Making the most out of life: Exploring the contribution of attention restorative theory in developing a non-pharmacological intervention for fatigue

Objectives: This study investigates an approach based on Kaplan's Attention Restorative Theory (ART) to develop a non-pharmacological intervention to help individuals manage the distressing effects of illness related fatigue. The study aims to: identify activities perceived as being enjoyable by individuals who have moderate to severe fatigue related to advanced illness; determine the core attributes of potentially beneficially interventions; analyse reported 'enjoyable' experiences within the ART framework by mapping emergent themes to attributes of attention restoration; and develop the prototype for a self-management intervention tool. Methods: A purposive sample of 25 individuals who experienced moderate to severe fatigue was selected from the local hospice and community. Focused semi-structured interviews probed the questions: What do you enjoying doing? What is it about the activity that you particularly enjoy? Framework analysis was used to manage responses. Results: Seventy-five 'enjoyable experiences' were identified, including artistic pursuits, voluntary work, socialising and learning. These activities were organised into four conceptual themes: Belonging, Expansive, Nurturing and Purposeful. When mapped against attributes of restorative activities specified in ART, there was some congruence and variation. It was clear that the participants expressed a great need to be safe and in a nurturing environment. Some participants placed a high value in and received great joy from contributing to the community; this was not noted in previous ART literature. Significance of results: This study has extended Kaplan's insightful work on restorative behaviours by revealing the value that purposeful, engaging and safe activities hold for people who live with fatigue. ART has inspired the research team to develop a self-management intervention tool to guide health care practitioners in promoting a non-pharmacological approach to manage fatigue through exploring, discovering and promoting experiences which engage, excite, nurture and challenge the person. Further research is needed to integrate this approach into clinical practice.