Emotional Support Messages Following a Cancer Diagnosis
Conditions: Psychological Stress, Anxiety
Sponsor: H. Lee Moffitt Cancer Center and Research Institute

Title: Emotional Support Messages Following a 
Cancer Diagnosis 
 
NCT03840109 
 
Protocol V3 dated 3/04/2019 

Reblin, Ray, Floyd, & Harvey 
 
1 
Study Title: Emotional Support Messages Following a Cancer Diagnosis 
 
Protocol version 3 dated 03/04/2019 
 
Principle Investigator 
Dr. Maija Reblin, Moffitt Cancer Center 
 
Research Team  
Dr. Colter D. Ray, San Diego State University 
Dr. Kory Floyd, University of Arizona 
Dr. Jacquelyn Harvey, University of Minnesota Duluth 
 
Background and Significance 
Social support messages are an important part of close relationships (Cutrona & Suhr, 1992); 
however, recipients perceive some supportive messages to be unhelpful or unwanted (Floyd & 
Ray, 2017). In general, emotional support messages are viewed as a particularly useful form of 
support in the months following a cancer diagnosis (Arora et al., 2007). There are instances, 
though, of cancer patients viewing some emotional support messages negatively (Ray & 
Veluscek, 2017, 2018). Much of the prior research looking at peoples' reactions to emotional 
support messages have done so by looking for differences between high, moderate, and low-
quality messages (High & Dillard, 2012), and have not considered the possibility that some 
offers of emotional support may contain both positive statements of empathy and caring and also 
negative statements of criticism and blame. Therefore, the present study investigates how cancer 
patients rate emotional support messages that consist of different percentages of positive and 
negative statements. Additionally, prior research has shown that some messages may be retained 
in memory for years after they are communicated (Knapp, Stohl, & Reardon, 1981), and some of 
these memorable messages can be classified as supportive messages (Wang, 2012). However, 
minimal research has focused on what is specifically remembered from supportive messages, 
particularly if those messages are composed of both positive and negative statements. Research 
by Ray and Veluscek (2017) has shown, though, that cancer patients can readily recall both 
positive and negative support messages received in the year after initial diagnosis and that 
receiving negative messages sometimes led to re-evaluating whether future updates would be 
shared with the supporter. Furthermore, the well-supported propensity for humans to pay greater 
attention and give more processing to negative information than positive information 
(Baumeister, 2001), would suggest that negative portions of ambivalent support messages would 
have a stronger influence on the recipient, particularly in terms of what is recalled (Bless, 
Hamilton, & Mackie, 1992; Finkenauer & Rimé, 1998). The present study tests this negativity 
bias and the findings will illuminate how cancer patients process, perceive, and recall emotional 
support messages that have both positive and negative components. To test the possible effects 
of negative portions of messages, 18 message conditions have been developed (see list provided 
under Participation heading). This results in a nested factorial design in which you have 5 

message conditions (0, 20, 40, 60, or 80 percent negativity), 2 conditions based on the placement 
of the negative portions (beginning or end), and 2 versions of each message condition to allow 
for the messages to be analyzed as random factors. A 5x2x2 design typically yields 20 cells; 
however, when there is 0% negative portions of a message, it is unnecessary to consider the 
placement of the negative portions that do not exist. This results in 18 conditions as opposed to 
20 conditions.  
 
Study Purpose/Objective 
To understand how cancer patients react to and recall emotional support messages that contain 
different percentages of positive statements of empathy and caring and also negative statements 
of criticism and blame. 
 
Study Aims 
Aim #1: To determine how cancer patients rate emotional support messages that consist of 
differing percentages of negative statements (0, 20, 40, 60, or 80 percent) and messages in which 
those negative portions occur at either the beginning or end of the supportive message. 
 
Aim #2: To determine what portions of emotional support messages that consist of differing 
percentages of negative and positive statements cancer patients recall in the minutes after reading 
a message, and whether the placement of the negative portions at either the beginning or end of 
the message also affects recall. 
 
Hypotheses & Research Questions 
 
Hypotheses 1-4 and Research Questions 1-4 address Study Aim #1. 
 
H1: Cancer patients’ ratings of message effectiveness differ based on the percentage of the 
support message that is negative. 
 
RQ1: How, if at all, do cancer patients’ ratings of message effectiveness differ depending on 
whether negative portions of messages occur at the beginning or end of the entire message? 
 
H2: Cancer patients’ ratings of supporter competence differ based on the percentage of the 
support message that is negative. 
 
RQ2: How, if at all, do cancer patients’ ratings of supporter competence differ depending on 
whether negative portions of messages occur at the beginning or end of the entire message? 
 
H3: Cancer patients’ likelihood of seeking support from a supporter in the future differs based 
on the percentage of the support message that is negative. 
 

RQ3: How, if at all, do cancer patients’ likelihood of seeking support from a supporter in the 
future differ depending on whether negative portions of messages occur at the beginning or end 
of the entire message? 
H4: Cancer patients’ self-reports of emotional improvement after receiving a support message 
differs based on the percentage of the support message that is negative. 
 
RQ4: How, if at all, do cancer patients’ self-reports of emotional improvement after receiving a 
support message differ depending on whether negative portions of messages occur at the 
beginning or end of the entire message? 
 
Hypotheses 5-7 address Study Aim #2. 
 
H5: Cancer patients recall negative portions of supportive messages more frequently than they 
recall positive portions of supportive messages. 
 
H6: As the percentage of negative portions of a supportive message increases, cancer patients 
likelihood to recall negative portions of supportive messages also increases. 
 
H7: The number of negative words recalled from the supportive messages by cancer patients 
differ depending on the percentage of the message that is negative. 
 
