Harnessing Generativity Among Young Adult Cancer Survivors

Study Overview
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Brief Summary
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Short, online interventions designed to enhance well-being may be particularly amenable for use with adolescent and young adult (AYA) cancer survivors (age 15-39 at diagnosis), an understudied group in the cancer community. The benefits of psychological well-being on both physical and mental health outcomes are well-known and, in recent years, researchers and policymakers have begun to view the period of adolescence and young adulthood as a window of opportunity to instantiate lasting habits and behaviors. Growing evidence suggests that prosocial behavior-a behavior that can be reliably manipulated through a short online intervention-may have beneficial effects on well-being and physical health. This has yet to be tested in AYA cancer survivors. Drawing from the literature on positive psychology and prosocial interventions, the proposed study will test the feasibility and efficacy of an 8-week online peer helping intervention designed to increase well-being among AYA cancer survivors. AYA cancer survivors (n = 176) will be recruited and randomized to one of three conditions: a peer helping condition, a cancer-specific writing plus peer helping condition, or a cancer-specific writing condition (control condition). The second group was added in response to a previous study, which found that writing about one's experience prior to helping other survivors may be more beneficial. Participants will complete a weekly writing activity once per week for 4 weeks, with instructions administered via a weekly email. Participants will also complete online assessments before, during, and after the 4-week intervention period.

Official Title
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The Effects of Prosocial Writing on Psychological Well-being: An Online Randomized Controlled Trial Among Young Adult Cancer Survivors

Conditions
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Cancer, Young Adults

Intervention / Treatment
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* Behavioral: Writing for others
* Behavioral: Processing + writing for others
* Behavioral: Facts-only writing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosis of cancer (any type) between the ages of 15 and 39 years have completed primary treatment and are in remission (partial or complete) between the ages of 18 and 39 years fluent in English have access to the internet and email. Exclusion Criteria: -none

