Finding My Way-UK: Promoting Positive Psychological Outcomes in People Living With and Beyond Curatively Treated Cancer: A Pilot Randomised Trial
Phase: NA
Conditions: Cancer Survivorship, Cancer, Neoplasms
Sponsor: Edge Hill University

 
 
 
 
 
 
Finding My Way-UK: Promoting Positive Psychological Outcomes in People Living 
with and Beyond Curatively Treated Cancer: Protocol for a Pilot Randomised Trial 
  
Document Type: Study Protocol with Statistical Analysis Plan  
Document Date: October 2025 
Kian Hughes1 (Principal Investigator), Professor Nicholas. J. Hulbert-Williams1, Professor 
Mark. J. Forshaw1, Professor Lisa Beatty2 
1Edge Hill University, UK, 2Flinders University, Australia 
 
 

Introduction 
Cancer survivorship  
Cancer, a leading cause of global mortality, constitutes a significant public health 
challenge, accounting for one in six deaths worldwide (World Health Organisation, 2022). 
Advancements in cancer detection and treatment have significantly increased survival rates in 
the UK, with 50% of individuals with cancer now surviving for 10+ years (Cancer Research 
UK, 2015). This increase in survivorship has brought more research attention to the 
psychological sequelae following a cancer diagnosis. Research findings highlight the 
prevalence of psychological comorbidities, with Kuhnt et al. (2016) suggesting that 39.4% of 
people living with and beyond cancer experience such comorbidities within 12 months post-
diagnosis, and a lifetime prevalence of any mental disorder of 56.3%. People living with and 
beyond cancer are susceptible to higher levels of psychological distress, depressive 
symptoms, anxiety, and a diminished quality of life (Gold et al., 2016). 
Benefit Finding 
Research indicates that a high percentage of people living with and beyond cancer 
report positive psychological changes following their diagnosis (Rinaldis et al., 2010). Terms 
such as benefit finding (Antoni et al., 2001), post-traumatic growth (Tedeschi & Calhoun, 
2004), and stress-related growth (Park et al., 1996) have all been used to describe these 
benefits. Although these concepts are often used interchangeably due to their conceptual 
overlap, important distinctions exist that warrant them being treated as separate constructs 
(Harding et al., 2014). For example, benefit finding is defined as the positive effects resulting 
from a trauma which may arise almost immediately following the experience (Helgeson et 
al., 2006). Whereas post-traumatic growth is defined as the positive psychological changes 
that occur after a struggle with a traumatic event (Tedeschi & Calhoun, 2004). Post-traumatic 
growth emphasises the process of struggle and adaptation, and typically takes longer to 

develop as it is contingent upon an active process of coping and change (Calhoun & 
Tedeschi, 1998). Despite the development of post-traumatic growth being contingent upon 
struggle and active change, it should not be confused with resilience. While the two are 
related, they are distinct constructs: resilience is about withstanding and recovering from 
trauma, whereas post-traumatic growth involves meaningful psychological change that arises 
from grappling with trauma (Elam & Taku, 2022). 
Benefit Finding and Associated Factors 
The relationships between benefit finding and psychological, sociodemographic, 
physical, and cancer-related factors are tenuous, with only a few factors consistently 
associated across various published studies. Systematic reviews have concluded that high 
benefit finding is frequently linked to higher levels of optimism, self-efficacy, psychological 
resilience, positive coping styles (e.g., positive reframing), marital status, and religious 
beliefs. However, associations between benefit finding and distress, depression, anxiety, 
social support, age at diagnosis, income, and cancer stage remain inconclusive (Harding et 
al., 2014; Pascoe & Edvardsson, 2013; Zhu et al., 2022). 
Lechner et al. (2006) suggested that these inconsistencies might be due to a 
curvilinear relationship between benefit finding and its associated factors. They proposed 
three distinct groups: low, intermediate, and high benefit finding. The low benefit finding 
group often experiences low distress because they do not perceive their cancer experience as 
a significant crisis, thus finding no need to seek benefits. The intermediate benefit finding 
group, characterised by a lack of use of adaptive coping strategies or reliance on others, tends 
to experience greater distress. In contrast, the high benefit finding group shows greater use of 
adaptive coping strategies and a reliance on others, leading to better psychosocial outcomes. 
Lechner et al. (2006) identified significant curvilinear relationships between benefit finding 
and various psychosocial outcomes, such as quality of life, positive affect, negative affect, 

