Enhancing Management of Patient Reported Outcomes With Emotion Regulation (EMPOWER)
Phase: NA
Conditions: Cancer Survivor
Sponsor: Wake Forest University Health Sciences

ENHANCING MANAGEMENT OF PATIENT REPORTED OUTCOMES WITH 
EMOTION REGULATION (EMPOWER) 
Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
CCCWFU 99516 
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Principal Investigator: 
 
John M. Salsman, Ph.D. 
Director of Clinical Research in Adolescent and 
Young Adult Oncology 
Wake Forest School of Medicine 
 
Co-Investigator(s):  
 
Lynne Wagner, Ph.D. 
 
 
 
 
 
Professor 
 
 
 
 
 
Department of Social Sciences and Health Policy 
 
 
 
 
 
Wake Forest School of Medicine 
 
 
 
 
 
 
 
Judith Moskowitz, Ph.D. 
Professor 
Department of Medical Social Sciences 
Northwestern University Feinberg School of Medicine 
 
Biostatistician: 
 
 
Janet A. Tooze 
Comprehensive Cancer Center of Wake Forest 
University 
 
 
Study Coordinator: 
 
Denisha Little-Greene, MMS 
 
Study Recruiter: 
 
 
 
 
Protocol Editor: 
 
 
Denisha Little-Greene, MMS 
 
 
 
Participating Institution(s): 
Northwestern University Feinberg School of Medicine 
 
 
Version Date: 
 
 
03.14.2016 
Amended: 
 
 
 
12.15.2016 
 
 
 
 
 
6.26.2017 
 
 
 
 
 
6.30.2017 
 
 
 
 
 
12.29.17 
 
NCT02832154 
 
Confidential 
 
 

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Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
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Table of Contents 
 
 
1.0 
Introduction and Background .......................................................................................... 3 
2.0 
Objectives ...................................................................................................................... 4 
3.0 
Study Population ............................................................................................................ 4 
4.0 
Methods…………………………………………………………………………………….……..5 
5.0 
Outcome Measures ........................................................................................................ 7 
6.0 
Analytic Plan................................................................................................................... 8 
7.0 
Data Managment ............................................................................................................ 9 
8.0 
Confidentiality and Privacy .......................................................................................... 100 
9.0 
Data Safety and Monitoring ......................................................................................... 100 
10.0 
Reporting of Unanticipated Problems, Adverse Events or Deviations…...……………….11 
 
 
 
 
 
 
 
 
 

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1.0 
Background, Rationale and Context 
 
In preparation for a full-scale randomized clinical trial (RCT) of an internet-
delivered positive affect (PA) intervention for young adult cancer survivors, the 
EMPOWER study will collect pilot data on the feasibility and acceptability of a 
theoretically-driven, empirically-grounded, individual intervention to promote 
positive affect (PA).1 An innovative, intervention for HIV patients (Lessons in 
Linking Affect and Coping: LILAC) will be adapted for use with young adult cancer 
survivors. This intervention teaches eight cognitive and behavioral skills to 
enhance PA, which may broaden and enhance an individual’s resources for 
adapting to stressful events.2 Feasibility and acceptability data will be collected 
with reports of daily positive and negative affect, general and domain-specific 
health-related quality of life, psychological well-being, and health behaviors. This 
will provide data to support further intervention studies, including an R01 proposal 
of a full-scale randomized clinical trial. 
 
The number of people surviving cancer and even thriving with cancer grows 
annually.  Historically, positive adjustment and growth in cancer has received little 
attention compared to impairment, disability and psychosocial morbidity.  Today, 
this important area of research is demonstrating increased growth and interest 
3,4,5,6.7 with significant potential applications for cancer control and population 
sciences.  8   
 
A number of different psychosocial interventions have proven effective with cancer 
patients. The majority of these interventions are group-based and focus on 
alleviating the psychosocial burden of cancer by reducing or managing 
psychological distress.9-12 Few interventions explicitly target PA. However, such 
interventions show promise for not only reducing the negative psychosocial impact 
of cancer and its treatment but for enhancing its positive psychosocial impact as 
well.13-16 A potential limiting factor of these PA interventions is that they are 
primarily group interventions targeted towards advanced cancer patients. Little is 
known about individualized PA interventions for cancer patients or survivors, but 
emerging and innovative research of a PA intervention for newly diagnosed HIV 
patients17-18 may have applications for cancer patients. Guided by Fredrickson’s 
broaden-and-build theory of positive emotions22 and funded by the NIMH 
(R01MH084723), Moskowitz’s RCT of a 5-session evidence-based intervention is 
designed to teach skills for increasing the frequency and intensity of daily PA and 
to examine the intervention’s effects on subsequent psychological well-being, 
health behaviors, and physical health after diagnosis with HIV. Patients with HIV 
experience similar negative and positive psychosocial sequelae as patients with 
cancer.19-22 This manualized web-based and home-delivered intervention (LILAC) 
focused explicitly on increasing positive affect, and has shown good feasibility, 
acceptability, and preliminary efficacy in people coping with significant health-
related stress 23,24 including women with advanced breast cancer. Thus, 
Moskowitz’ empirically-based PA intervention research may have beneficial 

ENHANCING MANAGEMENT OF PATIENT REPORTED OUTCOMES WITH 
EMOTION REGULATION (EMPOWER) 
Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
CCCWFU 99516 
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parallels to inform this current project. In this application, we propose to build on 
this prior work to adapt the LILAC intervention to improve health-related quality of 
life (HRQOL) for young adult survivors of cancer. 
2.0 
Objectives 
 
2.1 Primary Objectives 
 
2.1.1  To adapt an individualized positive affect intervention that was 
developed for newly diagnosed HIV patients to use with young adult 
cancer survivors. 
 
2.1.2  To pilot test the positive affect intervention with young adult cancer 
survivors to determine its feasibility and acceptability.   
 
2.2 Secondary Objective 
 
2.2.1  To describe health related quality of life, psychological well-being, and 
health behaviors in young adult cancer survivors 
3.0 
Study Population 
 
60 young adult cancer survivors will be recruited through the Comprehensive 
Cancer Center of Wake Forest University (N=40) and the Robert H. Lurie 
Comprehensive Cancer Center of Northwestern University (N=20).   
 
