Feasibility of a Self-Management + Peer Mentoring Intervention for Adolescent and Young Adult Childhood Cancer Survivors

Study Overview
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Brief Summary
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The goal of this project is to evaluate the feasibility of the Managing Your Health online self-management skills+peer mentoring intervention that focuses on overcoming survivor barriers to self-management of their survivorship care. We will conduct a pilot randomized controlled trial (RCT) of the intervention versus usual care with adolescent and young adult survivors of childhood cancer ages 18-25 years. Participants will complete survey measures at baseline, Time 2 (about 2 months after baseline), Time 3 (about 5 months after baseline), and Time 4 (about 12 months after baseline).

Detailed Description
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PRIMARY OBJECTIVES: I. Evaluate the feasibility of the online self-management+peer mentoring program in a pilot RCT. II. Assess preliminary efficacy of the intervention.

Official Title
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Promoting Follow-Up Care Self-Management for Adolescent and Young Adult (AYA) Childhood Cancer Survivors

Conditions
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Childhood Cancer Survivors

Intervention / Treatment
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* Behavioral: Managing Your Health: Self-Management + Peer Mentoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Young Adult Survivors: age 18-25; at least 2 years from treatment for any pediatric cancer diagnosed at age 0-19; low self-reported responsibility for healthcare as indicated by reporting parent is primarily responsible for healthcare or low score (1 or 2) on two or more items from Readiness for Transition Questionnaire - Survivor Version. Peer Mentor: age 21-29; at least 2 years from treatment for any pediatric cancer diagnosed at age 0-19; self-reported primary responsibility for healthcare and complete readiness to assume responsibility or high scores (3 or 4) on all items from Readiness for Transition Questionnaire - Survivor Version. Exclusion Criteria: • Documented or self-reported cognitive delay to prevent self-management of healthcare.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 29 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>The intervention consists of (1) online self-management educational modules and (2) weekly peer mentor calls to facilitate engagement with the modules and offer specialized support over approximately six weeks. | Behavioral: Managing Your Health: Self-Management + Peer Mentoring<br>* The online educational component consists of 5 self-management educational modules: (1) Understanding Your Survivorship Care Plan; (2) Managing Your Healthcare; (3) Family and Significant Other Involvement in Your Healthcare; (4) Emotions about Your Health and Follow-Up Care; (5) Staying Healthy. Participants will be matched with a peer mentor and complete a total of six calls. The first call is to build a rapport and identify the participant's self-management strengths, weaknesses, and goals. The next five calls align with the topic of each module, which the mentee is expected to complete prior to their scheduled call.<br>|
| No Intervention: Usual Care<br>Participants are not receiving the tested intervention. They continue to receive standard or routine psychosocial or transition care available to them as part of the normal practice | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility Measure: Enrollment (Young Adult Survivors) - Number of Eligible Patients Consented and Completing Baseline | Determined by number of eligible patients consented and completing baseline. Hypothesis: >50% of eligible will consent and complete the baseline. | Baseline | 
| Feasibility Measure: Retention in Study (Young Adult Survivors): Percent of Consented Patients Who Are Retained in the Study and Complete Time 3 Follow-up | Retention in study (Young Adult Survivors). Determined by the percent of consented patients who are retained in the study and complete Time 3 follow-up. Hypothesis: >80%. | Time 3 at about 5 months since Baseline. | 
| Feasibility: Completion of the Intervention (Young Adult Survivors): Percentage | Mean percent completed per task: (a) On-line self-management educational modules and (b) Weekly calls with peer mentor. | Time 2, about 2 months since baseline. | 
| Feasibility: Satisfaction With Intervention (Young Adult Survivors): Mean | Five items assess satisfaction with each aspect of the intervention: a. Overall program satisfaction; b. Content of online modules; c. Discussions with peer mentor; d. Frequency of calls with peer mentor; and e. Duration of program. First 3 items (a, b and c) were evaluated using a 5-point scale, (Minimum 1, Maximum 5) with higher scores indicating greater satisfaction. Item c evaluated on a scale from 1 not frequent enough to 3 too frequent. Item d uses a 1 way too short to 5 way too long scale. The sample mean will be examined. | Time 2, about 2 months since baseline. | 
| Feasibility: Utility of the Online Self-Management Modules (Young Adult Survivors): Questionnaire | The Utility Questionnaire is an 11-item scale that measures perceived ease of use and convenience of the online program using a 5-point scale, (minimum 1, maximum 5) with higher scores indicating greater perceived utility. An overall mean of all items will be calculated. | Time 2, about 2 months since baseline. | 
| Feasibility: Impact of the Online Self-Management Modules (Young Adult Survivors): Questionnaire | The Impact Questionnaire is a 13-item scale that measures perceived effectiveness of the online program using a 5-point scale, (minimum 1, and maximum 5) with higher scores indicating greater perceived effectiveness. An overall mean of all items will be calculated. | Time 2, about 2 months since baseline. | 
| Feasibility: Adherence Barriers to the Online Self-Management Modules (Young Adult Survivors): Questionnaire | The Adherence Barriers Questionnaire is a 6-item scale that measures perceived barriers to using the online program using a 5-point scale, (minimum 1 and maximum 5) with higher scores indicating greater perceived barriers. An overall mean of all items will be calculated. | Time 2, about 2 months since baseline. | 