depressive symptoms, and social disruption. Those with low or high benefit finding reported 
better quality of life and higher positive affect compared to those with intermediate benefit 
finding. Conversely, intermediate benefit finding was associated with higher negative affect, 
more depressive symptoms, and greater social disruption. Despite the issues surrounding 
generalisability, as the sample was solely comprised of women with breast cancer, these 
findings underscore the need to consider non-linear models to understand the complex 
relationships between BF and psychosocial outcomes. 
Promoting Benefit Finding in People Living With and Beyond Cancer 
Cognitive-Behavioural Therapy (CBT) based interventions are currently considered 
the gold standard in psychotherapy (David et al., 2018; Hulbert-Williams et al., 2018). This 
reputation is partly due to CBT's extensive evidence base, demonstrating its efficacy in 
reducing depression, anxiety, and distress, and improving quality of life in oncology 
populations (Zhang et al., 2022; Ye et al., 2018). However, a recent systematic review and 
meta-analysis by Li et al. (2020) found that other forms of therapy, such as mindfulness-
based interventions and expressive writing, might be equally effective in promoting positive 
psychology outcomes. Various psychological interventions aiming to improve benefit in 
individuals living with and beyond curatively treated cancer have been investigated. 
Interventions that have been tested include cognitive behavioural therapy (CBT)-based 
interventions such as Cognitive Behavioural Stress Management (CBSM; Antoni et al., 
2001), mindfulness-based therapies (Zernicke et al., 2014), expressive writing (Zhang et al., 
2023), and support groups (Van der Speck et al., 2017). Some researchers, however, have 
used the Post-Traumatic Growth Inventory to measure benefit finding, potentially 
confounding results. Despite this, Li et al. (2020) provided clear meta-analytic evidence that 
these conventional interventions are effective in promoting positive psychology outcomes, 

with intervention groups showing significant improvements compared to control groups, 
reflected by a medium effect size (Cohen’s d = .42).  
Despite these mixed findings, CBT continues to hold the 'gold standard' title. Hulbert-
Williams et al. (2018) argued that the extensive literature on CBT does not inherently imply 
its superiority. Instead, the prevalence of CBT studies might result from easier access to 
funding. This assertion is supported by evidence of the poor quality and ecological validity of 
several studies, which are often conducted in idealised conditions that do not reflect real-
world CBT settings. 
A systematic review investigating the efficacy of psychosocial interventions and their 
effective components in promoting benefit finding, specifically in a curatively treated cancer 
population, is warranted and is currently underway as the first study of my PhD.  
Barriers and Alternative Approaches 
Therapies and interventions such as those mentioned above traditionally adopt a face-
to-face design, which is prone to substantial barriers affecting uptake and adherence (Beatty 
et al., 2018). Other intervention modalities, such as telephone-based and web-based 
interventions, have demonstrated higher uptake compared to face-to-face interventions 
(Beatty et al., 2017; Brebach et al., 2016). The heightened intensity inherent in both group-
based and face-to-face interventions might inadvertently exclude individuals with elevated 
symptom burden, those residing in rural areas, or those facing socio-economic challenges 
(Beatty et al., 2022). Furthermore, despite enhanced levels of psychosocial support in urban 
areas, people living with and beyond cancer can still struggle to access it as demand often 
exceeds supply (Richards et al., 2016); access to these important interventions is difficult 
regardless of where the person resides. Moreover, both telephone-based and web-based 
interventions provide confidentiality to people living with and beyond cancer who are 

seeking mental health support, thus reducing perceived stigma and, in turn, improving uptake 
and adherence (Holland et al., 2010). 
Adapting and testing existing evidence-based interventions is a more practical and 
economical use of resources compared to designing entirely new and competing interventions 
(Hulbert-Williams et al., 2021). This is particularly important for web-based interventions, 
which represent a relatively new modality. A seminal systematic review reported that low 
adherence to web-based interventions was associated with poor web design, impersonal or 
overly exhaustive content, and a lack of human contact or feedback (Beatty & Binnion, 
2016). Additionally, web-based interventions often suffer from methodological issues such as 
non-randomised designs and small sample sizes (Vuori et al., 2023), which may raise 
questions regarding the validity of some studies. Therefore, rather than developing novel 
web-based interventions, further research should focus on optimising existing interventions to 
address these flaws and improve this modality.  
Finding My Way UK 
One of the most promising web-based interventions for people living with and beyond 
cancer is Finding My Way (Beatty et al., 2015). Finding My Way is a broad psychosocial 
intervention that integrates theoretical foundations from CBT, psychoeducation, and exercises 
from third-wave approaches such as mindfulness meditation. 
The efficacy of Finding My Way has been demonstrated through two randomised 
controlled trials. The initial single-site randomised controlled trial (Beatty et al., 2016) 
involved 60 participants with cancer diagnosed within the previous 6 months who were 
receiving treatment with curative intent. This study used an active, web-based control 
(information-only version of the same content) to compare against the intervention. 
Significant main effects for time were found across multiple outcomes including cancer-
specific distress, global quality of life, physical functioning, role functioning, social 

