day in-person residential stay and a two-day in-person residential follow-up stay ten weeks after the five-day stay. An online follow-up session was held five weeks after the five-day residential stay.³² Details of the content, duration, delivery, and providers are in Table 2, in accordance with the Template for Intervention Description and Replication checklist.⁴³ All sessions were mandatory except for the work and education component, in which the participants chose either return-to-work or return-to-education sessions.³² Each session followed Cole’s seven steps of group intervention: introduction, main activity, sharing, processing, generalization, application, and summary.⁴⁴

Table 2.

Description of the Content, Duration, and Delivery Form of Each Component of the Program at REHPA

Components	What	How	Who	Where	How much
Components	What	How	Who	Where	Sessions	Hours
Goal setting	Knowledge about behavioral change and motivation and practicing preparation, evaluation, and adaptation of goals and action plans based on the SMART framework^a.	Face-to-face or online in groups and individually	Occupational therapist/physiotherapist/nurse	Inside	5	5 hours and 15 minutes
Everyday life	Knowledge and management of fatigue and cognitive deficits, including an introduction to and practicing using an energy conservation scheme and strategies to address memory and concentration difficulties in everyday life.	Face-to-face in groups	Occupational therapist/nurse	Inside	3	3 hours and 30 minutes
Physical activity	Knowledge of and practice in doing physical activity and how to implement it in everyday life, including practicing different kinds of strength and aerobic exercise, and mindfulness/yoga.	Face-to-face in groups	Physiotherapist/ fitness instructor/ yoga/mindfulness instructor	Inside and outside	6	7 hours
Psychological issues	Knowledge of common psychological challenges in YACSs, normalization of them, and introduction to and practicing coping strategies to manage the challenges in everyday life.	Face-to-face in groups	Psychologist	Inside	2	4 hours
Education and work	Knowledge of rights as per Danish legislation and introduction to strategies of how to return to/maintain work/education, practicing identification and management of challenges regarding return to work/education.	Face-to-face in groups	Social worker	Inside	2^b	1 hour and 30 minutes
Rights and finance	Knowledge of grants and foundations relevant to YACSs and how to apply to them, practicing identification of relevant grants and foundations, and writing an application.	Face-to-face in groups	Nurse	Inside	1	1 hour and 30 minutes
Sexuality and relationship	Knowledge of sexual health issues relevant to YACSs and introduction to strategies for managing them in everyday life.	Face-to-face in groups	Sexologist	Inside	1	1 hour and 30 minutes
Peer-to-peer support	Introduction to the nonprofit organizations Young Cancer and Proof of Life, including knowledge of their activities and how to contact them.	Face-to-face in groups	Peers	Inside	1	1 hour^c
Individual consultation	Individual counseling on rehabilitation needs and goals, and strategies to meet them. The content of these sessions could address any of the above-described components.	Face-to-face individually	Depending on the individual’s needs: occupational therapist/physiotherapist/nurse/ psychologist/social worker/oncologist	Inside	2	1 hour and 30 minutes

A framework for setting Specific, Measurable, Achievable, Relevant, and Time-based goals.

The participants chose either a return to work or a return to education session.

Peer-to-peer support is incorporated in the whole program except for the individual counseling, and the program was delivered as a rehabilitation stay; therefore, the participants also interacted with each other outside the official program. Hence, the number of hours of peer-to-peer support is higher than outlined in the Table.

REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care; YACSs, young adult cancer survivors.

Data collection

Demographic and clinical characteristics were collected using Research Electronic Data Capture (REDcap) and included age, gender, living arrangements, marital status, children, education, employment, cancer type, time since diagnosis, and treatment modalities.⁴⁵

Data on the program’s acceptability to YACS were collected through four focus groups, two conducted after the five-day residential stay and two after the two-day follow-up. The focus groups were chosen to enable rich, interactive discussions and diverse perspectives.⁴⁶ All 19 participants took part. Each focus group comprised 9 to 10 participants.

The focus groups took place in a quiet room at REHPA and were moderated by a female physiotherapist and PhD scholar trained in qualitative interviewing. A nonparticipant observer, either a female PhD scholar with a background in nursing or a male PhD scholar who is a physiotherapist, attended each focus group to ensure coverage of all topics and questions outlined in the interview guide and comprehensive note-taking and reflexivity. None of the members of the research team conducting the focus groups had any prior relationship with the participants.

All the focus groups followed the same semistructured interview guide, which was developed using the seven constructs of the TFA framework^34,46 as outlined in Table 3. The interview guide was pilot tested prior to the focus groups. Before each focus group, the interviewer introduced herself, explained the purpose of the interview, outlined the data handling procedures, and encouraged the participants to speak openly. The interview setting was designed to encourage open and reflective dialogue to enable the participants to share their experiences in depth and build on each other’s responses. The first author facilitated the discussions by posing follow-up questions when appropriate, which allowed the participants to shape the conversation and emphasize topics they considered meaningful. All the focus groups were audio-recorded, transcribed verbatim, and pseudonymized to protect the identity of the participants. The transcripts were not returned to the participants for review. On average, the focus groups lasted 57 minutes (range: 53–60 minutes).

