'All I Had to Do Was Open My Mouth Wide'-A Qualitative Exploration of the Acceptability of Photobiomodulation for Oral Mucositis Management in Paediatric Supportive Care

BACKGROUND: Oral mucositis (OM) presents a common and debilitating side effect of chemotherapy for children and young people (CYP). Photobiomodulation is recommended for OM prevention in international guidance; however, the acceptability of photobiomodulation in paediatric cancer care is uncertain. This study explores this acceptability with CYP, their parents, and healthcare professionals (HCPs). METHODS: Semi-structured interviews with CYP/parent dyads and focus groups with HCPs were audio-recorded and professionally transcribed. Framework analysis was completed utilising the Theoretical Framework of Acceptability (TFA) using an initial deductive approach for theoretical rigour. Over-arching themes within and between constructs and participant groups were developed. Recruitment occurred alongside analysis until there was repetition of data and an absence of novel codes. RESULTS: Twenty-seven participants were interviewed. CYP were aged 8-15 years old; HCPs had diverse professional roles within paediatric oncology and dentistry. Over half of families and three quarters of HCPs had previous photobiomodulation experience. Data were coded for all seven TFA constructs. Four themes, consisting of multiple subthemes, were developed from 42 distinct codes: (i) positive attitudes towards photobiomodulation; (ii) importance of child-centredness and autonomy; (iii) lack of understanding of photobiomodulation treatment; (iv) perceived additional burden to healthcare teams. CONCLUSION: Photobiomodulation for OM prevention is acceptable to CYP, their parents, and HCPs during cancer treatment. Exploration of the theoretical facets of this acceptability supports adaptation of services to overcome highlighted challenges to photobiomodulation acceptance. Photobiomodulation services should be designed to reduce burden on healthcare services, with resources developed to support CYP's autonomy, comprehension and self-efficacy with intra-oral treatment.