All patients will meet the following inclusion criteria: 
 Able to read and understand English 
 Past history of a cancer diagnosis (excluding basal cell skin carcinoma) 
 15 to 39 years of age at diagnosis of first cancer and currently between 
the ages of 18-39 
 Within 0-5 years post-active treatment for initial diagnosis or recurrence 
 Wireless internet connection or a home computer that is connected to the 
internet 
 
Exclusion criteria: 
 Currently receiving palliative or hospice care 
 Significant psychiatric history 
 
We anticipate a large percentage of our target sample to have active 
mywakehealth accounts, and we plan to use the secure MyChart portal to send 
study information to potentially eligible patients to gauge their interest in the 
study and communicate as necessary with consented participants.   

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Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
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4.0 
Methods 
 
4.1 
Registration Procedures 
All patients entered on any CCCWFU trial, whether treatment, companion, 
or cancer control trial, must be registered with the CCCWFU Protocol 
Registrar or entered into ORIS Screening Log within 24 hours of Informed 
Consent. Patients must be registered prior to the initiation of treatment.   
 
You must perform the following steps in order to ensure prompt 
registration of your patient: 
 
1. Complete the Eligibility Checklist (Appendix B) 
2. Complete the Protocol Registration Form (Appendix A) 
3. Alert the Cancer Center registrar by phone, and then send the signed 
Informed Consent Form, Eligibility Checklist and Protocol Registration 
Form to the registrar, either by fax or e-mail. 
 
           
*Protocol Registration is open from 8:30 AM - 4:00 PM, Monday-
Friday. 
 
4. Fax/e-mail ALL eligibility source documents with registration. Patients 
will not be registered without all required supporting documents. 
Note: If labs were performed at an outside institution, provide a printout of 
the results. Ensure that the most recent lab values are sent. 
 
To complete the registration process, the Registrar will:   
 
 assign a patient study number 
 register the patient on the study 
 
4.2 Study Design 
Patients will be recruited through RHLCCC and CCCWFU. Study staff will work 
with the Wake Forest Health Sciences Comprehensive Cancer Center’s Cancer 
Informatics Group to identify potential CCCWFU patients from the electronic 
medical record and/or cancer registry. Potentially eligible patients will be recruited 
through a direct in-clinic approach as well as mailed letters followed by a phone 
call by a study team member. The recruitment call will be followed by an email 

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EMOTION REGULATION (EMPOWER) 
Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
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outlining the details discussed during the phone call and instructions on next steps 
and a link to the screening questionnaire (Recruitment Email Script).  IRB-
approved study flyers will be placed in the community at large, the Comprehensive 
Cancer Center at Wake Forest Baptist Medical Center and other strategic locations 
associated with Wake Forest Baptist Medical Center. IRB-approved study flyers 
may also be disseminated through email blasts or postings on websites of local 
cancer support agencies such as Cancer Services.  
 
Patients will then be screened for eligibility using an online screening questionnaire 
on Qualtrics.  Those that are ineligible will be displayed a message stating that 
he/she was ineligible. Patients who are eligible based will be navigated to the 
consent form and initial study questionnaire on Qualtrics, an online data collection 
tool that enables researchers to create study-specific websites for capturing patient 
data securely online. The instrument library includes self-report batteries or profiles 
from Patient-Reported Outcomes Measurement Information System (PROMIS) 
and the NIH Toolbox which include many of the measures that will be used in the 
study.  At completion of the baseline questionnaire, all patients will be given access 
to the PA intervention.  
The PA intervention is a 5 session online intervention that teaches 8 skills for 
increasing the frequency of positive emotions: 1) noting daily positive events25-28 
2) capitalizing on or savoring positive events;29-30 3) gratitude;31-33 4) 
mindfulness;34-37 5) positive reappraisal;38-45 6) focusing on personal strengths;42-
43,49-52 7) setting and working toward attainable goals;53-54,55-58and 8) small acts of 
kindness.59-63 The skills are presented over the course of 5 weeks. A week will 
consist of 1-2 days of didactic material and several days of brief, real-life skills 
practice and reporting, with each day’s “home practice” taking approximately 20-
30 minutes to complete. Patients cannot skip ahead, but they can return to old 
lessons or exercises if they choose. Most exercises are done in a “diary” format in 
which patients’ past responses are displayed next to their new ones, so that every 
time the patient visits that exercise they see their growing list of past positive 
experiences. Patients will be permitted up to 8 weeks to complete this self-guided 
intervention to account for normal interruptions and unexpected delays in life. 
 
Acceptability Interview. Research staff will conduct a 30-minute audio-recorded, 
post-intervention phone interview with all patients approximately one week after 
the intervention is complete to gather acceptability data.  The semi-structured 
interview includes questions where participants rank the skill sessions in terms of 
favorite topics, the likelihood of referral to others (a friend or someone diagnosed 
with cancer) and the likelihood of practicing learned skills.  There is also a section 
with open-ended questions, including questions about participant experiences with 
use of the website and home practice exercises 
Patient Incentives. Each patient will be paid $10 for each completed assessment 
for a maximum of $30. Patients will be paid in full upon completion of the study via 
virtual gift card. 

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Fidelity Monitoring. Whether patients understood and remember the intervention 
content will be assessed via multiple-choice "quiz" questions within each lesson. If 
patients are not able to answer a question, it will trigger a review of the relevant 
material (patients can also choose to review past material at any time). How 
frequently patients visit the website and how many times they complete the daily 
practice exercises for each skill will also be recorded. This information can be used 
in "dose-response" analyses to determine whether greater exposure to the 
exercises leads to stronger intervention effects. Patient progress will be monitored 
during the study and patients who appear to be having trouble or are disengaging 
from the intervention will be contacted. Our experience indicates that even very 
brief human contact can increase patients' commitment to the intervention. 
Patients will receive an email or phone call from a study staff member if they fail to 
visit the website more than 3 days in a week. Patients who cannot be reached or 
who do not resume visiting the website but also don't ask to leave the study will be 
re-contacted once per week for 3 weeks. After that they will be counted as non-
completers, though we will still try to contact them to obtain post-intervention 
measures. Patients who do not reach the final lesson at the end of 8 weeks will 
also be considered non-completers and will be asked to take the post-intervention 
measures at that time. 
5.0 
Study Outcomes and Study Measures 
 
Patients will complete self-report questionnaires at baseline (pre-test), 
approximately 8 weeks after baseline (post-test), then at 12 weeks (follow-up) for 
a total of 3 assessments, each lasting approximately 25-30 minutes. All 
measures will be completed from home via patients’ personal computers. In 
addition to the measures listed below, key demographics will be assessed 
(race/ethnicity, education, household income, insurance status), cancer type, 
time since diagnosis, type of treatment, and time since treatment (See Appendix 
3 for a complete list of measures). 
 