Table 3.

The Semi-Structured Interview Guide

TFA framework construct	Examples of questions
Affective attitude	Can you describe your overall impression of the session in your own words? Did you notice a clear theme or structure throughout the session? How did that affect your experience? How would you describe the quality of the session’s content? In what ways did the session’s content feel relevant or irrelevant to you?
Burden	Did any aspects of the session feel particularly demanding or challenging? Did participating in the session require anything extra from you, either mentally or physically? How did you experience the session in terms of focus, energy, or fatigue?
Ethicality	Did anything about the session or its delivery raise ethical or moral concerns for you? Can you describe how respected or acknowledged you felt during the session? Were there any topics or discussions that you found uncomfortable or preferred to avoid? Why?
Intervention coherence	Which elements or activities in [session name] did you find particularly useful in relation to [the objective of the session]? Can you describe any moments in which you felt that the session clearly supported the intended goals? Was there anything missing from the session that you believe would have helped in achieving [objective of the session]? After the five-day residential stay: Can you imagine how you might apply something you learned in this session once you’ve returned home from REHPA? After the two-day follow up: Can you describe if you have applied something you learned at the five-day residential stay in your everyday life?
Opportunity costs	Can you describe if you felt that attending this session meant giving up something else important? Can you describe if you felt that working with applying what you learned at the five-day residential stay meant giving up something important?
Perceived effectiveness	The session aimed to achieve: [purpose of session]. In your view, to what extent was this purpose met? What kind of impact, if any, do you think this session might have on your life in the short and long-term? How might you integrate the insights or skills from this session into your everyday life after REHPA? What parts of the program do you think supported your ability to manage your daily life better?
Self-efficacy	How would you describe your ability to engage with the session content or exercises? Did you feel prepared and able to participate in the session’s activities? If not, what would have helped you feel more ready or confident?

TFA, The Theoretical Framework of Acceptability.

Data analysis

The data were analyzed using the Framework Analysis approach, guided by the TFA constructs,^34,47 which informed the identification and organization of the study’s main themes. The analysis followed the five systematic steps of Framework Analysis: (1) Familiarization, (2) Developing a coding framework, (3) Indexing, (4) Charting, and (5) Mapping and interpretation.⁴⁷ The first and last authors independently conducted steps 1–4. During the familiarization step, they listened to the audio recordings and read the transcripts several times to gain an overall understanding of the data (Step 1). Next, they independently coded each transcript and applied an initial coding framework based on the seven TFA constructs (Steps 2 and 3). The data were then charted by grouping coded segments under the relevant TFA constructs, and potential quotes that vividly represented the constructs were noted (Step 4). The two authors cross-compared their results and discussed their coding, resolving any discrepancies through discussion until consensus was reached. In the final step (Step 5), the first and last authors collaboratively explored patterns and relationships within and across the TFA constructs to generate overarching interpretations and selected illustrative quotes to support their findings. The results were then reviewed and discussed with the wider author group to ensure credibility and consistency. Data saturation was considered achieved after the fourth focus group, as no new themes or insights emerged.

Participant validation (member checking) was not undertaken, as the findings were grounded in a clearly structured theoretical framework, and as cross-researcher triangulation was prioritized for credibility.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the Danish Data Protection Agency (22/28502). The Regional Ethics Committee of Southern Denmark determined that ethical approval was not required (20222000-50). All participants provided written informed consent. The data were securely stored on a password-protected server at Odense University Hospital, and confidentiality was maintained through pseudonymization.

Results

Twenty-five YACSs were referred, but five did not meet the inclusion criteria, and one canceled shortly before the rehabilitation stay. Hence, the final sample consisted of 19 YACSs, the majority of whom were women with breast cancer. The demographic and cancer-related clinical characteristics of the participants are presented in Table 4.

Table 4.

Demographic and Cancer Related Clinical Characteristics for the Included Young Adult Cancer Survivors (n = 19)

Demographic/Clinical characteristics	Frequency (percentage)
Gender
Female	18 (95)
Male	1 (5)
Age
18–29 years	8 (42)
30–39 years	11 (58)
Living alone (yes)	5 (26)
In a relationship (yes)	14 (74)
Children <18 years living at home (yes)	9 (47)
Highest educational degree^a
University/University college	17 (89)
Senior high school or vocational education	2 (11)
Employment or educational status
Full-time work	1 (5)
Part-time work or student	7 (37)
Full-time sick leave	9 (47)
Other^b	2 (11)
Cancer type
Breast cancer	11 (58)
Hematological cancers	5 (26)
Other^c	3 (16)
Time since diagnosis (n = 18)
0–12 months	8 (44.5)
13–24 months	8 (44.5)
More than 24 months	2 (11)

The classification is based on the International Standard Classification of Education (ISCED 97).

