Publications by authors named "Elyse Park"

260 Publications

"How am I going to make it through pregnancy?" A qualitative examination of prenatal maternal stress.

Birth 2021 Oct 16. Epub 2021 Oct 16.

Department of Psychology, Stony Brook University, Stony Brook, New York, USA.

Background: Prenatal maternal stress (PNMS) is common among childbearing women, and there is substantial evidence that persistent high levels of stress during pregnancy are associated with adverse birth outcomes and poorer postpartum mental health. Therefore, the purpose of this study was to examine the idiographic experiences of women who experienced elevated PNMS during their current or most recent pregnancy.

Methods: Six focus groups were conducted, and data were collected from 26 women (n = 16 pregnant and n = 10 postpartum) at a large medical center in the United States (US). Data from the semi-structured focus group prompts were analyzed by two independent raters using conventional content analysis .

Results: Three key themes emerged from the data: (1) Navigating Changing Circumstances, (2) Being a "Good" Mother, and (3) Loss of Control and Autonomy.

Discussion: The current study offers one of the first in-depth examinations of the experiences of highly stressed pregnant women using a qualitative approach and identifies stressors rarely described in quantitative research. These findings suggest that women's ability to prioritize their self-care, and receive structural/institutional supports in the workplace and instrumental support at home, and overall health literacy promote successful coping with stress and highlight important future directions for intervention.
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http://dx.doi.org/10.1111/birt.12598DOI Listing
October 2021

Development of a Prognostic Awareness Impact Scale for Patients with Advanced Cancer.

J Palliat Med 2021 Oct 11. Epub 2021 Oct 11.

Massachusetts General Hospital, Boston, Massachusetts, USA.

No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer. We developed the Prognostic Awareness Impact Scale (PAIS) using a qualitative approach. During phase 1, we convened a working group with a transdisciplinary team of clinicians from oncology ( = 2), psychology ( = 2), psychiatry ( = 1), palliative care ( = 3), and survey development ( = 1) to identify key domains of PAIS. Using a consensus-driven process, the team generated an item bank for each domain. During phase 2, we conducted cognitive interviews with 39 patients with advanced cancer to assess the understandability of the PAIS. The working group developed a conceptual framework for PAIS, identifying three domains: (1) cognitive understanding of prognosis (capacity to understand intellectually one's prognosis), (2) emotional coping (capacity to process prognostic uncertainty and terminal prognosis), and (3) adaptive response (capacity to use prognostic awareness to inform life decisions). Cognitive interviews revealed that patients had an accurate understanding of most PAIS items. Patients reported difficulty with binary response options for questions pertaining to emotional coping. They expressed difficulty answering numerous questions regarding their cognitive understanding of their prognosis. We revised the PAIS by (1) replacing binary response options with ordinal agreement scales; and (2) reducing the number of items focused on cognitive understanding of prognosis. We developed a conceptual framework to capture prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer using the PAIS. Future work should focus on validating the PAIS by testing its psychometric properties.
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http://dx.doi.org/10.1089/jpm.2021.0238DOI Listing
October 2021

Integrating tobacco treatment into lung cancer screening practices: Study protocol for the Screen ASSIST randomized clinical trial.

Contemp Clin Trials 2021 Oct 1:106586. Epub 2021 Oct 1.

Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America.

Background: Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support in Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS.

Methods: Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention.

Discussion: Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.
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http://dx.doi.org/10.1016/j.cct.2021.106586DOI Listing
October 2021

A Comprehensive Resiliency Framework: Theoretical Model, Treatment, and Evaluation.

Glob Adv Health Med 2021 24;10:21649561211000306. Epub 2021 Mar 24.

Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida.

Background: There is heterogeneity in conceptualizations of resiliency, and there is, to date, no established theoretically driven resiliency assessment measure that aligns with a targeted resiliency intervention. We operationalize resiliency as one's ability to maintain adaptive functioning in response to the ongoing, chronic stress of daily living, and we use a novel resiliency measure that assesses the target components of an evidence based resiliency intervention. We present our resiliency theory, treatment model, and corresponding assessment measure (Current Experience Scale; CES).

Methods: To establish the psychometric properties of the CES, we report the factor structure and internal consistency reliability (N = 273). Among participants in our resiliency intervention (N = 151), we explored construct validity in terms of associations with theoretical model constructs, a validated resiliency measure, and sensitivity to change from before to after the intervention.