5.1  
Primary Outcomes 
 
The primary outcomes for this study are measures of feasibility – accrual, 
refusal, retention, adherence and acceptability.  
 
5.2 
Secondary Outcomes 
 
5.2.1  Health-Related Quality of Life (HRQOL). The PROMIS global health items 
will be used to assess overall HRQOL,68 and the PROMIS-2969-70 to assess 
domain-specific aspects of HRQOL. The PROMIS Global scale consists of 
10 items that assess general health, including overall physical and mental 
health. The PROMIS-29 consists of 29 items that assess physical 
functioning, anxiety, depression, fatigue, sleep disturbance, social 

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Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
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functioning, pain interference, and pain intensity. These PROMIS measures 
will be supplemented with additional items from the PROMIS physical 
function short form71 and the PROMIS anger short form.72 The 4 PROMIS 
items for depression in this measure do not assess suicidality. 
 
5.2.2 Psychological well-being. Psychological well-being will be assessed with 
NIH Toolbox short forms for positive affect, life satisfaction, and meaning 
and purpose.73 In addition, the NIH PROMIS General Self-Efficacy short 
form74 will be administered as it is a closely related construct to 
psychological well-being and positively associated with better patient-
reported outcomes. 
5.2.3 Health Behaviors. Healthy behaviors often associated with enhanced 
coping and better adjustment will be assessed.75 Physical health behaviors 
will include: diet,76 exercise,77 alcohol consumption,76 and cigarette 
smoking.76 
6.0 
Statistical Considerations 
Wake Forest School of Medicine will be the Coordinating Center for the study 
and will conduct all data analysis. 
 
6.1 
Analysis of Primary Objective 
Accrual will be estimated as the number of patients accrued divided by the number 
of months of accrual. A 95% confidence interval for the monthly accrual rate will 
be calculated based on the Poisson distribution. The refusal rate will be estimated 
as the number of patients who refuse to participate divided by the number eligible. 
Retention will be primarily defined as the proportion of patients who provide 8 week 
and 12 week data. Patients who discontinue the intervention (refuse phone calls) 
but complete the outcome assessments will be counted in the numerator for 
calculating retention. Retention estimates will be calculated overall and by site. 
Adherence to the intervention will be calculated as the number of intervention 
sessions completed, the frequency of completing exercises, and number of 
website visits. We will calculate and report the mean adherence across all 
individuals as well as the proportion of patients who completed three or more 
sessions. Several measures will be used to quantify acceptability, including 
quantitative measures and interview. Means and the proportion responding 
affirmatively to the highest two responses for each question will be combined and 
exact 95% CIs will be calculated for these estimates. In addition, Dr. Salsman and 
Dr. Moskowitz will review open-ended (written) feedback and audio-recordings of 
phone interviews to identify meta-themes and determine saturation of concepts.78  
 
 
 

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6.2  
Analysis of Secondary Objective 
 
Quantitative outcomes will be assessed by a covariance pattern model for 
repeated measures to examine change in PA and PROMIS scores over time. 
 
6.2 
Power and Sample Size 
 
While this is a pilot study and we will not be testing the efficacy of the intervention, 
we do want to be able to estimate feasibility, acceptability, and changes in PA and 
PROMIS scores with a fair degree of precision. With a total of 60 patients we can 
estimate confidence intervals around means to within ±0.25 SD, and proportions 
within ±12.7%, with 95% confidence. Assuming that 20% of the patients may drop 
out, we could estimate confidence intervals for means within ±0.28 SD and 
proportions within ±14.1% for measures evaluated at the end of the study. 
Furthermore, the sample size of N=60 should permit us to achieve data saturation, 
or the point at which successive information serves only to replicate previous 
content themes and no new information is obtained.79 Past research reveals that 
saturation often occurs within the first 12 interviews.78  
 
6.3 
Estimated Accrual Rate 
 
It is anticipated that 3.2 patients a month will be accrued to this trial, meeting the 
target of 60 in 19 months. To date, we have recruited 18 patients in 6 months at 
the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. 
 
6.4 
Estimated Study Length 
 
Patients will complete their participation in 12 weeks, for an estimated study length 
of 15 months.  
 
 
7.0 
Data Management 
 
The web intervention is delivered via a customized website built on Moodle, a 
courseware platform that is used by schools and universities worldwide. Moodle 
allows delivery of text or video instruction as well as interactive activities such as 
journals and adaptive quizzes. Moodle is recognized as secure and well-tested 
software, and HIPAA-compliant. All communications with the website will use 
industry-standard TLS/SSL encryption. Another layer of security will be provided 
by avoiding any use of personally identifiable information, medical information, or 
other sensitive information in the context of the intervention. Patients' Moodle 
accounts will not be linked to their real name or email address. The design of our 
intervention website has been refined through a number of iterations based on 
user testing and feedback from study patients (e.g., simplifying the interface, 

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clearly labeling new material and exercises). We have also ensured that material 
is viewable on handheld, tablet, and laptop devices. 
 
