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Table 2 Tools to assess which treatment modules are indicated

From: A randomized controlled trial of web-based cognitive behavioral therapy for severely fatigued breast cancer survivors (CHANGE-study): study protocol

Treatment module

Instrument [REF]


Response format

Psychometric properties

Cut-off value

1. Coping with cancer and cancer treatment

Impact of Event Scale [62]

Intrusion and avoidance

4-point Likert scale, range 0–60

Cronbach’s α ranges between 0.87 and 0.96; adequate convergent validity [63]

Score ≥10 for each separate scale

2. Fear of cancer recurrence

Modified cancer acceptance scale [53]

Fear of disease recurrence

4-point Likert scale, range 3–12


Score ≥7


Cancer worry scale [64]

Worries about the risk of developing cancer (again)

4-point Likert scale, range 8–32

Cronbach’s α = 0.87; good convergent and divergent validity [64]

Score ≥14 [64]

3. Helpful thinking

Modified causal attribution list [52, 65]

Somatic and non-somatic attributions

4-point Likert scale

Cronbach’s α ranges between 0.71 and 0.77 [65]



Illness management questionnaire [6567]

Focusing on symptoms

6-point Likert-scale, range 9–54

Cronbach’s α ranges between 0.85 and 0.93 [66]

Score ≥30


Fatigue catastrophizing scale [68]

Catastrophizing in response to fatigue

5-point Likert scale, range 1–5

Cronbach’s α = 0.85 [68]

Score ≥2 (magnifying); score ≥7 (ruminating).


Self-efficacy scale [33, 65]

Self-efficacy with respect to fatigue

4 point Likert scale, range 7–28


Score ≤19

4. Sleep-wake rhythm

Sleep-wake diary

Sleep-wake rhythm

Bedtimes and wake-up times of 12 consecutive days and nights



5. Activity regulation

An actometer, a motion-sensing device, worn to the ankle for 12 consecutive days and nights

Activity pattern (relatively active versus low active)

Average physical activity level (number of accelerations per 5 min period) [69]

Adequate reliability and validity [73]


6. Social support

Van Sonderen Social Support Inventory, subscales Interactions (SSLI) and Discrepancies (SSLD) [70]

Discrepancy between actual and desired social support

4-point Likert Scale, range 34–136

Cronbach’s α = 0.93 (SSLI); α = 0.95 (SSLD); good content validity [71]

Score ≥14 (SSLI); score ≥50 (SSLD)