Stay-at-home or municipal clarification process.

Gynecological cancers and brain tumor.

Affective attitude

Overall, the participants expressed a very positive view of the program. Some prospectively thought that specific sessions might not be relevant or beneficial to them. However, they found that these sessions provided valuable knowledge and practical tools for addressing their challenges (Table 5, Quotes 1 and 2).

Table 5.

Participant Quotes Aligned with Theoretical Framework of Acceptability Framework Constructs

TFA framework construct	Quotes
Affective Attitude	“I didn’t think it (the ‘Grant café’ session, ed.) was relevant to me either; I’ve looked at the grant book before. But I found it relevant because she could explain and elaborate further, for example, when one is considered to be in need, as stated in many grant proposals. So, I actually became much more informed and realized that I could also apply for many of the grants.”
	“Because I have a job to return to, I didn’t think it was relevant for me, but it turned out that there were several things I didn’t know, so it was relevant for me. For example, regarding different arrangements and regulations.”
	“Before I went, I hoped it would be lecture-style sessions where I could just sit back and zone out. It felt overwhelming to have to engage with so many other sick people. But that interaction was actually what really made a difference, so the fact that most of it was in groups was essential for me.”
Burden	“… the first few days had such a packed schedule that it was hard to get anything out of it. So, more breaks should probably be included.”
	“… If there’s one thing that’s consistently made us really tired, it’s been when we weren’t involved or when it was just a Power Point presentation with theory.”
Ethicality	“It was actually nice that many of the issues the others talked about didn’t resonate with me because it made me feel such as maybe I’m doing quite well and better than some others. Though it sounds a bit strange to say it, and I felt a bit guilty for feeling that way. But it was actually comforting not to relate to everything.”“Sometimes I held back from saying how hard it can be, having kids and dealing with late effects at the same time. I knew some in the group couldn’t have children because of their cancer, and then you just feel such as you should be grateful you even have them. But there are still things that are really challenging that I’d such as to talk about with others.”
Intervention coherence	“I think it’s valuable to learn about what fatigue is, but it’s just as important to hear that others face the same issues as me and what they are doing about it in their everyday lives. That I learnt a lot from. So, it (peer-to-peer support, ed.) has been incredibly important for me.”
	“Nice to understand what I’m experiencing and realize it’s completely normal, but I was missing some advice on what I can do about it.”
Opportunity costs	“It can feel such as just one more thing to do on top of everything else in daily life, and it can be hard to find the time. On the other hand, it’s an investment meant to make everyday life easier, so you really should prioritize it, it’s just not always easy.”“The online format was convenient but felt less personal, and I missed the energy of being together in person, though since I already knew the others (the young adults, ed.), it still worked fine.”
Perceived effectiveness	“If I hadn’t attended this program, I wouldn’t have progressed as far in my process, especially in terms of returning to work. I don’t think I would have returned to full-time work by now if I hadn’t been here, received all the tools I have, and had the opportunity to share my thoughts.”“I had no idea my body was capable of so much; now I truly believe that my body can perform again.”
	“I had not met other young people with cancer before coming here, and I have felt incredibly lonely throughout this process, even though I have had plenty of good friends and a loving family around me. But after this experience, I feel such as part of a community and no longer feel alone with the challenges I face.”
Self-efficacy	“After the last stay (the five-day residential stay, ed.), I felt such as I went home with a suitcase full of tools to work on the things I wanted to before coming back here.”“We don’t necessarily have the capacity to search for it ourselves, even though there is a lot available online; it would be helpful to have it here, with input from professionals who have assessed what is good.”

TFA, The Theoretical Framework of Acceptability.

In general, the participants found the content of the sessions relevant and in line with their needs. How the content was delivered was mentioned as essential for how acceptable they found the sessions. The participants highlighted that the providers’ capacity to engage beyond the formal presentation significantly impacted their perception of the sessions. Furthermore, there was broad agreement that it enhanced the relevance and relatability of the content of the sessions when participants’ specific situations, challenges, and personal experiences were used as a starting point. This approach also facilitated better retention of the presented knowledge and theory.

All participants agreed that peer-to-peer support through group sessions was very rewarding and meaningful. Some participants expressed initial concerns about the group sessions, either because they identified as introverted or because they feared that they could not manage being around many other sick individuals (Table 5, Quote 3).

Burden

The participants described the 5-day residential stay as intense, which left some feeling fatigued and made it difficult for them to concentrate and engage in some sessions (Table 5, Quote 4). Conversely, the participants were unable to identify any elements or content that seemed less relevant or could be removed to allow for more breaks. Instead, they expressed a desire for additional time, particularly during the sessions “Psychological issues” and “Education and Work,” to delve deeper into their individual situations and receive personalized guidance.