Methods 
This is a cross-sectional, observational survey study. Data will be collected through a mass email 
disseminated through the online survey platform Qualtrics.  
 
Recruitment and Eligibility 
800 participants will be recruited from Moffitt TCC-consented patients who have agreed to be 
contacted for future research.  
 
Inclusion Criteria: Living patients, 18 years of age or older, diagnosis of breast, prostate, 
thoracic, or digestive cancer in the past 3 years, consent to the Moffitt TCC protocol and 
indication of their willingness to be contacted for future research by including an email contact, 
and ability to read and write fluently in English. 
 
A random selection of at least 800 patients who fit inclusion criteria will be drawn by Moffitt 
Collaborative Data Services. An invitation to participate in the current study will be sent to 
participants via an email disseminated through the online survey host Qualtrics. The contact list 
of email recipients will be uploaded into the Qualtrics system and the email will be sent from Dr. 
Colter Ray (study team member). If a potential participant were to choose to reply to this email 
with questions about the study or for any other reason, these replies would be sent to Dr. Colter 
Ray, who would be tasked with responding to the potential participant’s message. The invitation 
will include a description of the study and a link to the study survey.  
 

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in the survey in the future. Participants also answer an open-ended question in which they are 
asked what specific phrases or sentences they recall from the support message they read. 
 
During pilot tests of the questionnaire, the average time to complete was 7.5 minutes. Three 
weekly reminders will be sent by email to those who have not completed the survey to encourage 
participation. Those who opt out will not be contacted with follow-up emails. The recruitment 
emails will include a link that can be clicked to opt out of the recruitment process for the study.  
 
See Appendix A for the questionnaire and Appendix B for the message conditions. 
 
Planned Analyses 
The number of participants was determined through power analyses performed by the statistical 
software program G*POWER. The suggested sample size provided by G*POWER was 479. 
Specifically, this was determined by conducting an a priori analysis with an effect size (f) of .25, 
alpha error probability of .05, power (1 – β error probability) of .95, and 18 groups, which is the 
total number of message conditions listed above. Importantly, a power analysis using these same 
parameters but for an ANCOVA also yielded a suggested samples size of 479.  
 
Statistical analyses will consist of 5x2x2 nested factorial ANOVA models. The first study aim 
will be tested through 4 ANOVA models that will test for differences between participants who 
received the different messages in terms of 1) perceived message effectiveness, 2) perceptions of 
supporter competence, 3) likelihood to seek support from the supporter in the future, and 4) self-
reports of emotional improvement. Depending on the correlations among the dependent 
variables, a MANOVA may be used instead of an ANOVA to test the first aim of the study. 
Similarly, if significant covariates (such as age or times since diagnosis) are found, the 
ANOVA/MANOVA could become an ANCOVA or MANCOVA. To test the second aim of the 
study, a chi-square analysis will test to see if participants recall negative portions of messages 
more frequently than positive portions of messages depending on which message they received 
(i.e., dependent on the position and percentage of the negative message portions). The second 
aim will also be tested using ANOVA models to determine if significant differences occurred in 
the number of negative words that were recalled across the 18 messages received (i.e., dependent 
on the position and percentage of the negative message portions). The software program LIWC 
(Linguistic Inquiry and Word Count) will be used determine the number of negative words 
recalled by the participants in their open-ended responses.  
 
Potential Benefits 
There are no benefits for being in this study; however, by joining this research study, the 
participant is helping to provide information which may help science and society. 
 
Potential Risks 
 
Because of the personal nature of the questions to be asked, the participant might reflect on 
unpleasant memories while completing the questionnaire. Although not expected to occur, it is 

possible that a breach of confidentiality could occur if the computer on which the data file is 
stored is compromised or otherwise hacked or illegally accessed. 
 
Compensation, Benefits, and Risks 
At the end of the questionnaire, participants will be given the option to click a link to a separate 
Qualtrics survey where they can provide an email address to enter a lottery for one of five $50 
Visa e-Gift Cards. By having participants provide their email in a separate Qualtrics survey, the 
personal identifiable email data will be kept separate from the study data. The data from the 
Qualtrics survey will be stored in a password protected encrypted folder behind a university 
firewall that only the study team can access. The data for the drawings will be destroyed after the 
drawings have been conducted. The drawings will be conducted immediately following the end 
of data collection, which is expected to conclude by the end of 2019. The drawing will be 
conducted by a member of the research team, Dr. Colter Ray of the School of Communication at 
San Diego State University. A total of five $50 Visa e-Gift Cards will be given away. No 
participant will be able to win more than one of the five gift cards. The chances of winning a 
prize is approximately 1 in 120. The winner will be notified immediately by email in a message 
that also includes the instructions for activating their Visa e-Gift card. 
 
The researchers expect the study to indirectly benefit society by generating new knowledge 
about emotional support following a cancer diagnosis. Individual participants are not expected to 
benefit either directly or indirectly from participating.  
 
Participants will experience minimal if any risk at all. Because of the personal nature of some 
questions to be asked, the participant may reflect on unpleasant memories while completing the 
questionnaire. To protect their data, participants will be encouraged to do the questionnaire from 
a trusted, personal computer. The only other foreseeable potential risk is loss of privacy/breach 
of confidentiality if the data were to be accessed illegally by someone other than the research 
team. The safeguards against this possibility are discussed below. 
 
Data Storage 
The data will not be made available to members outside of the research team and will never be 
presented or published in such a way to identify a single participant. The SPSS dataset generated 
by Qualtrics and used for the statistical analyses will be deidentified. 
 
Data will be saved in a password protected encrypted folder behind a university firewall that 
only the study team can access. Any data transfer will be done using encrypted, secure channels. 
 
Data will be destroyed 5 years after the end of data collection 
 
 
 

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