Results: Results indicated that a 23-item, 6-factor solution was a good fit to the data (RMSEA = .08, CFI = .97; TLI =.96) and internal consistency was good (α = .81 to .95). The CES showed correlations in the expected direction with resiliency model constructs (all 's < .001) and significant post intervention improvements.

Conclusion: Our resiliency theory, treatment model, and outcome appear aligned; the CES demonstrated promise as a psychometrically sound outcome measure for our resiliency intervention and may be used in future longitudinal studies and resiliency building interventions to assess individuals' resiliency to adapt to ongoing stress.
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http://dx.doi.org/10.1177/21649561211000306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327002PMC
March 2021

Feasibility and Acceptability of a Collaborative Lung Cancer Screening Educational Intervention Tailored for Individuals With Serious Mental Illness.

J Am Coll Radiol 2021 Aug 7. Epub 2021 Aug 7.

Harvard Medical School, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

Purpose: Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and changes in attitudes toward LCS (phase 2).

Methods: Phase 1: We conducted three focus groups with mental health, primary care, and radiology clinicians and utilized rapid qualitative analysis to adapt the LCS intervention (LCS walk-through video and smoking cessation handouts) tailored for individuals with SMI. Phase 2: We enrolled LCS-eligible patients with SMI (n = 15) and assessed the feasibility (>50% enrollment; >75% completion) and acceptability (>75% overall satisfaction) of an LCS educational intervention delivered by a radiologist and a mental health clinician at a community mental health clinic. We explored changes in participant attitudes about lung cancer, LCS, and smoking before and after the intervention.

Results: Phase 1: Focus groups with primary care (n = 5), radiologists (n = 9), and mental health clinicians (n = 6) recommended person-centered language and adapting a video demonstrating the process of LCS to address concerns specific to SMI, including paranoia and concrete thinking. Phase 2: Fifty percent (15 of 30) of eligible patients enrolled in the LCS intervention, 100% (15 of 15) completed the intervention, and 93% (14 of 15) were satisfied with the intervention. Participants reported a significantly greater worry about developing lung cancer postintervention, but there were no other significant differences.

Conclusions: Radiologists can partner with primary care and community mental health clinics to lead equity efforts in LCS among individuals with SMI.
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http://dx.doi.org/10.1016/j.jacr.2021.07.010DOI Listing
August 2021

A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial.

JMIR Form Res 2021 Jun 30;5(6):e28952. Epub 2021 Jun 30.

Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.

Background: Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch.

Objective: The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study.

Methods: Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study.

Results: A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Mean 2.60 vs Mean 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03).

Conclusions: This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.
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http://dx.doi.org/10.2196/28952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280830PMC
June 2021

Moderators of a resiliency group intervention for frontline clinicians during the COVID-19 pandemic.

J Affect Disord 2021 10 24;293:373-378. Epub 2021 Jun 24.

Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Benson-Henry Institute, Boston, MA, USA; Benson-Henry Institute for Mind Body Medicine, Boston, MA, USA.

Background: To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP.

Methods: 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping.

Results: Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-R: 1.0 [0.4 to 1.6]; CAMS-R: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping.

Discussion: Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).
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http://dx.doi.org/10.1016/j.jad.2021.06.036DOI Listing
October 2021

Challenges and Growth: Lived Experience of Adolescents and Young Adults (AYA) with a Sibling with ASD.

J Autism Dev Disord 2021 Jun 13. Epub 2021 Jun 13.

Benson-Henry Institute for Mind Body Medicine, Mass General Hospital, Boston, USA.

Adolescent and young adult (AYA) siblings of individuals with autism experience unique challenges that can promote both growth and emotional maladjustment. This study explored sibling and parent reports of siblings' lived experiences and identified learning, stressors, and concerns from those experiences. 20 neurotypical (NT) AYA siblings (ages 13-24), and 21 parents were interviewed. Themes that emerged from the data analysis included: (1) learning, empathy, and compassion (2) relationship between the degree of functional impairment and the nature of the sibling relationship; (3) reluctance to share information about siblings with peers; (4) hypervigilance associated with unpredictable behavior; (5) worries and concerns about the future. These findings contribute to the existing literature on the impact and nature of neurotypical siblings' lived experience.
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http://dx.doi.org/10.1007/s10803-021-05135-0DOI Listing
June 2021

Examining the effects of stress and psychological distress on smoking abstinence in cancer patients.

Prev Med Rep 2021 Sep 18;23:101402. Epub 2021 May 18.

Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States.

Introduction: Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence.

Methods: Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n = 72) completed qualitative exit-interviews.