The participants reported that too much theory and lack of active involvement as participants in sessions was burdensome and fatiguing (Table 5, Quote 5). For example, they found the “Fatigue—what can I do?” session very theory-heavy and challenging. However, when they engaged directly with the energy conservation techniques in the subsequent workshop, the material became more relatable and personalized, which renewed their engagement. They also described that it was very useful to gain knowledge about the distinction between tiredness, fatigue, and exhaustion, and how these interact.

Ethicality

Although peer-to-peer support was generally viewed as a beneficial element and as acceptable, it also challenged the morals of some participants (Table 5, Quote 6). Some participants with children felt uncomfortable discussing parenting challenges in group sessions, knowing that others in the group had faced reduced fertility or infertility due to their cancer (Table 5, Quote 7). Hence, several participants suggested holding a separate session for YACSs with children to discuss issues related to this.

Intervention coherence

The participants reported that they understood how providing them with knowledge, strategies, practical exercises to manage everyday life, and peer-to-peer support contributed to the overall program aim. They exemplified this by pointing out that they had received and worked with tools that supported them in managing some of their challenges. In particular, they mentioned the goal-setting form as extremely tangible and easy to use, and useful to take home and apply in everyday life. The same applied to the energy conservation forms in the session “How can I distribute my energy?”

The participants reported that being introduced to relevant knowledge that supported them in addressing everyday challenges was important to enhance their lives. Specifically, they found information on managing fatigue and cognitive deficits, understanding their rights under Danish legislation, recognizing common psychological challenges, and addressing sexual health issues to be particularly useful. Some participants also noted that knowledge in combination with sharing experiences with other YACSs was important to them to cope with their challenges (Table 5, Quote 8). Furthermore, they expressed a desire for additional activities and opportunities to apply the knowledge in practical, real-world contexts, thereby making it more relevant and actionable for their specific situations (Table 5, Quote 9).

Opportunity costs

None of the participants expressed that the program required them to sacrifice any benefits, profits, or values. However, there was broad consensus that integrating rehabilitation into a daily routine already filled with practical tasks, family obligations, work or studies, and leisure activities can be challenging (Table 5, Quote 10).

Some participants noted that the online component, the follow-up sessions on “Goals and direction,” made balancing work, studies, and everyday life easier. Nonetheless, they felt that the online format was less personal and more distant, lacking the immediacy and atmosphere of in-person sessions (Table 5, Quote 11).

Perceived effectiveness.

Generally, the participants described that the program helped them to manage different challenges in their daily lives, which improved their lives (Table 5, Quote 12). Several participants reported experiencing a sense of mastery, both during sessions and between the stays, in terms of their physical abilities and managing everyday life. For example, several participants described increased self-efficacy regarding their physical abilities after the session “SilentFit” (Table 5, Quote 13). Furthermore, the participants reported better mood, acceptance of their situation, and a reduced feeling of loneliness after the program (Table 5, Quote 14).

Some participants considered that expanding the program to include knowledge about diet and fertility issues and a cognitive and memory assessment had enhance the program’s effectiveness.

Self-efficacy

Overall, the participants said that they were able to complete the sessions and the required work between the two stays (Table 5, Quote 15). However, they emphasized that the lack of specific information on where to access additional knowledge, tools, or resources limited their ability to actively apply what they had learned to their daily lives. For instance, many found “MediYoga” relevant but lacked specific information and guidance on where they could practice it in their local community (Table 5, Quote 16).

Discussion

This study explored the acceptability of the YATAC program among YACSs, using the TFA framework. Overall, the content and the delivery of the program were perceived as acceptable, and the participants identified elements related to all seven TFA constructs. However, some constructs were more prominently reflected in the participant feedback than others.

The participants expressed highly positive affective attitudes toward the program, reporting that its content was well aligned with their needs. This is perhaps unsurprising, given that the program was codeveloped with YACSs to enhance relevance and engagement.^31,48 Many participants shared characteristics with the codesign group (e.g., well-educated women with breast cancer), which may have enhanced its relevance.³¹ Nevertheless, these findings are noteworthy, as young adults are typically less inclined than older adults to engage with interventions that do not align with their values and preferences.^49,50 When individuals perceive external pressure to adopt approaches that do not align with their needs, they may reject the intervention’s message and disengage from participation.^49,50

As in previous studies, the participants highly valued the peer-to-peer support component.^51–53 However, the group format raised ethical concerns; some withheld personal experiences to avoid upsetting others, particularly on sensitive topics such as parenting, an issue linked to guilt and isolation in the literature.^54,55 This highlights the potential benefit of optional or subgroup-specific sessions. Peer exposure has previously been found to sometimes provoke anxiety;⁵⁵ however, this was not evident here. On the contrary, some participants felt reassured by hearing about others’ greater challenges and gaining a different perspective on their own situations.