Informed consent document 
ORIS 
Protocol registration form 
ORIS 
Pre-, post- and follow-up test 
Questionnaires (Qualtrics) 
Qualtrics 
Intervention Sessions 1-5 
Moodle 
Phone Interview 
Audio-recorded and stored among 
password protected study files  
 
8.0 
Confidentiality and Privacy 
 
Confidentiality will be protected by collecting only information needed to assess study 
outcomes, minimizing to the fullest extent possible the collection of any information that 
could directly identify subjects, and maintaining all study information in a secure 
manner. To help ensure subject privacy and confidentiality, only a unique study 
identifier will appear on the data collection form. Any collected patient identifying 
information corresponding to the unique study identifier will be maintained on a linkage 
file, store separately from the data. The linkage file will be kept secure, with access 
limited to designated study personnel. Following data collection subject identifying 
information will be destroyed (state the anticipated time the data will be destroyed, e.g. 
three years after closure of the study, and the method of destruction), consistent with 
data validation and study design, producing an anonymous analytical data set. Data 
access will be limited to study staff. Data and records will be kept locked and secured, 
with any computer data password protected. No reference to any individual patient will 
appear in reports, presentations, or publications that may arise from the study. 
9.0 
Data Safety and Monitoring 
 
The principal investigator will be responsible for the overall monitoring of the data and 
safety of study patients. The principal investigator will be assisted by other members of 
the study staff. 
 
The risks of this study are low; however staff will be trained to handle situations with 
sensitivity and empathy.  The study coordinator will be trained to monitor for significant 
patient distress or depressive symptoms and will be instructed on the appropriate 
courses of referral is a patient is considered to be at risk for a safety concern.   

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10.0 Reporting of Unanticipated Problems, Adverse Events or 
Deviations 
 
Any unanticipated problems, serious and unexpected adverse events, deviations or 
protocol changes will be promptly reported by the principal investigator or designated 
member of the research team to the IRB and sponsor or appropriate government 
agency if appropriate.

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ENHANCING MANAGEMENT OF PATIENT REPORTED OUTCOMES WITH EMOTION 
REGULATION (EMPOWER) 
Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
CCCWFU 99516 
 
Appendix A – Subject Eligibility Checklist 
 
IRB Protocol No.  
CCCWFU Protocol No. 
Study Title:  
Principal Investigator:   
 
Inclusion Criteria 
(as outlined in study protocol) 
Criteria 
is met 
Criteria is 
NOT met 
Source Used to Confirm * 
(Please document dates and lab results) 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
Exclusion Criteria 
(as outlined in study protocol) 
Criteria 
NOT 
present 
Criteria is 
present 
Source Used to Confirm * 
(Please document dates and lab results) 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
□ 
□ 
 
 
This subject is      
 eligible /  ineligible     for participation in this study. 
 
ORIS Assigned PID: __________________  
 
 
 
 
 
 
 
 
Signature of research professional confirming eligibility:_______________________ Date: __________ 
 
Signature of Treating Physician**:  _____________________________________     Date:___________ 
 
* Examples of source documents include clinic note, pathology report, laboratory results, etc. When listing the 
source, specifically state which document in the medical record was used to assess eligibility. Also include the date 
on the document. Example: “Pathology report, 01/01/14” or “Clinic note, 01/01/14” 
 
**Principal Investigator signature can be obtained following registration if needed 
 
 

ENHANCING MANAGEMENT OF PATIENT REPORTED OUTCOMES WITH EMOTION 
REGULATION (EMPOWER) 
Comprehensive Cancer Center of Wake Forest University (CCCWFU) 
CCCWFU 99516 
 
 
APPENDIX B:  REDUCED REGISTRATION FORM 

 
 
 
Appendix C – Study Measures 
 
Variables 
Construct/Measures 
Demographics 
Age, gender, ethnic, edu, income, job & mar. 
status, insurance, etc. 
Clinical 
Cancer dx, stage, adj. tx, etc. 
Quality of Life 
Global Impact Items PROMIS 
PROMIS Global 10 
PROMIS-29 
+ 4 additional PROMIS physical function items 
PROMIS Anger SF 
Psychological 
Well-Being 
NIH PROMIS General Sell-Efficacy Scale SF 
 
NIH Toolbox Life Satisfaction SF 
NIH PROMIS Meaning & Purpose SF 
NIH Toolbox Positive Affect SF 
Health 
Behaviors 
Diet 
Alcohol Use & Smoking 
Leisure Time Exercise Questionnaire 
  
  
 
 
 
 

 
 
 
 
EMPOWER Sociodemographic Questions 
 
 
SDC01  
What is your current age? 
 
 
 
 
 
 
 
 
 
SDC02  
Are you of Hispanic origin, such as Latin American, Mexican, Puerto Rican, or Cuban? 
 
01  
  Yes, of Hispanic origin 
02  
  No, not of Hispanic origin 
09  
  Decline to answer 
 
SDC03            Do you consider yourself…? 
 
 
 
01                 White or Caucasian 
02 
Black or African American 
03 
Asian 
04 
Native Hawaiian/Other Pacific Islander 
05 
Native American or Alaska Native 
06 
Mixed racial background 
07 
Other race 
09  
   Decline to answer  
 
SDC04             What is your gender? 
 
01  
   Female 
 
 
02 
     Male 
 
 
 
 
SDC05  
What is your marital status? 
 
 
01                 Single, never married 
 
 
02                 Married 
 
 
03                 Divorced 
 
 
04                 Separated 
 
 
05                 Widowed 
 
 
06                 Living with partner 
 
SDC06               Do you currently live alone or with others? 
 
01                 Live alone  
 
02                 Live with others (e.g., parent, roommate,  
 
                     spouse/partner, brother, sister, children) 
 
 
SDC07              Are you now responsible for raising any children under the age of 18? 
01                No  
02                Yes 
 
 
 
 
 
 
 
 
 

 
 
 
SDC08            Which of the following income categories best describes your total household income before  
            
taxes?  
01                  
Less than $15,000 
02                  
$15,000 to $24,999 
03                  
$25,000 to $34,999 
04                  
$35,000 to $49,999 
05                 
$50,000 to $74,999 
06                  
$75,000 to $99,999 
07                  
$100,000 to $124,999 
08                 
$125,000 to $149,999 
09                  
$150,000 to $199,999 
10                  
$200,000 to $249,999 
11                  
$250,000 or more 
994   
Decline to answer 
 
 
SDC09     What is the highest level of education you have completed?   
 