functioning, and anxious preoccupation. The intervention group showed significantly higher 
physical functioning at 3-month follow-up compared to controls (d = -0.52, p = 0.02), with 
trends approaching significance for cancer-specific distress post-intervention (p = 0.10) and 
global quality of life at 6-month follow-up (p = 0.10). Moderate between-group effect sizes 
also favoured the intervention for cancer-specific distress (d = 0.43) and global quality of life 
(d = -0.43) at 6-month follow-up, and anxious preoccupation post-intervention (d = 0.38) 
Building on these findings, a larger multisite randomised controlled trial conducted by 
Beatty et al. (2019) demonstrated the efficacy of Finding My Way in reducing cancer-specific 
distress and general distress in both the intervention group and the control participants. 
However, there were no significant between-group differences. Similar to the single-site 
randomised controlled trial, this lack of a significant between-group finding might be partly 
explained by the use of an attention control group, therefore attributable to an overlap in 
content rather than a lack of intervention efficacy. Despite this, the multisite randomised 
controlled trial found significantly higher emotional functioning in the experimental group 
and lower short-term health service utilisation, which might help reduce the aforementioned 
supply and demand barrier to psychosocial interventions. Collectively, these trials provide 
evidence for efficacy across different domains, with the single site-study showing benefits for 
physical functioning and quality of life, while the multisite study demonstrated advantages 
for emotional functioning and healthcare utilisation. 
A key strength of Finding My Way lies in its adaptable modules. These modules can 
be tailored to address specific types of cancer, participant age, and gender, ensuring the 
program is effective in achieving desired outcomes for each individual. This versatility 
distinguishes it from face-to-face interventions that might necessitate retraining for 
individuals leading the intervention. Therefore, further investigation into FMW, potential 
moderators, and its effects on different outcomes is warranted to facilitate a more finely tuned 

and tailored intervention. Demonstrating Finding My Way’s adaptability, Finding My Way-
Advanced (FMW-A; Beatty et al., 2021) tailors the intervention for women with metastatic 
breast cancer. Feedback from interviews directly informed revisions, optimising the content's 
relevance for this specific population. 
The adaptability of Finding My Way allows for easy transfer to different cultures, as 
evidenced by replication studies currently occurring worldwide. For example, Finding My 
Way has been adapted to align with the UK cancer care context (Hulbert-Williams et al., 
2021). Similar to the Australian version, Finding My Way-UK consists of six modules 
supplemented with expert testimony, testimonials from individuals living with and beyond 
cancer, interactive exercises and worksheets, assessment tools, and guided mindfulness 
meditation exercises. These modules guide individuals through the cancer experience and 
cover topics such as: (1) treatment and communication with treatment teams; (2) coping with 
cancer treatment side effects; (3) managing distress; (4) challenges to identity, body image, 
and sexuality; (5) social support and family concerns; and (6) issues that arise after treatment. 
To increase the intervention's relatability for individuals living with and beyond cancer in the 
UK, several changes have been made. Expert testimony now includes a broader range of 
professionals, such as psychologists, oncologists, surgeons, and managers of local cancer 
support centres with backgrounds in nursing, replacing Australian psychologists and 
oncologists. Testimonials of people living with and beyond cancer have been re-recorded 
with a UK-based cohort to enhance participants' affiliation and connectedness with the shared 
stories and experiences. Additionally, Australian-specific resources and treatment information 
have been replaced with their British equivalents and signposted accordingly. 
The FMW-UK trial conducted by Hulbert-Williams et al. (2021) primarily aimed to 
improve cancer-specific distress, with secondary outcomes being depression, quality of life, 
and healthcare utilisation. Preliminary quantitative findings from this study suggest that, in 

line with previous FMW trials (Beatty et al., 2019), engagement was good. Although 
participants in the intervention group showed improvements in cancer-specific distress and 
depression, the intervention effect was non-significant. The researchers suggest that this lack 
of significant findings may be due to low baseline distress levels. In support of this, 
participants with high baseline distress showed greater improvements, and there was more of 
an intervention effect in this group, but the sub-sample was too small to reach statistical 
significance. Qualitative feedback revealed some frustrations with the intervention. Namely, 
participants felt the intervention came too late in their cancer journey and would have 
preferred earlier access. Some also reported negative emotional responses, such as frustration 
or doubt, as the weekly module release schedule forced them to reflect on areas they did not 
initially perceive as issues. Despite these challenges, participants also perceived benefits from 
the intervention. They gained knowledge, understanding, and perspective, particularly in 
recognising underlying anxiety and stress. Survivor video testimonies within the intervention 
were reported as providing a sense of hope, optimism, and reassurance. 
Pilot Trial Rationale 
In response to participant feedback from the previous Finding My Way-UK trial 
(Hulbert-Williams et al., 2021), this study will modify the intervention delivery, trial 
duration, and recruitment strategy to enhance feasibility and engagement. Firstly, the 
intervention delivery will be adjusted to provide participants immediate access to all six 
modules, rather than the previous sequential weekly release. This modification aims to 
increase flexibility and user autonomy, allowing participants to engage with the content at 
their own pace. This change directly addresses prior feedback indicating that the weekly 
module release schedule was misaligned with participants’ needs, as some modules were 
perceived as arriving too late in their cancer journey. By offering unrestricted access, 
participants will be able to prioritise the content most relevant to their current concerns. 