The participants also demonstrated a clear understanding of the intervention’s coherence and purpose. They particularly valued the use of goal setting to help improve the management of everyday challenges. This was somewhat unexpected, as previous studies have described goal setting as a difficult aspect of rehabilitation, even in programs tailored to young adults with cancer.^53,56 Interestingly, several studies suggest that the primary barrier to effective goal setting lies not with the patients, whose perspective was explored in this study, but with the health care professionals, who may struggle to adapt their clinical routines and communication style.⁵⁶

The opportunity costs were not directly reported; however, the participants acknowledged that balancing the program with everyday demands could be challenging. Many YACSs juggle work, education, and caregiving responsibilities alongside their rehabilitation needs—a challenge documented in existing literature.⁵⁷ To facilitate integration into daily life, online delivery formats were recommended. Such formats have previously been found acceptable and feasible for YACSs.^30,58 Nevertheless, evidence suggests that face-to-face peer support may be more effective in enhancing self-efficacy, perceived control, and cancer-related knowledge compared with online peer support.⁵⁹

The participants perceived the YATAC program as effective, reporting increased confidence in managing daily activities and reduced feelings of loneliness—outcomes that are aligned with the program’s theoretical foundation and with prior research.^53,60,61 Interactive sessions were preferred, whereas theory-heavy content felt burdensome. The participants also recommended adding cognitive assessments and information on diet and fertility—areas previously identified as important.^62–64 Although diet was excluded during the coproduction process, the current findings suggest that it should be considered in future versions.³¹

Although the participants generally felt confident in engaging with the program, they expressed a need for clearer guidance on accessing additional resources. This may reflect fatigue, cognitive challenges, or lower health literacy, which is common among young adults and linked to difficulties with navigating complex health care systems.⁶⁵ However, as health literacy was not assessed, these interpretations should be treated with caution.

Strength and limitations

This study’s strength lies in its participant-focused approach and use of a structured framework to explore the acceptability of the YATAC program to YACSs. Including all participants in the focus groups ensured diverse insights, and data saturation was achieved through a transparent, validated analysis. The limitations include underrepresentation of men, ethnic minorities, and varied cancer types. Although the results are not generalizable, their consistency supports the validity of the findings.

Conclusion

The YATAC program was deemed acceptable by the YACSs, who reported enhanced physical self-efficacy, improved mood, greater acceptance of their condition, reduced feelings of loneliness, and increased self-efficacy in managing everyday life. The program was perceived as particularly effective when the sessions were practical, peer-supported, and tailored to individual needs. The participants suggested improvements such as longer sessions; the inclusion of additional topics such as diet, fertility, and cognitive concerns; and clearer guidance on accessing relevant resources. The findings provide valuable insights for future program development, including the refinement of context—mechanism–outcome configurations and the design of broader interventions. Further research is needed to assess the program’s long-term impact and its applicability across more diverse and representative populations.

Authors’ Contributions

Conceptualization of the research project: M.A., M.S.P., M.A.H., and K.l.C.; Methodology and data collection: M.A., D.S.J., M.S.P., and K.l.C.; Formal analysis: M.A. and K.l.C.; Writing—original draft preparation: M.A.; Writing—review and editing: M.A., M.S.P., M.A.H., and K.l.C.; Supervision: M.S.P., M.A.H., and K.l.C.; Project administration: M.A.; All authors have read and agreed to the published version of the article.

Footnotes

Acknowledgment

The authors are grateful to the YACSs who participated in the program and to REHPA for hosting the program. The authors extend the thanks to the professionals who delivered the program and the staff who assisted with its operation. Special thanks to Birthe Kargaard, Christina Wendelboe, Christina Strandsberg, and Signe Hulsbæk. The authors would also like to express the gratitude to Mod!Kræft at Zealand University Hospital, Roskilde; Kræftværket at Rigshospitalet, Copenhagen University Hospital; Livskræften at Odense University Hospital; Frirumm1 at Aarhus University Hospital; and the patient organization Young Cancer at the Danish Cancer Society for helping with recruitment. The authors would like to thank Anne Therese Karlsson and Jens-Jakob Kjer Møller for their assistance with the focus groups. Finally, the authors acknowledge OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, for their support and services related to OPEN REDCap.

Author Disclosure Statement

The authors have no relevant financial or nonfinancial interests to disclose.

Funding Information

M.A. received a PhD grant from the Region of Southern Denmark (19/37135). In addition, the study is funded by REHPA, which receives financial support from the Danish Government.