 
01                      Grade school – between 1 and 8 years 
 
 
02                      Some high school 
03 
     High school diploma or equivalent (e.g., 
 
  GED) – 12 years 
04 
     Some college, vocational or training school 
05 
     College graduate 
06 
     Some graduate school 
 
 
07                      Graduate degree 
 
 
 
SDC10     What was your school/employment status right before you were diagnosed with cancer?  Please        
 
     mark all that apply. 
 
01          
Part-time student  
02          
 Full-time student 
03          
 Working part-time 
04          
 Working full-time 
05          
 Unemployed 
06          
 Full-time homemaker or family caregiver 
07  
  
 Other (please describe in box below) 
 
 
 
 
 
 
 
 

 
 
 
SDC11         How did your school/employment status change because of your cancer or its treatment?  Please    
                    mark all that apply. 
 
01         It has not changed because of my cancer or its  
 
 
  treatment 
02         I quit working completely 
03         I quit going to school completely 
04         I changed my work status from full-time to part- 
 
 
 time 
05         I changed my school status from full-time to part- 
 
 
 time 
06         I took more than 2 weeks total time off from  
 
 
 work 
07 
I took more than 2 weeks total time off from 
 
school 
08  
 Other (please describe in box below) 
 
 
 
SDC12a          Are you now covered by any type of health insurance? 
 
01         No  
02         Yes 
 
 
If Yes, GO TO QUESTION SDC12b 
SDC12b.        How is this health insurance provided? MARK ALL THAT APPLY. 
 
01 Through your employer/school 
02 Through your spouse’s employer/school 
03 Through your parent 
04 Medicaid or other public assistance program 
05 Other State Program (for example, Medi-Cal , SCHIP) 
06 Military or Veteran’s Benefits 
07 Other (please describe in the box below) 
 
 
09 I don’t know 
 
 
 
 
 
 

 
 
 
Disease and Treatment Information 
 
SDC13      Please circle which statement best describes your current activity level: 
 
 
0= Normal activity, without symptoms 
 
1= Some symptoms, but do not require bed rest during waking 
day 
       
2= Require bed rest for less than 50% of waking day 
 
3= Require bed rest for more than 50% of waking day 
 
4= Unable to get out of bed 
       
 
 
SDC14   What is your height? (feet/inches)_______/________  
 
 
SDC15   What is your weight? (lbs) ____________ 
 
 
 
SDC16   What was the date of your cancer diagnosis? (month and year) __________/__________ 
 
  SDC17    Please select one of the boxes below that reflects your “primary” cancer diagnosis (e.g., original location of 
your cancer).  If none of the boxes is correct, please select “Other” and explain. 
  Basal cell skin cancer   Bladder cancer 
 
 
 
  Leukemia 
 
 
  Bone tumor  
 
 
 
  Lung cancer 
 
  Brain cancer  
 
 
 
  Melanoma (skin cancer) 
 
  Breast cancer  
 
 
 
  Myeloma 
 
  Central Nervous System tumor  
 
  Non-hodgkin lymphoma 
 
  Cervical cancer 
 
 
 
  Ovarian cancer 
 
  Colorectal cancer 
 
 
 
  Prostate cancer 
 
  Esophageal cancer 
 
 
 
  Sarcoma (bone or soft tissue) 
 
  Head and neck cancer  
 
 
  Stomach cancer 
 
  Hepatobiliary cancer (liver, pancreas, 
 
  Testicular cancer 
bile duct) 
  Hodgkin lymphoma 
 
 
 
  Thyroid cancer 
 
  Kidney cancer 
 
 
 
  Other:  ______________________ (explain) 
 

 
 
 
SDC18  Has your cancer spread to any lymph nodes:   
 
 
 
   
0=No 
 
 
 
1=Yes 
 
 
 
2=Not sure 
 
SDC19a.  Has your cancer spread to another part of your body (other than to any lymph nodes)? 
 
 
 
0=No 
 
 
1=Yes 
 
 
2=Not sure 
 
SDC19b.   If yes, please check all that apply: 
 
 
 Bone 
 
 
 Brain 
 
 
 Lung 
 
 
 Liver 
 
 
 Other: ____________ (please specify) 
 
SDC20a       Are you currently receiving treatment? (check all that apply) 
 
 chemotherapy 
 radiation treatment 
 I am not currently receiving treatment. 
 
 
 
 
SDC20b       If applicable, when did you complete your cancer treatment(s)? 
 
a.  surgery              _______/______(month and year) OR   I did not receive surgery for my cancer. 
 
b. chemotherapy  _______/______(month and year) OR   I did not receive chemotherapy for my cancer 
 
c.  radiation          _______/______(month and year) OR   I did not receive radiation for my cancer 
 
                             
 
SDC21a      Where did you receive most of your primary active cancer treatment (surgery, chemotherapy,    
       
radiation therapy)? 
01   Academic medical center    
02   Community-based hospital or health center 
03   Office-based private practice 
 
SDC21b         List the name of the institution where you received most of your primary active cancer      
           
treatment  (surgery, chemotherapy, radiation therapy). 
 
 
SDC22      A survivorship care plan (SCP) is a document that includes a summary or your cancer treatment and 
recommendations for follow-up care and for staying healthy. Following completion of your primary active 
treatment for cancer, did you receive a SCP from your nurse or doctor? 
01   No    
02   Yes 
03   I don’t know 
 
SDC23            Do you now (within the past month), or have you ever had any of the following conditions? 
 
 
(please check all that apply) 
 

 
 
 
 
 
AIDS/HIV  
 
 
 
Hypertension 
Acid Reflux (heartburn) 
 
 
Insomnia 
 
Anemia 
 
 
 
 
Multiple Sclerosis (MS) 
 
Anxiety 
 
 
 
 
Migraine/Headaches 
 
Arthritis 
 
 
 
 
Ulcers 
 
 
Asthma 
 
 
 
 
Other (specify below) 
Back Pain  
Depression 
Diabetes 
Fibromyalgia 
Heart Disease 
Hepatitis 
 
 
 

 
 
 
Global Impact 
 
 
 
 
 
 
 
 
 
  
 
 
Completely 
positive 
Mostly 
positive; a 
little negative 
A little more 
positive than 
negative 
Equally 
positive and 
negative 
A little more 
negative than 
positive 
Mostly 
negative; 
a little 
positive 
Completely 
negative 
1 
How positive 
or negative 
has the overall 
impact of your 
illness been on 
your views 
about yourself 
and your life? 