Results: Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group × time interactions or main effects of treatment group on stress or distress measures (p's > 0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p's < 0.05). In adjusted logistic regression models, lower levels anxiety at 3 months predicted confirmed smoking abstinence at 6 months (p = .03). Qualitatively, at 6 months, patients reported their stress and smoking were connected and that the cessation counseling was helpful.

Conclusions: Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.
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http://dx.doi.org/10.1016/j.pmedr.2021.101402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163988PMC
September 2021

Predictors of Enrollment of Older Smokers in Six Smoking Cessation Trials in the Lung Cancer Screening Setting: The Smoking Cessation at Lung Examination (SCALE) Collaboration.

Nicotine Tob Res 2021 Jun 2. Epub 2021 Jun 2.

Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States.

Significance: Increased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer. The NCI's Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings.

Methods: We included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining.

Results: Of 6,285 trial- and LCS-eligible individuals, 3,897 (62%) declined and 2,388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to 'NRT Only' trials, those approached for 'NRT+prescription medication' trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using 'Phone+In Person' methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using 'Phone Only' methods. Some of the reasons for declining enrollment included 'too busy' (36.6%), 'not ready to quit' (8.2%), 'not interested in research' (7.7%), and 'not interested in the intervention offered' (6.2%).

Conclusion: Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers.

Implications: We explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites. The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.
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http://dx.doi.org/10.1093/ntr/ntab110DOI Listing
June 2021

Material, behavioral, and psychological financial hardship among survivors of childhood cancer in the Childhood Cancer Survivor Study.

Cancer 2021 Sep 1;127(17):3214-3222. Epub 2021 Jun 1.

University of Utah, Salt Lake City, Utah.

Background: Medical financial burden includes material, behavioral, and psychological hardship and has been underinvestigated among adult survivors of childhood cancer.

Methods: A survey from 698 survivors and 210 siblings from the Childhood Cancer Survivor Study was analyzed. The intensity of financial hardship was estimated across 3 domains: 1) material, including conditions that arise from medical expenses; 2) behavioral, including coping behaviors to manage medical expenses; and 3) psychological hardship resulting from worries about medical expenses and insurance, as measured by the number of instances of each type of financial hardship (0, 1-2, and ≥3 instances). Multivariable logistic regressions were conducted to examine the clinical and sociodemographic predictors of experiencing financial hardship (0-2 vs ≥3 instances).

Results: The intensity of financial hardship did not significantly differ between survivors and siblings. Survivors reported more instances of material hardship than siblings (1-2 instances: 27.2% of survivors vs 22.6% of siblings; ≥3 instances: 15.9% of survivors vs 11.4% siblings; overall P = .03). In multivariable regressions, insurance was protective against all domains of financial hardship (behavioral odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06-0.22; material OR, 0.37; 95% CI, 0.19-0.71; psychological OR, 0.10; 95% CI, 0.05-0.21). Survivors who were older at diagnosis, female, and with chronic health conditions generally had higher levels of hardship. Brain radiation and alkylating agents were associated with higher levels of hardship.

Conclusions: Material, behavioral, and psychological financial burden among survivors of childhood cancer is common.
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http://dx.doi.org/10.1002/cncr.33613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489494PMC
September 2021

Increasing Lung Screening in the Latino Community.

J Am Coll Radiol 2021 05;18(5):633-636

Assistant Chair for Clinical Research, Department of Radiology, University of Michigan Medical Center, Ann Arbor Michigan; and University of Michigan, School of Medicine, Ann Arbor, Michigan.

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http://dx.doi.org/10.1016/j.jacr.2021.03.007DOI Listing
May 2021

A Pilot Study of a Stress Management Program for Incarcerated Veterans.

Mil Med 2021 Mar 27. Epub 2021 Mar 27.

Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.

Introduction: Veterans involved in the justice system are an understudied population warranting attention given their higher risk of mental health concerns and psychosocial challenges. Thus, there is a need for programs to support the psychological health of incarcerated veterans. The present study sought to determine the acceptability and effectiveness of a mind-body stress reduction program for incarcerated veterans.

Materials And Methods: Twenty-four incarcerated veterans (100% male; Mage = 44.87 (SD = 13.84)) completed a 6 week mind-body stress reduction course, or Resilient Warrior. Participants completed validated, self-report assessments of mood, functioning, mindfulness, and coping at pre- and post-program as well as having post-program qualitative feedback surveys.

Results: Results showed improvement in depressive symptom severity, self-efficacy, and resilience over the study duration (P < .05), but not stress reactivity, mindfulness, sleep disturbance, or perceived stress. The intervention was reported as helpful by 96% of participants, with 86% of participants stating they would recommend the course to others.