Supplemental Material

References

Abdelhadi

, Joseph

, Pollock

, et al. Additional medical costs of chronic conditions among adolescent and young adult cancer survivors. J Cancer Surviv, 2022; 16(3):487–496; doi: 10.1007/s11764-021-01044-4

Janssen

SHM

, van der Meer

, van Eenbergen

, et al. Short- and long-term impact of cancer on employment and financial outcomes of adolescents and young adults (AYAs): A large population-based case-control registry study in the Netherlands. ESMO Open, 2022; 7(4):100521; doi: 10.1016/j.esmoop.2022.100521

Schulte

FSM

, Chalifour

, Eaton

, et al. Quality of life among survivors of adolescent and young adult cancer in Canada: A Young Adults With Cancer in Their Prime (YACPRIME) study. Cancer, 2021; 127(8):1325–1333; doi: 10.1002/cncr.33372

Janssen

SHM

, van der Graaf

WTA

, van der Meer

, et al. Adolescent and Young Adult (AYA) cancer survivorship practices: An overview. Cancers (Basel), 2021; 13(19):4847; doi: 10.3390/cancers13194847

Trama

, Stark

, Bozovic-Spasojevic

, et al. Cancer burden in adolescents and young adults in Europe. ESMO Open, 2023; 8(1):100744; doi: 10.1016/j.esmoop.2022.100744

World Health Organization. Cancer Country Profile 2020: Denmark. Available from: https://cdn.who.int/media/docs/default-source/country-profiles/cancer/cancer-dnk-2020.pdf?sfvrsn=e9241162_4&download=true [Last accessed: 4 January 2025 ].

You

, Lv

, Li

, et al. Worldwide cancer statistics of adolescents and young adults in 2019: A systematic analysis of the Global Burden of Disease Study 2019. ESMO Open, 2021; 6(5):100255; doi: 10.1016/j.esmoop.2021.100255

Miller

, Fidler-Benaoudia

, Keegan

, et al. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin, 2020; 70(6):443–459; doi: 10.3322/caac.21637

Thorsen

, Bøhn

, Lie

, et al. Needs for information about lifestyle and rehabilitation in long-term young adult cancer survivors. Support Care Cancer, 2022; 30(1):521–533; doi: 10.1007/s00520-021-06418-z

10.

Dahl

, Fosså

, Lie

, et al. Employment status and work ability in long-term young adult cancer survivors. J Adolesc Young Adult Oncol, 2019; 8(3):304–311; doi: 10.1089/jayao.2018.0109

11.

Husson

, Zebrack

, Aguilar

, et al. Cancer in adolescents and young adults: Who remains at risk of poor social functioning over time? Cancer, 2017; 123(14):2743–2751; doi: 10.1002/cncr.30656

12.

Mao

, Armstrong

, Bowman

, et al. Symptom burden among cancer survivors: Impact of age and comorbidity. J Am Board Fam Med, 2007; 20(5):434–443; doi: 10.3122/jabfm.2007.05.060225

13.

Warner

, Kent

, Trevino

, et al. Social well-being among adolescents and young adults with cancer: A systematic review. Cancer, 2016; 122(7):1029–1037; doi: 10.1002/cncr.29866

14.

Bleyer

, Barr

. Cancer in young adults 20 to 39 years of age: Overview. Semin Oncol, 2009; 36(3):194–206; doi: 10.1053/j.seminoncol.2009.03.003

15.

Patterson

, McDonald

, Zebrack

, et al. Emerging issues among adolescent and young adult cancer survivors. Semin Oncol Nurs, 2015; 31(1):53–59; doi: 10.1016/j.soncn.2014.11.006

16.

Forbes

, Tanner

, Engstrom

, et al. Patient reported fatigue among adolescent and young adult cancer patients compared to non-cancer patients: A systematic review and meta-analysis. J Adolesc Young Adult Oncol, 2024; 13(2):242–250; doi: 10.1089/jayao.2023.0094

17.

Vandraas

, Reinertsen

, Kiserud

, et al. Fear of cancer recurrence among young adult cancer survivors—exploring long-term contributing factors in a large, population-based cohort. J Cancer Surviv, 2021; 15(4):497–508; doi: 10.1007/s11764-020-00943-2

18.

Bentsen

, Aagesen

, Bidstrup

, et al. Sexuality, intimacy, and body image among adolescents and young adults with cancer: A qualitative, explorative study. Support Care Cancer, 2024; 32(4):219; doi: 10.1007/s00520-024-08405-6

19.

Bentsen

, Pappot

, Hjerming

, et al. Thoughts about fertility among female adolescents and young adults with cancer: A qualitative study. Support Care Cancer, 2023; 31(7):421; doi: 10.1007/s00520-023-07887-0

20.

Hauken

, Larsen

, Holsen

. Meeting reality: Young adult cancer survivors’ experiences of reentering everyday life after cancer treatment. Cancer Nurs, 2013; 36(5):E17–E26; doi: 10.1097/NCC.0b013e318278d4fc

21.

Thornton

, Li

, Yeh

, et al. Self-efficacy in symptom management for adolescents and young adults with cancer: A systematic review. Support Care Cancer, 2021; 29(6):2851–2862; doi: 10.1007/s00520-020-05960-6

22.

DeRouen

, Smith

, Tao

, et al.; AYA HOPE Study Collaborative Group. Cancer-related information needs and cancer’s impact on control over life influence health-related quality of life among adolescents and young adults with cancer. Psychooncology, 2015; 24(9):1104–1115; doi: 10.1002/pon.3730

23.