 
 
Not at all 
A little bit 
Somewhat 
Quite a bit 
Very much 
2 
Overall, how much has 
having your illness 
affected your views about 
yourself and your life? 






 
 
 
Positive Affect 
Positive Affect 
  
Item ID  
  
For the next set of questions, please tell us 
how true each statement was of you in the 
past 7 days. 
  
1 
PA001 
In the past 7 days: 
I felt cheerful. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
2 
PA002 
In the past 7 days: 
I felt attentive. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
3 
PA006 
In the past 7 days: 
I felt delighted. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
4 
PA010 
In the past 7 days: 
I felt happy. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
5 
PA014 
In the past 7 days: 
I felt joyful. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
6 
PA019 
In the past 7 days: 
I felt enthusiastic. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
7 
PA020 
In the past 7 days: 
I felt determined. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
8 
PA021 
In the past 7 days: 
I felt interested. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
9 
PA025 
In the past 7 days: 
I was thinking creatively. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 

 
 
 
10 
PA026 
In the past 7 days: 
I liked myself. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
11 
PA030 
In the past 7 days: 
I felt peaceful. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
12 
PA037 
In the past 7 days: 
I felt good-natured. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
13 
PA039 
In the past 7 days: 
I felt useful. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
14 
PA042 
In the past 7 days: 
I felt understood. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
15 
PA044 
In the past 7 days: 
I felt content. 
1 = Not at all 
2 = A little bit 
3 = Somewhat 
4 = Quite a bit 
5 = Very much 
 
 
 

 
 
 
General Life Satisfaction  
 
 
 
 
General Life Satisfaction 
  
Item ID  
  
For the next set of questions, 
please indicate how much you 
agree or disagree with each 
statement. 
  
35 
PA045m 
Indicate how much you 
agree or disagree: 
In most ways, my life is close to 
perfect. 
1 = Strongly disagree 
2 = Disagree 
3 = Slightly disagree 
4 = Neither agree nor disagree 
5 = Slightly agree 
6 = Agree 
7 = Strongly agree 
36 
PA046 
Indicate how much you 
agree or disagree: 
If I could live my life over, I would 
change almost nothing. 
1 = Strongly disagree 
2 = Disagree 
3 = Slightly disagree 
4 = Neither agree nor disagree 
5 = Slightly agree 
6 = Agree 
7 = Strongly agree 
37 
PA047 
Indicate how much you 
agree or disagree: 
I am satisfied with my life. 
1 = Strongly disagree 
2 = Disagree 
3 = Slightly disagree 
4 = Neither agree nor disagree 
5 = Slightly agree 
6 = Agree 
7 = Strongly agree 
38 
PA048 
Indicate how much you 
agree or disagree: 
So far I have gotten the important 
things I want in life. 
1 = Strongly disagree 
2 = Disagree 
3 = Slightly disagree 
4 = Neither agree nor disagree 
5 = Slightly agree 
6 = Agree 
7 = Strongly agree 
39 
PA049m 
Indicate how much you 
agree or disagree: 
My life situation is excellent. 
1 = Strongly disagree 
2 = Disagree 
3 = Slightly disagree 
4 = Neither agree nor disagree 
5 = Slightly agree 
6 = Agree 
7 = Strongly agree 

 
 
 
 
Meaning and Purpose  
  
 
 
 
 
 
 
 
 
Neither 
 
 
 
 
 
Strongly  
Disagree 
agree nor 
Agree    Strongly 
  
disagree  
 
 
disagree 
   
     agree 
PA203_ 
C  
I have a good sense of 
what makes my life 
meaningful.  
 
 
 
 
 
PA205_ 
C  
I generally feel that 
what I do in my life is 
valuable and 
worthwhile.  
 
 
 
 
 
PA210_ 
C  
I have very clear goals 
and aims for my life.  
 
 
 
 
 
  
  
  
  
Not at all  A little bit Somewhat Quite a bit Very much  
PA221_ 
C  
My life has meaning.  
 
 
 
 
 
PA224_ 
C  
My life has 
significance.  
 
 
 
 
 
PA227_ 
C  
I have a clear sense of 
direction in life.  
 
 
 
 
 
PA232_ 
C  
I experience deep 
fulfillment in my life.  
 
 
 
 
 
PA237_ 
C  
My life has purpose.  
 
 
 
 
 
  
 
 

 
 
 
 
General Self-Efficacy  
  
  
For the next set of questions, please read each sentence and rate your level of confidence in managing various 
situations, problems, and events.  
  
   
  
  
 
 
 
 
      I am not 
I am a  
I am 
 
I am 
 
 
 
 
 
 
 
       At all  
a little  
somewhat 
quite 
      I am very 
    Confident 
confident 
confident        confident      confident 
GSE11_C  
I can manage to solve 
difficult problems if I try 
hard enough.  
 
 
 
 
 
GSE14_C  
I am confident that I could 
deal efficiently with 
unexpected events.  
 
 
 
 
 
GSE19_C  
If I am in trouble, I can 
think of a solution.  
 
 
 
 
 
GSE20_C  
I can handle whatever 
comes my way.  
 
 
 
 
 
  
  
 
 

 
 
 
PROMIS-29  
(+4 additional PROMIS physical functioning items and PROMIS Anger SF) 
 
Please respond to each question or statement by marking one box per row. 
 
  
Physical Function 
Without 
any 
difficulty 
With a 
little 
difficulty 
With 
some 
difficulty 
With 
much 
difficulty 
Unable 
to do 
1 
Are you able to do chores such as vacuuming 
or yard work? .......................... 
 
