Enhancing Hope Among Patients With Poor-Prognosis Breast Cancer and Oncologists

Study Overview
=================
Brief Summary
-----------------
The study will access whether breast cancer patients and oncologists can become more hopeful after participating in a hope enhancement workshop. Several validated tools, Adult Hope Scale (AHS), Herth Hope Index (HHI), Maslach Burnout Inventory (MBI) and other quality of life parameter surveys, will be administered at specified intervals.

Detailed Description
-----------------
The aim of the proposed research is to study the impact of hope interventions on the coping behavior of women with advanced breast cancer and physicians who provide care to patients with cancer. It is the investigator's contention, that improved hopefulness among cancer patients can be manifest in improved Quality of Life (QOL). The challenge is to find specific interventions that can optimize hopefulness and thereby direct individuals to adopt behavior styles that contribute to a positive effect on QOL. Two separate single-day interventions and hope applications will be developed for patients and oncologists, respectively. What will be common for each workshop is that there will be an experienced counselor designated as coordinator who will be in charge of implementing the program and monitoring group dynamics. The interventions will be structured with the program advancing from the identification of goals to the development of directions reasonable pathways for achieving the delineated goals. In addition to goal-directed exercises, the workshop will employ narrative techniques which utilize literary triggers as a springboard for reflective writing. The smartphone-based application will prompt study participants on a daily basis to engage in additional, short activities designed to augment hopefulness, assess progress in achieving goals, and identifying challenges. In addition, the application will allow sustained interaction of workshop participants through social media exchange. Course materials will be sent to study participants one week prior to the conduct of the workshop. Baseline assessment of hopefulness will be carried out via the aforementioned validated scales on the day of the workshop. Re-assessment of hopefulness will occur at the end of the day and at the 3- month interval visits.

Official Title
-----------------
Enhancing Hope Among Patients With Poor-Prognosis Breast Cancer and Oncologists

Conditions
-----------------
Despair Among Cancer Patients and Oncologists

Intervention / Treatment
-----------------
* Behavioral: Hope Enhancement Workshop


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Inclusion Criteria (patient component of study) Diagnosis of invasive breast cancer that is Stage IV. Female, 18 years of age or older. Able to proficiently speak, read, write English. ECOG performance status between 0 and 3. Subjects must have a smartphone with at least 3rd generation mobile technology, and willingness to download and utilize specialized application Expected to continue cancer care at the institution where cancer was begun for the duration of the study. Inclusion Criteria (physician component of study) Board certification or board eligibility in any of the 3 oncologic disciplines: Medical Oncology Surgical Oncology Radiation Oncology Able to proficiently speak, read, write English. Subjects must have a smartphone with at least 3rd generation mobile technology, and willingness to download and utilize specialized application NB: There will not be active recruitment of physicians who are subordinate to the respective investigators. In the event that such a physician desires to enroll on the study, formal application will be made to the institutional ethics committees to verify that coercion has not taken place. Exclusion Criteria: Exclusion Criteria (applies to both patients and physicians) Participant actively undergoing psychotherapy for depression. Documented history of Alzheimer's disease or other forms of dementia. Participants practicing mindfulness meditation for an average of more than 1 hour/week.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Subjects will be offered participation in workshops where techniques are taught for enhancing hopefulness. Validated questionnaires will be administered before and after this intervention to assess efficacy.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Breast Cancer patient<br>Patients with Stage IV breast cancer will be taught to build hope by defining attainable goals for themselves in a Hope Enhancement Workshop. | Behavioral: Hope Enhancement Workshop<br>* Participants in the workshops will be prompted and guided through exercises that help them get in touch with goals that are not explicitly related to cure of disease. These goals will include symptom relief and other personal and or professional objectives.<br>|
| Active Comparator: Oncologists<br>Oncologists will will be taught to build hope by defining attainable goals for themselves and for their patients in a Hope Enhancement Workshop. | Behavioral: Hope Enhancement Workshop<br>* Participants in the workshops will be prompted and guided through exercises that help them get in touch with goals that are not explicitly related to cure of disease. These goals will include symptom relief and other personal and or professional objectives.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measurement of the change in Hope Enhancement | Enhancement of hopefulness as measured by Adult Hope Scale | The primary measurement will be carried out prior to and 3 months following the workshop | 
| Measurement of the change in Hopefulness | Enhancement of hopefulness as measured by Herth Hope Index. | The primary measurement will be carried out prior to and 3 months following the workshop | 
| Measurement of the change in Quality of Life and Emotional Stress Anxiety | The study will measure QOL and emotional stress anxiety prior to and 3 months following the intervention. Towards these ends, we will use the Patient-Reported Outcomes Measurement Information System (PROMIS) scale (10-point version). | The primary measurement will be carried out prior to and 3 months following the workshop | 
| Measurement of the change in Quality of Life and Well Being | The study will measure QOL and well-being prior to and 3 months following the intervention. Towards these ends, we will use the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (FACIT-Sp-12) scale. | The primary measurement will be carried out prior to and 3 months following the workshop | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measurement of the change in burnout among oncologists | The study will measure burnout among oncologists using the Maslach Burnout Inventory Scale (MBI) to gauge the willingness of oncologists to incorporate hope enhancement techniques to their clinical routine with patients following the workshop intervention. | The measurement will be carried out prior to and 3 months following the workshop. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Disambiguation, Depression, Burnout