Secondly, participant engagement patterns from previous Finding My Way trials in 
Australia and the UK have highlighted a decline in module completion rates after the third 
week (Hulbert-Williams et al., 2021; Rigg et al., 2024). Given this pattern, and in conjunction 
with the shift to full module access upon enrolment, the intervention duration will be reduced 
from six weeks to four weeks. This adjustment is intended to optimise adherence and 
retention while ensuring that participants derive maximum benefit within a more 
engagement-sustaining timeframe. Conducting a pilot trial will enable further evaluation of 
whether these modifications enhance adherence and retention outcomes. 
Furthermore, the previous Finding My Way-UK trial (Hulbert-Williams et al., 2021) 
recruited participants through multiple NHS hospital sites in North-West England and North 
Wales via the National Institute for Health Research (NIHR) Clinical Research Network 
(CRN) research nurses. However, this approach required approximately 18 months, 
highlighting significant logistical and time constraints. To streamline recruitment, this pilot 
trial will evaluate the feasibility of online recruitment strategies, including social media 
outreach and collaborations with cancer charities. Specifically, we will assess whether cancer 
charities can support recruitment efforts by disseminating study information through their 
newsletters. Testing these alternative recruitment strategies will provide insights into their 
efficiency, reach, and scalability, thereby informing the design of a future full-scale RCT. 
Finally, informed by qualitative feedback from the previous FMW-UK trial (Hulbert-
Williams et al., 2021), which highlighted reports of benefit finding, this study will include 
questionnaires assessing benefit finding and other related positive psychology constructs. 
While this pilot study is not powered for inferential statistical testing, these measures will 
provide preliminary data on participant burden and response variability. Additionally, the 
collected data will aid in estimating clinically meaningful effect sizes and refining sample 

size calculations for a subsequent full-scale RCT; this would represent the first test of the 
FMW programme targeting positive cancer-related psychological adjustment. 
Aims and Hypotheses 
The primary aim of this pilot trial is to evaluate the feasibility and acceptability of 
testing the Finding My Way-UK intervention using these new design features, and for these 
positive psychology outcome measures. This will be assessed by examining recruitment rates, 
retention rates, adherence to the intervention (i.e., the number of modules accessed and 
module completion rates), and participant engagement with study procedures.  
As a secondary aim, this pilot trial will conduct preliminary exploratory analyses to 
explore changes in benefit finding over time. Given the small sample size, the study is not 
powered to detect statistically significant effects. However, exploratory analyses will provide 
early signals of efficacy and trends in benefit finding and related psychosocial outcomes, 
including subjective well-being, post-traumatic growth, hope, resilience, and self-
management self-efficacy. The findings will inform the feasibility of measuring these 
constructs in a full-scale RCT and contribute to refining study procedures, including outcome 
measurement selection and timing. As there are a few comparable published studies on which 
to base an appropriate sample size calculation for a full trial, we will use the data from this 
pilot study to calculate indicative effect sizes in preparation for running a future RCT. 
Furthermore, this study will explore patterns of information seeking styles, assessing 
whether higher levels of this construct are associated with greater intervention engagement 
and greater benefit finding. Additionally, demographic characteristics will be examined to 
determine whether certain participant subgroups engage more readily with the intervention. 
Findings from this pilot trial will provide feasibility data and preliminary outcome trends 
guiding the design of a future full-scale RCT. 
Methods 