Guzik

, McKinney

, Ulack

, et al. Outcomes that matter most to young adults diagnosed with cancer: A qualitative study. J Adolesc Young Adult Oncol, 2021; 10(5):534–539; doi: 10.1089/jayao.2020.0150

24.

Adams

, Herman

, Lega

, et al. Young adult cancer survivorship: Recommendations for patient follow-up, exercise therapy, and research. JNCI Cancer Spectr, 2021; 5(1):pkaa099; doi: 10.1093/jncics/pkaa099

25.

Maribo

, Ibsen

, Thuesen

, et al. Hvidbog om rehabilitering [White Book on Rehabiltation]. Rehabiliteringsforum: Aarhus, Danmark; 2022.

26.

Wade

. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil, 2020; 34(5):571–583; doi: 10.1177/0269215520905112

27.

Kudre

, Chen

, Richard

, et al. Multidisciplinary outpatient cancer rehabilitation can improve cancer patients’ physical and psychosocial status-a systematic review. Curr Oncol Rep, 2020; 22(12):122; doi: 10.1007/s11912-020-00979-8

28.

Szczepańska-Gieracha

, Mazurek

. The role of self-efficacy in the recovery process of stroke survivors. Psychol Res Behav Manag, 2020; 13:897–906; doi: 10.2147/prbm.S273009

29.

Fitch

, Nicoll

, Lockwood

, et al. Adolescent and young adult perspectives on challenges and improvements to cancer survivorship care: How are we doing? J Adolesc Young Adult Oncol, 2021; 10(4):432–442; doi: 10.1089/jayao.2020.0097

30.

Aagesen

, la Cour

, Møller

, et al. Rehabilitation interventions for young adult cancer survivors: A scoping review. Clin Rehabil, 2023; 37(10):1347–1374; doi: 10.1177/02692155231168720

31.

Aagesen

, Pilegaard

, Janssens

, et al. Development of a rehabilitation programme for young adult cancer survivors using co-production. Res Involv Engagem, 2024; 10(1):134; doi: 10.1186/s40900-024-00667-y

32.

Aagesen

, la Cour

, Hauken

, et al. The ‘Young Adult Taking Action’ programme for young adult cancer survivors: A study protocol for a feasibility study. Scand J Occup Ther, 2023; 30(8):1472–1488; doi: 10.1080/11038128.2023.2244563

33.

Tong

, Sainsbury

, Craig

. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care, 2007; 19(6):349–357; doi: 10.1093/intqhc/mzm042

34.

Sekhon

, Cartwright

, Francis

. Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Serv Res, 2017; 17(1):88; doi: 10.1186/s12913-017-2031-8

35.

Olesen

, la Cour

, With

, et al. A cross-sectional evaluation of acceptability of an online palliative rehabilitation program for family caregivers of people with amyotrophic lateral sclerosis and cognitive and behavioral impairments. BMC Health Serv Res, 2022; 22(1):697; doi: 10.1186/s12913-022-07986-4

36.

Chew-Graham

, Kitchen

CEW

, Gascoyne

, et al. The feasibility and acceptability of a brief psychological intervention for adults with long-term health conditions and subthreshold depression delivered via community pharmacies: A mixed methods evaluation-the Community Pharmacies Mood Intervention Study (CHEMIST). Pilot Feasibility Stud, 2022; 8(1):27; doi: 10.1186/s40814-022-00992-7

37.

Liptrott

, Lovell

, Bee

. Influence of needs and experiences of Haemato-oncology patients on acceptability of a telephone intervention for support and symptom management: A qualitative study. Clin Nurs Res, 2020; 29(8):627–637; doi: 10.1177/1054773820940865

38.

Pavlova

, Teychenne

, Olander

. The concurrent acceptability of a postnatal walking group: A qualitative study using the theoretical framework of acceptability. Int J Environ Res Public Health, 2020; 17(14):5027; doi: 10.3390/ijerph17145027

39.

Rasmussen

, Jespersen

, Backmann

, et al. Practice description, research clinic REHPA. Standard residential rehabilitation course for people with or after cancer. REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care: Nyborg; 2020.

40.

Dean

, Siegert

, Taylor

. Interprofessional Rehabilitation: A Person-Centred Approach. Wiley-Blackwell: Chichester, West Sussex, UK; 2012.

41.

Bandura

. Social cognitive theory: An agentic perspective. Annu Rev Psychol, 2001; 52:1–26; doi: 10.1146/annurev.psych.52.1.1

42.

John Dewey Society. Education and culture. Iowa City: University of Iowa; 1944.

43.

Hoffmann

, Glasziou

, Boutron

, et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. Bmj, 2014; 348:g1687; doi: 10.1136/bmj.g1687

44.

Cole

. Group dynamics in occupational therapy: The Theoretical basis and Practice application of group intervention. SLACK Incorporated: New Jersey, USA; 2017.

45.

Harris

, Taylor

, Minor

, et al.; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform, 2019; 95:103208; doi: 10.1016/j.jbi.2019.103208

46.