Conclusions: The Resilient Warrior program is acceptable and well-tolerated for incarcerated veterans as well as may improve aspects of psychological health. Future studies could examine how stress reductions program might improve recidivism rates and quality of life after the release of incarcerated veterans.
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http://dx.doi.org/10.1093/milmed/usab121DOI Listing
March 2021

Association of Cigarette Use and Substance Use Disorders among US Adults with and without a Recent Diagnosis of Cancer.

Curr Oncol 2020 12 12;28(1):86-93. Epub 2020 Dec 12.

Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.

Background: Few studies have examined substance use disorders (SUDs) in cancer patients and it is unclear whether SUDs differentially impact cigarette smoking in patients with vs. without cancer. This study used epidemiological data to estimate current cigarette smoking prevalence and quit ratios among US adults with and without SUDs by cancer status.

Methods: Data were drawn from the 2015-2018 National Survey on Drug Use and Health ( = 170,111). Weighted current smoking prevalence and quit ratios were estimated across survey years by SUDs (with vs. without) and by cancer status (with vs. without).

Results: Among those with cancer, current smoking prevalence was higher for those with vs. without SUDs (47% vs. 13%, < 0.001) and quit ratios lower for those with vs. without SUDs (45% vs. 71%, = 0.002). A similar pattern was observed in adults without cancer, with higher smoking prevalence (56% vs. 21%, < 0.001) and lower quit ratios (23% vs. 51%, < 0.001) observed for those with vs. without SUDs, respectively. In adjusted logistic regressions, the SUD × cancer status interaction was not significant for smoking prevalence or quit ratios (AOR = 1.2; 95% CI: 0.7, 2.1, = 0.56; AOR = 1.0; 95% CI: 0.5, 2.0, = 0.91, respectively), though smoking prevalence was lower and quit ratios higher for adults with vs. without cancer ( < 0.05).

Conclusions: Among US adults with and without cancer, individuals with SUDs evidenced higher cigarette smoking and lower quit ratios than those without SUDs. Addressing SUDs and their impact on smoking cessation is critical in cancer patients with implications for improving health and treatment outcomes.
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http://dx.doi.org/10.3390/curroncol28010011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816172PMC
December 2020

Lower distress tolerance is associated with greater anxiety and depression symptoms among patients after acute coronary syndrome.

Gen Hosp Psychiatry 2021 May-Jun;70:143-144. Epub 2021 Feb 2.

Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Benson-Henry Institute for Mind-Body Medicine, Boston, MA, USA.

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http://dx.doi.org/10.1016/j.genhosppsych.2021.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320852PMC
February 2021

PSST! I Need Help! Development of a Peer Support Program for Clinicians Having Serious Illness Conversations During COVID-19.

J Gen Intern Med 2021 Apr 26;36(4):1094-1097. Epub 2021 Jan 26.

Continuum Project, Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1007/s11606-020-06565-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837336PMC
April 2021

Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic.

Int J Environ Res Public Health 2021 01 24;18(3). Epub 2021 Jan 24.

Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

The impact of the COVID-19 pandemic on US adults' smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May-June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.
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http://dx.doi.org/10.3390/ijerph18031011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908271PMC
January 2021

Examining the effects of problematic alcohol use on cigarette abstinence in recently diagnosed cancer patients enrolled in a cessation trial: A secondary analysis.

Addict Behav 2021 04 29;115:106794. Epub 2020 Dec 29.

Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Tobacco Research and Treatment Center, Department of Medicine and Health Policy Research Center, The Mongan Institute, MGH, Boston, MA, United States.

Aims: Among people with cancer, dual alcohol and tobacco use increases risk for morbidity and mortality. Most smoking cessation clinical trials with this patient population have excluded individuals with problematic alcohol use. This investigation examined whether problematic alcohol use affects smoking cessation in cancer patients.

Methods: Mixed-methods secondary analysis of data from the Smokefree Support Study, a randomized-controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Problematic alcohol use was assessed at enrollment using the Cut-Down-Annoyed-Guilty-Eye-Opener (CAGE), weekly frequency of alcohol use and binge drinking measures. Alcohol use was categorized as: no current alcohol use, moderate and problematic use. The primary outcome was biochemically-confirmed cigarette abstinence at 6-months. A subset of patients (n = 72) completed qualitative exit-interviews.

