Michael Johnston, Ph

Additional file 1. Extract from Patient Self-Care Protocol

Item Encounter Objective Activities Assessment Mode of facilitating self-efficacy (specific Number behavioral strategy) [Arranged chronologically by time of delivery]

1 Clinical Establish positive Western history; Clinician’s Verbal persuasion (CRF described as a signal Intake clinician-patient TCM pulse and assessment at end of pointing to clues for developing a wellness plan relationship tongue diagnosis; clinical intake that clinician and patient can cooperate to specific inquiries develop) on fatigue 2 Participatory Patient orally Acupuncturist At Participatory Verbal persuasion (acupuncturist describe the Session 1 contracts to self- helps patient locate Session 2, clinician benefits of self-massage for health promotion massage 5 5 points related to dialogues with and well-being); Vicarious experience specified overall well-being participant about and (acupuncturist models self-massage on acupressure points and then teaches a observes her self- patient); Performance accomplishment for a total of 20 simple stimulation acupressure (patient practices self-massage); Verbal minutes a day technique (gently & persuasion (acupuncturist provides realistic slowly pressing up positive feedback to patient about their self- & down) massage); Physiologic feedback (patient learns to use physiologic feedback to distinguish when self-massage is helpful or not); Performance accomplishment (patient orally contracts to self-massage 5 specified acupressure points for 20 minutes a day) 3 Participatory Patient implements Acupuncturist At Participatory Same as Item 2 (above); also: Verbal Session 2A more advanced helps patient learn Session 3, clinician persuasion (acupuncturist provides verbal techniques into more advanced dialogues with encouragement to reinforce self-change); self-acupressure techniques (sliding patient about her Physiologic feedback (acupuncturist helps routine press and rotating self-acupressure and participant appropriately associate self- press) observes her self- acupressure to changes in physiological states) acupressure

1 4 Participatory Patient cooperates Acupuncturist At Participatory Performance accomplishment (develop a Session 2B with acupuncturist describes several Session 3, patient goal for exercise); Vicarious experience to develop a different non- reports to clinician (Participants were given the option to view realistic strenuous exercise about exercise video clips with acupuncturist of specific individualized goal routines, including exercise routines, such as Tai Chi); Vicarious for exercise potential benefits experience (acupuncturist may model specific and problems; this exercise components); Verbal persuasion discussion is (acupuncturist describes specific benefits of tailored to account exercise routines for fatigue and well-being); for patient’s Physiological feedback (acupuncturist individual health identifies which physical discomforts are signs condition that exercise is too strenuous) 5 Participatory Patient cooperates Acupuncturist At Participatory Performance accomplishment (develop a Session 3 with acupuncturist describes nutritious Session 4, patient goal and prescription for healthy eating); to develop realistic food selection, reports to Vicarious experience (Acupuncturist carries individualized goals healthy food acupuncturist about out a role play on mindful eating); Verbal for improving preparation food persuasion (acupuncturist describes the intake of food that techniques and positive impact on relief of fatigue for specific is nutritious, mindful food food selections: eating oatmeal for breakfast, healthily prepared, consumption incorporating barley into the diet, and eating and mindfully manners healthy servings of broccoli, sweet potatoes, consumed and cabbage); Physiological feedback (acupuncturist identifies the ways in which routines such as eating at regular times and atmosphere such as no television will help to relieve fatigue) 6 Participatory Patient cooperates Acupuncturist Patient self- Performance accomplishment (develop a Session 4A with acupuncturist teaches simple assessment goal and prescription for relaxation); Vicarious to identify a relaxation experience (Acupuncturist demonstrates relaxation techniques relaxation technique(s) of interest; Verbal technique to persuasion (acupuncturist describes how incorporate into her relaxation may reduce fatigue); Physiological lifestyle feedback (acupuncturist helps participant to

2 develop a mindful awareness of the ways in which practicing relaxation will help to relieve fatigue) 7 Participatory Positive closure Acupuncturist N/A N/A Session 4B reviews overall protocol on integrative medicine lifestyle changes and reinforces potential benefits