Brinkmann

, Kvale

. InterViews. Learning the Craft of Qualitative Research Interviewing. SAGE Publications: Thousand Oaks, CA; 2015.

47.

Ritchie

, Lewis

, McNaughton

, et al. Qualitative Research Practice: A Guide for Social Science Students and Researchers. Sage: London; 2013.

48.

Grindell

, Coates

, Croot

, et al. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: A systematic review. BMC Health Serv Res, 2022; 22(1):877; doi: 10.1186/s12913-022-08079-y

49.

Stok

, de Ridder

DTD

, de Vet

, et al. Hungry for an intervention? Adolescents’ ratings of acceptability of eating-related intervention strategies. BMC Public Health, 2016; 16(1):5; doi: 10.1186/s12889-015-2665-6

50.

Somefun

, Casale

, Haupt Ronnie

, et al. Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: A systematic review and evidence map. BMJ Open, 2021; 11(12):e055160; doi: 10.1136/bmjopen-2021-055160

51.

Kelly

, Pearce

, Mulhall

. ‘Being in the same boat’: ethnographic insights into an adolescent cancer unit. Int J Nurs Stud, 2004; 41(8):847–857; doi: 10.1016/j.ijnurstu.2004.03.011

52.

Matsui

, Taku

, Tsutsumi

, et al. Role of peer support in posttraumatic growth among adolescent and young adult cancer patients and survivors. J Adolesc Young Adult Oncol, 2023; 12(4):503–511; doi: 10.1089/jayao.2022.0064

53.

Hauken

, Holsen

, Fismen

, et al. Participating in life again: A mixed-method study on a goal-orientated rehabilitation program for young adult cancer survivors. Cancer Nurs, 2014; 37(4):E48–E59; doi: 10.1097/NCC.0b013e31829a9add

54.

Phan

, Laurence

, Marec-Berard

, et al. The place of sick peers in adolescents and young adults with cancer: Advantage, disadvantage, and what makes barriers to the encounter. J Adolesc Young Adult Oncol, 2023; 12(6):879–889; doi: 10.1089/jayao.2022.0176

55.

Jablotschkin

, Binkowski

, Markovits Hoopii

, et al. Benefits and challenges of cancer peer support groups: A systematic review of qualitative studies. Eur J Cancer Care (Engl), 2022; 31(6):e13700; doi: 10.1111/ecc.13700

56.

Crawford

, Maxwell

, Colquhoun

, et al. Facilitators and barriers to patient-centred goal-setting in rehabilitation: A scoping review. Clin Rehabil, 2022; 36(12):1694–1704; doi: 10.1177/02692155221121006

57.

Lidington

, Vlooswijk

, Stallard

, et al. ‘This is not part of my life plan’: A qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis. Eur J Cancer Care (Engl), 2021; 30(5):e13458; doi: 10.1111/ecc.13458

58.

Devine

, Viola

, Coups

, et al. Digital health interventions for adolescent and young adult cancer survivors. JCO Clin Cancer Inform, 2018; 2:1–15; doi: 10.1200/cci.17.00138

59.

Kiemen

, Czornik

, Weis

. How effective is peer-to-peer support in cancer patients and survivors? A systematic review. J Cancer Res Clin Oncol, 2023; 149(11):9461–9485; doi: 10.1007/s00432-023-04753-8

60.

Corke

, Langelier

, Gupta

, et al. A pilot study to evaluate the feasibility and acceptability of a tailored multicomponent rehabilitation program for Adolescent and Young Adult (AYA) cancer survivors. Cancers (Basel), 2025; 17(7):1066.

61.

Hauken

, Holsen

, Fismen

, et al. Working toward a good life as a cancer survivor: A longitudinal study on positive health outcomes of a rehabilitation program for young adult cancer survivors. Cancer Nurs, 2015; 38(1):3–15; doi: 10.1097/ncc.0000000000000138

62.

McDuffee

, Shi

, Dunker

, et al. Closing the gap: The need for fertility intervention for young adult cancer survivors. J Adolesc Young Adult Oncol, 2025; 14(4):378–382; doi: 10.1089/jayao.2024.0126

63.

Lea

, Martins

, Fern

, et al. The support and information needs of adolescents and young adults with cancer when active treatment ends. BMC Cancer, 2020; 20(1):697; doi: 10.1186/s12885-020-07197-2

64.

Chan

, Cheng

, Wang

, et al. Cognitive impairment in adolescent and young adult cancer patients: Pre-treatment findings of a longitudinal study. Cancer Med, 2023; 12(4):4821–4831; doi: 10.1002/cam4.5295

65.

Friis

, Lasgaard

, Osborne

, et al. Gaps in understanding health and engagement with healthcare providers across common long-term conditions: A population survey of health literacy in 29,473 Danish citizens. BMJ Open, 2016; 6(1):e009627; doi: 10.1136/bmjopen-2015-009627

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.07 MB