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An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial

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Abstract

Background

Young adult (YA) cancer survivors experience clinically significant distress and have limited access to psychosocial support. Given growing evidence for unique adaptive benefits of positive emotion in the context of health-related and other life stress, we developed an eHealth positive emotion skills intervention for post-treatment survivors called EMPOWER (Enhancing Management of Psychological Outcomes With Emotion Regulation) and evaluated feasibility and proof of concept for reducing distress and enhancing well-being.

Method

In this single-arm pilot feasibility trial, post-treatment YA cancer survivors (ages 18–39) participated in the EMPOWER intervention which included 8 skills (e.g., gratitude, mindfulness, acts of kindness). Participants completed surveys at baseline (pre-intervention), 8 weeks (post-intervention), and 12 weeks (1-month follow-up). Primary outcomes included feasibility (assessed by participation percentage) and acceptability (would recommend EMPOWER skills to a friend). Secondary outcomes included psychological well-being (mental health, positive affect, life satisfaction, meaning/purpose, general self-efficacy) and distress (depression, anxiety, anger).

Results

We assessed 220 YAs for eligibility; 77% declined. Of those screened, 44 (88%) were eligible and consented, 33 began the intervention, and 26 (79%) completed the intervention. Overall retention was 61% at 12 weeks. Average acceptability ratings were high (8.8/10). Participants (M = 30.8 years, SD = 6.6) were 77% women, 18% racial/ethnic minorities, and 34% breast cancer survivors. At 12 weeks, EMPOWER was associated with improved mental health, positive affect, life satisfaction, meaning/purpose, and general self-efficacy (ps < .05, ds = .45 to .63) and decreased anger (p < .05, d =  − 0.41).

Conclusion

EMPOWER demonstrated evidence of feasibility and acceptability as well as proof of concept for enhancing well-being and reducing distress. Self-guided, eHealth interventions show promise for addressing YA cancer survivors’ needs and warrant additional research to optimize survivorship care.

Trial Registration

ClinicalTrials .gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154

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Availability of Data and Material

The data analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to express their deep gratitude to the young adult cancer survivors who graciously provided their time and input to participate in and evaluate this intervention. Their investment led to improvements that we hope will benefit other young adults with cancer as part of future efficacy testing for EMPOWER. We would also like to thank Drs. Abby Rosenberg and Stacy Sanford for their thoughtful review and feedback of our intervention content that led to important refinements prior to pilot testing.

Funding

Research reported in this publication was supported by the National Cancer Institute of the NIH under award number K07CA158008 (PI: Salsman) & R01CA242849 (MPIs: Salsman & Moskowitz). Dr. McLouth was supported by NCI R25 CA122061 (PI: Avis).

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Authors and Affiliations

  1. Department of Social Sciences and Health Policy, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    John M. Salsman

  2. Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA

    Laurie E. McLouth

  3. Department of Biostatistics and Data Science, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA

    Janet A. Tooze

  4. Health Care Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Denisha Little-Greene

  5. Google Inc, San Francisco, CA, USA

    Michael Cohn

  6. Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mia Sorkin Kehoe

  7. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Judith T. Moskowitz

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  1. John M. Salsman
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  2. Laurie E. McLouth
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  3. Janet A. Tooze
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  4. Denisha Little-Greene
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  5. Michael Cohn
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  6. Mia Sorkin Kehoe
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  7. Judith T. Moskowitz
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Contributions

Drs. John M. Salsman and Judith T. Moskowitz were responsible for the study conception and design. Material preparation and data collection were performed by Drs. Laurie E. McLouth and Michael Cohn and by Mss. Denisha Little-Greene and Mia Sorkin. Data analysis was performed by Dr. Janet A. Tooze. The first draft of the manuscript was written by Dr. John M. Salsman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to John M. Salsman.

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Ethics Approval

All study procedures involving human participants were in accordance with the ethical standards of the institutional review boards at the Northwestern University Feinberg School of Medicine and the Wake Forest University School of Medicine and with the 1964 Helsinki declaration and its later amendments.

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All participants provided informed consent prior to beginning the study.

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The authors declare no competing interests.

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Salsman, J.M., McLouth, L.E., Tooze, J.A. et al. An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial. Int.J. Behav. Med. 30, 639–650 (2023). https://doi.org/10.1007/s12529-023-10162-5

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