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 39 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Peer helping condition<br>Participants in the peer helping condition will be asked to write about their cancer experience with an emphasis on using the experience to benefit a newly-diagnosed AYA cancer patient. | Behavioral: Writing for others<br>* Participants will receive general instructions for completing the writing sessions and will be asked to write for at least 20 minutes per session. Topics covered in each session will vary and are related to common cancer-related themes (e.g., receiving a diagnosis, undergoing treatment, etc.). Participants will be instructed not to worry about grammar, spelling, or sentence structure and reminded that their responses will remain anonymous. Writing sessions (four in total) will be spaced 1 week apart, and participants will be instructed to write about their experience for the benefit of a newly-diagnosed cancer patient.<br>|
| Experimental: Processing + peer helping condition<br>Participants in the processing + peer helping condition will be asked to first write about their deepest thoughts and feelings about their cancer experience (3 writings), then share advice to a newly-diagnosed AYA cancer patient (final writing). | Behavioral: Processing + writing for others<br>* Participants will receive general instructions for completing the writing sessions and will be asked to write for at least 20 minutes per session. Topics covered in each session will vary and are related to common cancer-related themes (e.g., receiving a diagnosis, undergoing treatment, etc.). Participants will be instructed not to worry about grammar, spelling, or sentence structure and reminded that their responses will remain anonymous. Writing sessions (four in total) will be spaced 1 week apart. For the first three writing sessions, participants will write their deepest thoughts and feelings regarding cancer diagnosis and treatment. In the final writing session, participants will be instructed to write about their experience for the benefit of a newly-diagnosed cancer patient.<br>|
| Placebo Comparator: Facts-only writing condition<br>Participants in the facts-only writing condition will be asked to write about their cancer experience. Unlike the previous conditions, they will not be instructed to write for the benefit of a newly-diagnosed AYA cancer patient. | Behavioral: Facts-only writing<br>* Participants will receive general instructions for completing the writing sessions and will be asked to write for at least 20 minutes per session. Topics covered in each session will vary and are related to common cancer-related themes (e.g., receiving a diagnosis, undergoing treatment, etc.). Participants will be instructed not to worry about grammar, spelling, or sentence structure and reminded that their responses will remain anonymous. Writing sessions (four in total) will be spaced 1 week apart. Unlike the previous conditions, participants will not be instructed to write about their experience for the benefit of a newly-diagnosed cancer patient.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in psychological well-being | Well-being within the past month will be measured at baseline, post-intervention, and the 1-month follow-up via the 14-item Mental Health Continuum-Short Form (MHC-SF). The MHC-SF is comprised of three empirically derived subscales: the 3-item Emotional Well-Being Subscale, the 6-item Psychological Well-Being Subscale, and the 5-item Social Well-Being Subscale. Higher scores on each subscale, and the total score overall (range: 0-56), indicate greater well-being. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in depressive symptoms | Depressive symptoms over the past week will be measured at baseline, post-intervention, and the 1-month follow-up via the 20-item Center for Epidemiological Studies Depression Scale (CES-D). The CES-D is a measure of symptom severity, with higher scores (range: 0-60) indicating greater depressive symptoms. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in anxiety | Symptoms of anxiety over the past 2 weeks will be measured at baseline, post-intervention, and the 1-month follow-up via the 7-item Generalized Anxiety Disorder- 7 (GAD-7). Higher scores on the GAD-7 (range: 0-21) indicate greater severity of symptoms. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in perceived impact of cancer | Perceived impact of cancer will be measured at baseline, post-intervention, and the 1-month follow-up via the Impact of Cancer Scale, Version 2. The following subscales will be administered: positive self-evaluation (4 items; range: 4-20), worry (7 items; range: 7-35), body change concerns (3 items; range: 3-15), physical appearance concerns (3 items; range: 3-15), and altruism/empathy (4 items; range: 4-20. Higher scores on each subscale indicate greater perceived severity of impact. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in health-related quality of life | Health-related quality of life over the past week will be measured at baseline, post-intervention, and the 1-month follow-up via 12-item Short Form Health Survey (SF-12). Higher scores on the SF-12 (range: 0-100) indicate greater quality of life. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in pain intensity and interference | Pain intensity over the past week will be measured at baseline, post-intervention, and the 1-month follow-up using the 1-item PROMIS pain intensity questionnaire (range: 1-5). Pain interference over the past week will be measured at baseline, post-intervention, and the 1-month follow-up using the 4-item PROMIS pain interference questionnaire (range: 4-20). Higher scores indicate greater pain intensity and interference. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in cognitive functioning | Cognitive functioning over the past week will be measured at baseline, post-intervention, and the 1-month follow-up using the 4-item PROMIS Cognitive Functioning Questionnaire (range: 4-20). Higher scores indicate greater cognitive functioning. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in sleep quality and disturbance | Sleep quality and disturbance over the past week will be measured at baseline, post-intervention, and the 1-month follow-up using the 4-item PROMIS Sleep Disturbance Questionnaire (range: 4-20). Higher scores indicate greater sleep disturbance. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in fatigue | Fatigue over the past week will be measured at baseline, post-intervention, and the 1-month follow-up using the 4-item PROMIS Fatigue Questionnaire (range: 4-20). Higher scores indicate greater fatigue. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in social support | Social support will be measured at baseline, post-intervention, and the 1-month follow-up using the 21-item 2-way Social Support Scale. This scale measures 4 dimensions of social support: instrumental support received, instrumental support given, emotional support received, and emotional support given. A higher total score (range: 0-105) indicates more feelings of perceived support. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in generativity | Feelings of generativity will be measured at baseline, post-intervention, and the 1-month follow-up using the 13-item Generativity Scale. This measure consists of two subscales: generative desire and generative achievement, with higher scores (range: 13-78) indicating greater desire/achievement. | At the baseline survey (the day the intervention begins), at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in positive and negative affect | Reports of positive and negative affect will be assessed at baseline, post-intervention, the 1-month follow-up, and at each writing session using the 10-item positive affect subscale and 10-item negative affect subscales of the Positive and Negative Affect Schedule (PANAS-X). Two additional adjectives were also included, happy and calm. Greater scores indicate higher feelings of positive (range: 10-50) and negative affect (range: 10-50). | At the baseline survey (the day the intervention begins), at each writing session, at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up | 
| Change in fulfillment of psychological needs | Fulfillment of psychological needs will be measured at baseline, post-intervention, the 1-month follow-up, and at each writing session using the 9-item Balanced Measure of Psychological Needs. This item has three subscales: autonomy, connectedness, and relatedness, with higher scores (range: 9-45) indicating greater needs satisfaction. | At the baseline survey (the day the intervention begins), at each writing session, at the post-intervention survey (1 week after the final writing assignment), and at the 1-month follow-up |