 
 
 
 
2 
Are you able to go up and down stairs at a 
normal pace?.............................................. 
 
 
 
 
 
3 
Are you able to go for a walk of at least 
15 minutes?................................................ 
 
 
 
 
 
4 
Are you able to run errands and shop? ...... 
 
 
 
 
 
 
Not at all 
Very little 
Somewhat 
Quite a lot 
Cannot do 
 
5 
Does your health now limit you in doing 
two hours of physical labor? 
 
 
 
 
 
 
 
 
 
 
6 
Does your health now limit you in doing 
moderate work around the house like 
vacuuming, sweeping floors or carrying in 
groceries? 
 
 
 
 
 
 
 
 
 
7 
Does your health now limit you in lifting or 
carrying groceries? 

 
 
 
 
 
 
 
 
 
8 
Does your health now limit you in doing 
heavy work around the house like scrubbing 
floors, or lifting or moving heavy furniture?  
 
 
 
 
 
 
 
Anxiety 
In the past 7 days… 
Never 
Rarely 
Sometimes 
Often 
Always 
9 
I felt fearful................................................ 





 
10 
I found it hard to focus on anything other 
than my anxiety ......................................... 





11 
My worries overwhelmed me .................... 





12 
I felt uneasy ............................................... 






 
 
 
 
Depression 
In the past 7 days... 
Never 
Rarely 
Sometimes 
Often 
Always 
13 
I felt worthless ........................................... 





14 
I felt helpless.............................................. 





 
15 
I felt depressed........................................... 





16 
I felt hopeless............................................. 





  
Anger 
During the past 7 days… 
Never 
Rarely 
Sometimes 
Often 
Always 
17 
I was irritated more than people knew 





18 
I felt angry 





19 
I felt like I was ready to explode 





20 
I felt grouchy 





21 
I felt annoyed 





 
Fatigue 
During the past 7 days… 
Not at all 
A little bit 
Somewhat 
Quite a bit 
Very much 
22 
I feel fatigued .............................................  
 
 
 
 
23 
I have trouble starting things because I 
am tired......................................................  
 
 
 
 

 
 
 
 
 
 
Fatigue 
In the past 7 days… 
Not at all 
A little bit 
Somewhat 
Quite a bit 
Very much 
24 
How run-down did you feel on average? ... 





25 
How fatigued were you on average? .......... 





 
Sleep Disturbance 
In the past 7 days… 
Very poor 
Poor 
Fair 
Good 
Very good 
26 
My sleep quality was.................................. 





 
In the past 7 days… 
Not at all 
A little bit 
Somewhat 
Quite a bit 
Very much 
27 
My sleep was refreshing............................. 





28 
I had a problem with my sleep .................. 





29 
I had difficulty falling asleep .................... 





 
Ability to Participate in Social Roles 
and Activities 
Never 
Rarely 
Sometimes 
Usually 
Always 
30 
I have trouble doing all of my regular 
leisure activities with others .................... 





31 
I have trouble doing all of the family 
activities that I want to do ....................... 





32 
I have trouble doing all of my usual work 
(include work at home) ........................... 





33 
I have trouble doing all of the activities 
with friends that I want to do .................. 





 
Pain Interference 
In the past 7 days… 
Not at all 
A little bit 
Somewhat 
Quite a bit 
Very much 
34 
How much did pain interfere with your 
day to day activities? .................................. 





35 
How much did pain interfere with work 
around the home? ....................................... 





36 
How much did pain interfere with your 
ability to participate in social activities? . 





37 
How much did pain interfere with your 
household chores? ..................................... 






 
 
 
PROMIS Global Items 
 
   Please respond to each item by marking one box per row.  
 
 
 
 

 
 
 
 
 
  
  
  
  
  
  
  
 
 
 
 

 
 
 
Diet  
1. About how many cups of fruit (including 100% pure fruit juice) do you eat or drink each day?  
a. None  
b. ½ cup or less 
c. ½ cup to 1 cup 
d. 1 to 2 cups 
e. 2 to 3 cups 
f. 3 to 4 cups 
g. 4 or more cups 
 
2. About how many cups of vegetables (including 100% pure vegetable juice) do you eat or drink each day?  
a. None  
b. ½ cup or less 
c. ½ cup to 1 cup 
d. 1 to 2 cups 
e. 2 to 3 cups 
f. 3 to 4 cups 
g. 4 or more cups 
 
3. About how often do you drink regular pop/soda or other sugar sweetened beverages (not diet or calorie-free) in a 
typical week?  
a. Every day  
b. 5 - 6 days a week 
c. 3 - 4 days a week  
d. 1 - 2 days a week  
e. Less often than 1 day a week  
f. I don’t drink any regular soda/pop or other sugar sweetened beverages 
4. How many times per week do you eat fast food meals or snacks? 
a. Every day  
b. 5 - 6 days a week 
1 cup of fruit could be:  
 
1 small apple  
 
1 large banana  
 
1 large orange  
 
8 large strawberries  
 
1 medium pear  
 
2 large plums  
 
32 seedless grapes  
 
1 cup (8 oz.) fruit juice  
 
½ cup dried fruit  
 
1 inch-thick wedge of watermelon 
1 cup of vegetables could be: 
 
3 broccoli spears  
 
1 cup cooked leafy greens 
 
2 cups lettuce or raw greens  
 
12 baby carrots  
 
1 medium potato 
 
1 large sweet potato  
 
1 large ear of corn  
 
1 large raw tomato  
 
2 large celery sticks 
 
1 cup of cooked beans 

 
 
 
c. 3 - 4 days a week  
d. 1 - 2 days a week  
e. Less often than 1 day a week  
f. I don’t drink eat any fast food meals or snacks 
 
 
 
 
 

 
 
 
Alcohol 
5. Do you drink alcohol? 
 Yes 
 No 
a. If yes, how many days per week do you drink alcohol? 
__________ 
b. How many drinks containing alcohol do you have on a typical day 
when you are drinking? 
__________ 
 
 
Smoking  
6. Do you currently smoke? 
 Yes 
 No 
a. If yes, how many packs a day do you smoke? 
_________ 
7. Did you smoke previously? 
 
 Yes 
 No 
a. If you are a former smoker, how many years has it been since you 
quit? 
__________ 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
 
 

 
 
 
Current Physical Activity  
 
For this questionnaire, we want you to recall your current leisure time physical activity (do not include work or household 
activities) during a typical week. When considering the number of times per week, please only include those times that 
you were physically active for more than 15 minutes.  
 
