'Making it Personal': Exploring fluctuations in chronic symptoms using N-of-1 methods to improve self-management

Background: Fatigue is the most commonly reported, most disabling but least understood symptom experienced by patients with chronic diseases such as Cancer, Multiple Sclerosis (MS) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Patterns and predictors of symptoms such as fatigue may differ considerably from one individual to another but these differences are concealed in research using group-based designs (e.g. randomised controlled trials) that focus on exploring the average results for the groups studied. Tools for assessing fatigue symptoms typically involve self-reported retrospective recall which can be subject to a number of memory biases. Furthermore, fatigue assessment is typically conducted on only one occasion, which results in a limited understanding about how fatigue fluctuates over time. N-of-1 methods involve the repeated, quantitative and prospective measurement of a health-related outcome in an individual over time. N-of-1 methods can be used to identify patterns and predictors of fatigue over time that are unique to the individual. Methods: This project will involve a series of n-of-1 observational studies to explore fluctuations in fatigue and potential predictors (activity, sleep, stress, mood etc.) over time in patients with cancer, MS and/or ME/CFS. Daily data about fatigue and other symptoms, along with potential predictors of these symptoms, will be collected from participants three times per day for a period of 6 weeks using an electronic diary with integrated physical activity monitor. Data will be analysed using time series analysis. Participants will receive detailed feedback about the patterns and predictors of their fatigue at the end of the study, which may lead to better self-management of fatigue symptoms. Learning objectives: The student(s) will learn about a novel research method; N-of-1 methods play a key role in the movement towards personalised medicine, patient-centred health care and shared decision-making. The student(s) will gain experience and skills in relation to conducting an n-of-1 study with a clinical population.