Study Design  
A single-blinded randomised controlled trial will be employed, compared with a 
treatment-as-usual control. 1:1 randomisation will occur at the patient level, where 
participants will be randomised into either the intervention group or the treatment-as-usual 
control. This trial will follow the CONSORT guidelines for pilot RCTs (Eldridge et al., 2016). 
Ethical approval has been sought and obtained from The Science Research Ethics Committee, 
Edge Hill University (ETH2425-0268). 
Setting  
This study will be conducted entirely online. The Finding My Way-UK intervention 
platform was originally developed for a previous study (Hulbert-Williams et al., 2021) using 
WordPress v5.7.1 (WordPress Foundation) and is hosted through Kinsta. Videos are uploaded 
to YouTube and embedded at relevant points on the website, ensuring they are not publicly 
listed to prevent unauthorised access. Access to the Finding My Way-UK website is restricted 
to participants with credentials (username and password) provided by our team, ensuring that 
only authorised users can view the content.  
Participants  
Inclusion Criteria 
Individuals will be eligible to participate if: (1) they have been diagnosed with any 
cancer within the last 12 months ;(2) their cancer is being (or, indeed, was) treated with 
curative intent; (3) they are aged 16 years and over; (4) they possess sufficient English 
proficiency to provide informed consent and use with the program; and, (5) they are able to 
access the internet and have access to an email address (or are willing to set an email address 
up with our help). 
Exclusion Criteria  

Individuals will be ineligible to participate if: (1) they have a diagnosis of cancer that 
is not being treated with curative intent (for example, metastatic, stage IV, or otherwise 
advanced-stage disease); and/or, (2) they have a severe comorbidity that may hinder their 
ability to participate fully (such as being unable to complete study procedures or provide 
informed consent). 
Withdrawal Criteria 
Participants may withdraw from the trial at any time during the intervention by 
informing the research team via email or phone. Participants who withdraw via phone, will be 
asked for their reasons for withdrawal, those participants who withdraw via email will receive 
a follow-up phone call regarding their reasons for withdrawal. If a participant is willing to 
share them, the reasons for withdrawal will be documented. Additionally, individuals will be 
asked if they consent to any existing data to be included in the final analysis, if consent is not 
obtained, their data and any documentation related to their involvement will be permanently 
erased from the database.  
Recruitment 
We will employ a multifaceted recruitment strategy to maximise reach and to recruit a 
diverse range of people living with and beyond cancer. We will approach cancer support 
groups and charities, offering their members the opportunity to participate in the study. If the 
charities allow and where it is feasible, in-person recruitment may take place. Study 
advertisements will be posted on social media platforms such as X/Twitter, Reddit, and Meta 
(Facebook/Instagram). Additionally, participants who consented to being re-contacted from a 
previous study in this programme of work will be reapproached for potential participation if 
they meet all other inclusion criteria.  
Procedure  

Upon expressing interest in the study, potential participants will receive a detailed 
information pack via email, explaining the research goals and procedures, and providing the 
research team's contact information for any queries. The information pack will include a link 
to the study recruitment website, which is hosted on the Qualtrics survey platform. This 
website includes the full trial information sheet and a web-based consent form. Once 
participants provide informed consent, they will be automatically directed to the baseline 
survey, also hosted within Qualtrics, with the flexibility to complete the survey in multiple 
sessions. 
Upon completion of the baseline questionnaires, a research team member will 
randomly assign participants to either the intervention or control group using Microsoft 
Excel, ensuring equal distribution across groups. Participants in the intervention group will 
receive an email with login credentials for the Finding My Way UK website, while the 
control group will receive a PDF information pack listing national resources for 
psychological support, with an option for a mailed printed copy. 
Intervention group participants will be encouraged to first access the FMW-UK 
website within one week, with reminder emails sent to those who have not logged in. The 
platform allows full access to all modules upon login, enabling participants to complete them 
at their own pace. Participants will be encouraged to log on at least weekly, completing a new 
module on each visit, though in reality they are able to engage as often as they choose. They 
will also receive access to a booster module one month after completing the main program. 
To encourage engagement with the intervention and the questionnaires, a multi-stage 
process will be in place to remind participants to complete follow-up questionnaires. 
Participants will receive an email at the time that follow-up questionnaires are due for 
completion; participants who do not complete the questionnaires within one week of the 
initial email will receive a follow-up reminder via an automated text messaging service. 

Finally, if participants have not completed the questionnaires within two-weeks of the initial 
email, (one week after the automated text message reminder), they will receive a phone call 
reminder (via an automated or professional calling service). Questionnaires will be 
administered at baseline, at the fourth week (post-intervention), and at a three-month follow 
up.  At the conclusion of the study, participants will be sent a debrief sheet, and all 
participants will have up to six months from this point in which they can freely use FMW-
UK.  
Measures 
Study Outcomes 
At the baseline assessment, participants will be asked to provide demographic 
information including age, sex/gender, ethnicity, sexual identity, marital status, employment 
status, level of education attained, household income, and postcode. Additionally, medical 
data relevant to their cancer diagnosis will be collected, including cancer type, diagnosis date, 
and treatments received. 
Primary Outcome  
The primary outcome is the feasibility and acceptability of the intervention. 
Feasibility will be assessed through recruitment rates (number of participants enrolled each 
month), program engagement (number of intervention modules accessed and completed by 
each participant, supplemented by completion rates of exercises and worksheets), and 
research attrition (proportion of participants completing the post-intervention survey and the 
three-month follow-up). Acceptability will be evaluated using both quantitative and 
qualitative methods. At baseline, participants will be asked an open-ended question about 
their expectations for the intervention, specifically what they hope will change or improve. At 
follow-up, participants will rate the extent to which the intervention met these expectations 
(quantitative acceptability) and provide free-text responses describing any unexpected 