Example: You typically swim vigorously for 20 minutes 2 times per week and run for 40 minutes 3 times per 
week: 
 
Times per Week 
Average Duration Each 
Time You Exercised (in 
minutes) 
1) 
Strenuous Exercise (Heart Beats Rapidly) 
(e.g., running, jogging, hockey, football, soccer, squash, 
basketball, cross country skiing, judo, roller skating, 
vigorous swimming, vigorous long distance bicycling) 
 
___5____ 
 
__30___ 
 
Times per Week 
Average Duration Each 
Time You Exercised (in 
minutes) 
1) 
Strenuous Exercise (Heart Beats Rapidly) 
(e.g., running, jogging, hockey, football, soccer, squash, 
basketball, cross country skiing, judo, roller skating, vigorous 
swimming, vigorous long distance bicycling) 
 
 
________ 
 
________ 
2) 
Moderate Exercise (Not Exhausting) 
(e.g., fast walking, baseball, tennis, easy bicycling, volleyball, 
badminton, easy swimming, alpine skiing, popular and folk 
dancing) 
 
 
________ 
 
________ 
3) 
Mild Exercise (Minimal Effort) 
(e.g., yoga, archery, fishing from river bank, bowling, 
horseshoes, golf, snowmobiling, easy walking, 
 
________ 
 
________ 

 
 
 
Date:  __________ 
 
 
 
 
 
 
I.D. # __________ 
Intervention Evaluation (Phone Interview Script) 
 
Thank you for taking the time to talk with me today.  I just wanted to remind you that this 
telephone conversation is being recorded for quality assurance purposes.  I expect our 
conversation will be brief, under 30 minutes.  Then in one month you’ll be hearing from [name 
of RA] as a reminder to complete your final follow-up assessment.   
 
******************************************************************************
****** 
First, I’d like to ask you a few questions about these sessions and the study so far.  
 
Let’s go back through the skills we’ve covered: 
 
a. Positive Events 
b. Capitalizing (revisiting positive events) 
c. Gratitude Journal 
d. Formal Mindfulness (breath awareness) 
e. Informal Mindfulness (mindfulness in daily life) 
f. Positive Reappraisal 
g. Personal strengths  
h. Goals 
i. Acts of Kindness 
 
1.  Please rank the sessions from your most favorite (1) to least favorite (9): 
 
__________ Positive Event 
__________ Capitalizing 
__________ Gratitude Journal 
__________ Mindfulness Formal (Breath Awareness) 
__________ Mindfulness Informal (Mindfulness in Daily Activities) 
__________ Positive Reappraisal 
__________ Personal strengths 
__________    Attainable Goals 
__________ Acts of Kindness 
 
 
2.  On a scale of 0 to 10, with 0 being “definitely not” to 10 being “definitely yes”, to 
what extent would you recommend these skills to a friend?    
(Please circle your response) 
 
0 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
 Definitely not  
 
 
 
 
 
       
 
            Definitely 

 
 
 
. 
3.  To what extent would you recommend this intervention to someone newly 
diagnosed with cancer?    (Please circle your response) 
 
 
0 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
Definitely not    
 
  
 
 
 
 
 
            Definitely 
 
*************************************************************************** 
 
How likely are you to practice the following skills over the next 6 months?        
(Please circle your response) 
 
 
4. 
Positive Event: 
 
0 
1 
2 
3 
4 
    Other ___ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
5. 
Capitalizing: 
 
0 
1 
2 
3 
4 
    Other ___ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
6. 
Gratitude Journal: 
 
0 
1 
2 
3 
4 
    Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
7. 
Mindful Breath Awareness: 
 
0 
1 
2 
3 
4 
    Other_____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
8. 
Mindfulness in Daily Activities: 
 
0 
1 
2 
3 
4 
    Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 

 
 
 
9. 
Positive Reappraisal: 
 
0 
1 
2 
3 
4 
     Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
10. 
Personal Strengths: 
 
0 
1 
2 
3 
4 
    Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
11.       Attainable Goals: 
 
0 
1 
2 
3 
4 
    Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
 
12. 
Acts of Kindness 
 
0 
1 
2 
3 
4 
    Other ____ 
       Not at all        Once a month      Once a week    2-3 times/week          Daily 
 
*************************************************************************** 
Planning for continued practice 
 
For this last section, I’d like to talk about continued practice of the skills we covered. A basic 
premise of these coping skills is that they only work if you continue to practice them.  
Again these skills are like muscles, if you don’t exercise them, they aren’t likely to work 
very well. For these skills to be beneficial to you, you need to make them habits. 
 
 
 
 
  It sounds like you plan to continue (XX skill from above participant is going to practice most 
frequently) but are less likely to continue (XX skill from above participant is going to 
practice less).  First let’s talk about the one that you plan to continue.  What about it is 
appealing to you?  How do you plan to fit it into your day and make it a habit?   
 
 
 
 
How about your least favorite skill?  Can you tell me what about that one makes you less likely 
to try and incorporate it into your life?  
 
 

 
 
 
 
 
One of the interesting things about any new skill is that after a while you might get bored with it 
or it may stop having the same impact that it had initially.  If (skill participant rates as 
most likely to continue) starts getting old for you, you should go back to the skills and 
choose another one and increase your practice of that one.  Let’s talk about (XX skill that 
participant rated the second most likely to practice) and ways you might be able to 
incorporate that into your daily life.   
 
 
*************************************************************************** 
Questions about website usage: 
 
Can you talk about your experience using the intervention website?  
Probe: What features did you like?  
      What could have been clearer?  
 
 
What did you think of the at home practice exercises?  
 
 
If the participant did not progress through all the lessons 
Why did you stop at lesson X?  
 
 
 
 
 
 
 
 
 
In about four  weeks (cite specific dates), I will email you the final online questionnaire for the 
study. This will mark the end of your participation in the study.   
 
Are there any questions I can answer for you now? 
 
Thank you again for your time and participation in this study. We really appreciate it!  
 
 
Hang up.