| Acceptance of Peer Mentors (Young Adult Survivors and Peer Mentors): Questionnaire | Acceptance will be evaluated by young adult survivors' and peer mentors' report on perceived alliance with each other using the Working Alliance Inventory - Short Form Revised (Hatcher & Gillaspy, 2006), a validated measure of the quality and strength of the relationship. Items are rated on a 5-point scale. The measure yields 3 subscales summary scores that can range from 5 to 20, with higher scores indicating more positive relationships. Sum scores on each sub-scale with be calculated: Bond, Goal, and Task. | Time 2, about 2 months since baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare Responsibility (Young Adult Survivors) | The Readiness for Transition Questionnaire - Survivor Version (RTQ) assesses the degree to which survivors are responsible for 10 healthcare behaviors, including knowing their survivorship care plan, scheduling annual visits, scheduling specialist appointments, taking and filling medications (if prescribed), explaining medical history to others, knowing insurance coverage, attending appointments, communicating with providers, and calling providers, on a 4-point scale, with higher scores indicating higher levels of responsibility. The RTQ yields a total mean score for responsibility. It also has one item evaluating overall readiness to assume complete responsibility for healthcare with response options of Not at all ready, somewhat ready, mostly ready, or completely ready. The sample mean for the Total Responsibility score and overall readiness item will be calculated (range 1-4) | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Knowledge (Young Adult Survivors) | The knowledge subscale from the Transition Readiness Inventory (TRI) measures knowledge of survivorship care using a 5-point scale, with higher scores indicating greater knowledge. A mean score will be calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline) | 
| Self-Management Skills/Self-Efficacy (Young Adult Survivors) | The Skills/Self-Efficacy sub-scale from the Transition Readiness Inventory (TRI) measures self-management skills and self-efficacy for survivorship care using a 5-point scale, with higher scores indicating greater skills/efficacy. A mean score will be calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline) | 
| Self-Management Goals (Young Adult Survivors) | The Goals subscale from the Transition Readiness Inventory (TRI) measures self-management goals for survivorship care using a 5-point scale, with higher scores indicating greater goals. A mean score will be calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline) | 
| Self-Management Beliefs (Young Adult Survivors) | The Beliefs/Expectations sub-scale from the Transition Readiness Inventory (TRI) measures self-management beliefs for survivorship care using a 5-point scale, with higher scores indicating more positive beliefs. A mean score will be calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline) | 
| Self-efficacy for Communicating With Physician (Young Adult Survivors): Scale | This single item measures confidence in communicating with a physician about health concerns using a 10-point scale, with higher scores indicating greater confidence. Range is from 1-10. | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Self-efficacy for Communicating With Family About Healthcare (Young Adult Survivors): Scale | This scale measures confidence in communicating with family about healthcare concerns using a 5-point scale, with higher scores indicating greater confidence. A mean score is calculated (range from 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Self-efficacy for Managing Late Effects (Young Adult Survivors): Scale | This scale consists of three items measuring confidence in managing late effects using a 5-point scale, with higher scores indicating higher confidence. A mean score is calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Self-efficacy for Survivorship Care Planning (Young Adult Survivors): Scale | This scale consists of three items measuring confidence in survivorship care planning using a 5-point scale, with higher scores indicating higher confidence. A mean score is calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Health Insurance Self-efficacy (Young Adult Survivors): Scale | This scale consists of seven items measuring confidence in managing health insurance using a 5-point scale, with higher scores indicating higher confidence. A mean score is calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Survivorship Care Attitudes (Young Adult Survivors) | This scale consists of four items measuring attitudes toward survivorship care using a 5-point scale, with higher scores indicating more positive attitudes. A mean score is calculated (range 1-5). | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Self-efficacy for Managing Emotions (Young Adult Survivors): Scale | The Patient-Reported Outcomes Measurement Information System (PROMIS) Self-Efficacy for Managing Chronic Conditions - Managing Emotions-Short Form is an 8-item measure of confidence in managing emotions. A mean score will be calculated (range 1-5). Higher scores indicate higher confidence in managing emotions. | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline) | 
| Emotional Support (Young Adult Survivors) | The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Support-Short Form is a 4-item measure of perceived emotional support. A mean score will be calculated (range 1-5), with higher scores indicative of having better perceived emotional support. | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). | 
| Informational Support (Young Adult Survivors) | The Patient-Reported Outcomes Measurement Information System (PROMIS) Informational Support-Short Form is a 4-item measure of perceived availability of helpful information or advice. A mean score will be calculated (range 1-5), with higher scores indicating higher perceived informational support. | Baseline, Time 2 (about 2 months since baseline), Time 3 (about 5 months since baseline), Time 4 (about 12 months since baseline). |