changes or impacts (qualitative acceptability). Free-text responses will be subjected to basic 
thematic analysis to identify common themes relating to participant experience and 
acceptability.  
Secondary Outcomes 
Benefit Finding. This variable will be assessed using The Benefit Finding Scale 
(BFS; Antoni et al., 2001), a 17-item measure in which participants respond on a 5-point 
Likert scale, where responses range from 1 (not at all) to 5 (extremely). The BFS was 
originally developed to investigate benefit finding in individuals living with and beyond 
breast cancer, therefore, the original stem “having had breast cancer…” will be adapted to 
“having had cancer…” to ensure it is applicable for individuals diagnosed with all types of 
cancer. The BFS is associated with excellent internal consistency reliability (α=.95; Antoni et 
al., 2001). The range of possible scores is 17-85; with higher scores indicating higher levels 
of benefit finding. 
Subjective Well-Being. Subjective well-being will be examined using the 
Satisfaction with Life Scale (Diener et al., 1985), a five-item questionnaire appraised on a 7-
point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). This scale had 
demonstrated high internal reliability with Cronbach’s alpha ranging from ⍺ = .82 - .91 
(Diener et al., 1985; Proctor et al., 2023). Total scores higher than 25 indicate high 
satisfaction with life in all areas, scores ranging from 20-24 indicate a general satisfaction 
with life, and scores lower than 20 indicate dissatisfaction with at least one area in life.  
Hope. Hope will be assessed using the Herth Hope Index (HHI; Herth, 1992), a 12-
item scale designed to measure levels of hope in individuals experiencing chronic illness, 
including cancer. Participants respond on a 4-point Likert scale ranging from 1 (strongly 
disagree) to 4 (strongly agree). The HHI captures three dimensions of hope: temporality and 
future, positive readiness and expectancy, and interconnectedness. The scale has 

demonstrated excellent internal reliability, with Cronbach’s alpha reported as ⍺ = 0.97 (Herth, 
1992) and stability over time with a test-retest correlation of 0.91. Total scores range from 12 
to 48, with higher scores indicating greater levels of hope. 
Resilience. Resilience will be assessed using the 10-item Connor-Davidson 
Resilience Scale (CD-RISC-10; Campbell-Sills & Stein, 2007), an abbreviated version of the 
original 25-item scale developed by Connor and Davidson (2003). This abbreviated measure 
evaluates an individual’s capacity to adapt to adversity. Participants respond to each item on a 
5-point Likert scale ranging from 0 (Not true at all) to 4 (True nearly all the time). The CD-
RISC-10 has demonstrated excellent internal reliability, with Cronbach’s alpha reported as ⍺ 
= 0.85 (Campbell-Sills & Stein, 2007). Total scores range from 0 to 40, with higher scores 
indicating greater resilience.  
Exploratory Outcomes 
 Given the exploratory nature of this pilot study, self-management self-efficacy and 
information-seeking styles will be examined to assess their potential role in the intervention. 
It is currently uncertain whether these constructs will be directly affected by Finding My 
Way-UK (i.e. as an intervention outcome) or whether they will function as moderators in the 
relationship between the intervention and benefit finding (the primary outcome in a future 
full-scale trial). Due to this uncertainty, these variables will be examined as exploratory 
outcomes, allowing for flexibility in their interpretation based on emerging data. 
Self-Management Self-Efficacy. Self-management self-efficacy will be assessed 
using the Self-Efficacy for Managing Chronic Disease 6-item Scale (Lorig et al., 2001), a 6-
item scale designed to measure confidence in managing the consequences of chronic disease 
and its treatment. Participants rate their confidence on a 10-point Likert scale ranging from 1 
(not at all confident) to 10 (totally confident). The scale has demonstrated excellent internal 

reliability, with Cronbach’s alpha reported as ⍺ = 0.91 (Lorig et al., 2001). The score of the 
scale is the mean of the six items, with higher scores indicating higher self-efficacy. 
Information Seeking Styles. The Participants’ information-seeking styles will be 
assessed using the Cancer Information-Seeking Preferences (CISP) questionnaire (Loiselle, 
2019), a single-item measure designed to categorise how individuals engage with cancer-
related information. The CISP presents participants with the question: “Which of the 
following statements best describes why and how you go about getting information about 
your cancer?” Respondents select one of five predefined statements: (i) “I seek as much 
cancer information as possible on my own”; (ii) “I seek more cancer information to better 
take care of myself”; (iii) “I seek cancer information from others diagnosed with cancer to 
compare with my own situation”; (iv) “I do not seek much cancer information on my own - I 
would rather focus on other things in my life”; or (v) “Cancer is stressful enough; I do not 
seek cancer information.” Based on their response, participants are classified into one of five 
information-seeking typologies: intense seekers, complementary seekers, fortuitous seekers, 
minimal/uninterested seekers, or guarded avoiders. 
Sample Size  
The sample size for this pilot trial has been determined based on the recommendations of 
Whitehead et al. (2016), which suggests that pilot trials should aim to estimate the standard 
deviation of the primary outcome with sufficient precision to optimise the sample size for the 
future, full-scale RCT. To the best of our knowledge, no directly comparable studies have 
examined benefit finding as the primary outcome in a similar online psychosocial 
intervention. Given this, the effect size for the main trial was inferred from previous online 
Cognitive-Behavioural Stress Management (CBSM) interventions, which have reported 
effect sizes ranging from 0.13 to 0.46 (Antoni et al., 2001; Cruess et al., 2000; McGregor et 
al., 2004; St Fleur et al., 2024; Walsh et al., 2022). Based on these estimates, an effect size of 

0.35 was selected for the main trial sample size calculation. Following the recommendations 
of Whitehead et al. (2016) for small-to-medium effect sizes, a pilot study sample size of 20-
25 participants per arm would typically be sufficient. However, since this effect size was 
inferred from CBSM interventions, additional participants are needed to ensure a more 
precise estimate of the standard deviation for the main trial. Therefore, to enhance precision 
while maintaining feasibility, a total of 60 participants (30 per arm) will be recruited for this 
trial. This sample size is expected to provide a reliable estimate of the standard deviation to 
refine the main trial’s sample size calculation while also allowing for the assessment of trial 
feasibility, recruitment, and retention rates.  
Statistical Analysis 
Statistical analyses will be conducted using R (R Foundation for Statistical 
Computing), with IBM SPSS used for supplementary analyses as needed. Given the pilot 
nature of this study, the analyses will focus on descriptive statistics, feasibility outcomes, 
exploratory trends, and exploratory effect sizes, rather than hypothesis-driven inferential 
testing. The primary aim of the statistical analysis is to assess the feasibility and acceptability 
of the Finding My Way-UK intervention by evaluating recruitment rates, retention rates, 
adherence, and engagement.  
Initially, data cleaning will be performed to ensure all data values are valid, plausible, 
and free of inconsistencies. Erroneous data entries will be removed, and missing data will be 
handled using appropriate methods. The type of missing data will be assessed to determine 
whether it is Missing Completely at Random (MCAR), Missing at Random (MAR), or 
Missing Not at Random (MNAR). Little’s MCAR test will be used to determine whether the 
data are MCAR; non-significant results here would suggest the data is MCAR. If the result is 
significant, logistic regression will be used to test whether the data is MAR by creating binary 
indicators for missingness and modelling the probability of missing data based on observed 

variables. Significant predictors here would suggest the data is MAR. If non-significant, the 
data will be considered MNAR, and sensitivity analyses will be performed using different 
assumptions about the missing data. Significant variations in results would indicate MNAR. 
If the data is identified as MCAR or MAR, missing data will be handled through multiple 
imputation techniques.  
Descriptive statistics, including means, standard deviations, frequencies, and 
percentages, will be used to summarise key feasibility outcomes. Recruitment rates will be 
reported as the number of participants enrolled per month and the effectiveness of different 
recruitment sources. Retention rates will be examined at each follow-up time point to assess 
participant engagement over time. Adherence to the intervention will be assessed by 
summarising the number of modules accessed, percentage of modules completed, and 
frequency of logins. Baseline comparisons between completers and dropouts will be 
conducted using independent t-tests and chi-square tests to explore patterns of attrition and 
potential feasibility concerns. Similarly, baseline comparisons between the intervention and 
control groups will be performed to assess demographic and clinical equivalence. 
To summarise changes over time, Linear Mixed Effects Models (LMEM) will be 
employed to estimate means and standard errors for descriptive purposes, maximising the use 
of available data by accounting for participant-level missingness. However, as this study is 
not powered to detect statistically significant differences, no formal inferential statistical tests 
will be performed. Instead, pre-post between group effect sizes (Cohen’s d) will be reported 
to provide an indication of potential intervention effects. Additionally, Reliable Change 
Indices (RCI) will be calculated to determine the proportion of participants who demonstrate 
clinically meaningful change in benefit finding and related psychosocial outcomes. This 
approach will provide preliminary signals of efficacy while maintaining a primary focus on 
feasibility and engagement.  

Data Sharing 
 
In line with our commitment to open science practices, the study will be registered on 
the Open Science Framework prior to its commencement. Upon final publication of the study 
findings, anonymised datasets will be made publicly available on the Open Science 
Framework. The shared dataset will primarily include variables related to feasibility 
outcomes, including recruitment rates, retention rates, adherence metrics (e.g., number of 
modules accessed, percentage of modules completed), engagement data (e.g., login 
frequency, time spent on the platform), and secondary outcome psychometrics. Participants 
will be explicitly asked to consent to the sharing of their anonymised data with the research 
community and will be removed from the shared dataset if they do not consent. The consent 
process will ensure that participants are fully informed about the nature of data sharing, 
including the potential benefits and risks. The published data will be accompanied by 
metadata and documentation to facilitate reuse by other researchers. This will include a data 
dictionary explaining each variable in the dataset, a detailed codebook describing the 
measures used and how composite scores were calculated, documentation on data cleaning 
and preparation processes, and R scripts used for data analysis. Given that this is a feasibility-
focused pilot study, the dataset will be positioned as a resource for refining recruitment, 
retention, and engagement strategies for future trials, rather than drawing definitive 
conclusions about intervention efficacy.  
Timeline 
We will seek to obtain ethical approval by August 2025. Upon receiving approval, 
recruitment will commence, with the aim of enrolling all participants within four months, 
from August to December 2025. Participants will complete a two-week onboarding process, 
followed by the four-week intervention, with final data collection occurring at the three-
month follow-up. Accordingly, we anticipate completing all data collection and commencing 

data cleaning and preliminary analysis by May 2026. We aim to report the findings from the 
study in Autumn 2026. 
Discussion 
This pilot trial aims to assess the feasibility of using the Finding My Way-UK 
intervention to promote benefit finding and positive psychological wellbeing among 
individuals living with and beyond curatively treated cancer. Specifically, it will evaluate 
recruitment rates, retention rates, intervention adherence, and participant engagement, all of 
which are critical for determining whether a future, full-scale RCT is viable. In addition, 
exploratory analysis will provide preliminary insights into potential changes in benefit 
finding and related psychosocial outcomes, helping to refine hypotheses and study procedures 
for future research.  By assessing these feasibility outcomes, this study will contribute to the 
growing body of literature on web-based interventions for oncology populations, an area 
where further research has been encouraged (Beatty et al., 2019). 
Benefit finding has been shown to be significantly related to lower depression and 
higher positive well-being (Helgeson et al., 2006). There is also a significant positive 
correlation between benefit finding and psychological flexibility, suggesting it is a key 
component of psychological adjustment following a cancer diagnosis (Hulbert-Williams & 
Storey, 2016). Traditional interventions, such as Cognitive-Behavioural Stress Management 
(Antoni et al., 2001; Penedo et al., 2006) and Expressive Writing (Zhang et al., 2023), have 
demonstrated efficacy in promoting benefit finding in individuals living with and beyond 
cancer. However, these face-to-face interventions often face barriers to uptake and adherence 
due to their heightened intensity, which might exclude individuals with elevated symptom 
burden, those residing in rural areas, or those facing socio-economic challenges (Beatty et al., 
2022). Even in urban areas with enhanced levels of psychosocial support, people living with 

and beyond cancer can struggle to access it due to the high demand often exceeding supply 
(Richards et al., 2016). 
Web-based interventions such as Finding My Way UK offer a promising alternative 
by providing flexible, accessible, and confidential support that can overcome many barriers 
associated with traditional interventions. By delivering content online, these interventions can 
reach a wider audience, including those who may not have access to in-person support. 
Despite this potential, no studies have specifically measured the efficacy of web-based 
interventions in promoting benefit finding among people living with and beyond cancer. 
This pilot trial will contribute to addressing this gap by first assessing the feasibility 
of online recruitment and recruitment via cancer charities, as well as patterns of adherence 
and engagement with the intervention. These findings will provide critical insights into 
whether a full-scale trial using such recruitment strategies is methodologically viable. 
Secondly, the results from this study will inform the design and implementation of a future 
full-scale RCT evaluating the effectiveness of Finding My Way-UK in promoting benefit 
finding and other psychosocial outcomes in individuals living with and beyond cancer. 
Moreover, insights into participant experiences will contribute to ongoing efforts to develop 
accessible, evidence-based digital health interventions for individuals living with and beyond 
cancer. 
 
 
 

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