Results: Among all participants, biochemically-confirmed cigarette abstinence rates were 25% (n = 32), 28% (n = 27), and 36% (n = 20) for participants reporting no current alcohol use, moderate use, and problematic use, respectively (p = 0.33). In logistic regression analysis, neither problematic alcohol use (AOR = 0.96, 95% CI = 0.35-2.67, p = .94) nor the problematic use by study arm interaction (AOR = 2.22, 95% CI = 0.59-8.39, p = .24) were associated with biochemically-confirmed 6-month abstinence. Qualitatively, participants reported that drinking alcohol triggers urges to smoke.

Conclusion: Newly diagnosed cancer patients reporting problematic alcohol use were not less likely to quit smoking than those without. Additional research is needed to investigate whether problematic alcohol users may benefit from smoking and alcohol behavior change interventions at the time of cancer diagnosis.
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http://dx.doi.org/10.1016/j.addbeh.2020.106794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118391PMC
April 2021

A positive psychology-motivational interviewing program to promote physical activity in type 2 diabetes: The BEHOLD-16 pilot randomized trial.

Gen Hosp Psychiatry 2021 Jan-Feb;68:65-73. Epub 2020 Dec 11.

Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Background: The majority of persons with type 2 diabetes (T2D) do not meet recommended levels of physical activity, despite clear links between physical activity and superior medical outcomes in this population. The objective of this trial was to assess the feasibility and impact of a novel 16-week combined positive psychology-motivational interviewing (PP-MI) program to promote physical activity among inactive persons with T2D.

Methods: This pilot randomized trial compared the 16-week, phone-delivered PP-MI intervention to an attention-matched diabetes counseling condition among 70 persons with T2D and low levels of baseline moderate to vigorous physical activity (MVPA; <150 min/week). The primary study outcomes were feasibility (assessed via rates of session completion) and acceptability (assessed via mean participant ratings [0-10] of the ease and utility of weekly sessions). Key secondary outcomes included between-group differences in improvement in positive affect, other psychological outcomes, and accelerometer-measured physical activity, assessed using mixed effects regression models, at 16 and 24 weeks.

Results: Participants completed a mean 11.0 (SD 4.4; 79%) of 14 PP-MI phone sessions, and composite mean ratings of ease/utility were 8.6/10, above our a priori benchmarks for feasibility/acceptability (70% session completion; 7.0/10 mean ratings). PP-MI participants had small to medium effect size (ES) difference improvements in MVPA (ES difference = 0.34) and steps/day (ES difference = 0.76) at 16 weeks, with sustained but smaller effects at 24 weeks (ES difference = 0.22-0.33).

Conclusions: Next-step studies of this PP-MI program in T2D patients can more rigorously explore the intervention's effects on physical activity and clinical outcomes.
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http://dx.doi.org/10.1016/j.genhosppsych.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307449PMC
December 2020

Responding to COVID-19 Stress: Disseminating Mind-Body Resiliency Approaches.

Glob Adv Health Med 2020 1;9:2164956120976554. Epub 2020 Dec 1.

Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

The COVID-19 pandemic has resulted in unprecedented stress and uncertainty, particularly among vulnerable populations such as healthcare workers who are facing a multitude of current and looming economic and psychosocial stressors. As clinician-scientists delivering mind-body interventions in our hospital, we suggest applying evidence-based mind-body techniques that promote resiliency and adaptive coping during these difficult times. Interventions that package a variety of mind-body skills into one cohesive program, such as the Stress Management and Resiliency Training - Relaxation Response Resiliency Program (SMART-3RP), offer promise for meeting the variety of stress management needs (e.g., health concerns, isolation) present during the COVID-19 pandemic. From our work with frontline healthcare clinicians and other caregiver populations, we offer recommendations for adapting the delivery, modality, and content of mind-body practices during the COVID-19 pandemic and suggest key skills for promoting resiliency and buffering against the future stressors that lie ahead for everyone.
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http://dx.doi.org/10.1177/2164956120976554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716064PMC
December 2020

A virtual resiliency program for lymphoma survivors: helping survivors cope with post-treatment challenges.

Psychol Health 2020 Nov 28:1-16. Epub 2020 Nov 28.

Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.

To adapt and test the feasibility, acceptability, and preliminary efficacy of an 8-week resiliency group program for posttreatment lymphoma survivors.. This is an exploratory mixed methods study. Phase 1: We conducted qualitative interviews to inform program adaptation. Phase 2: Using a single-arm pilot design, we assessed program feasibility, acceptability, and preliminary efficacy (exploratory outcomes: stress coping, uncertainty intolerance, distress). We also examined the feasibility of collecting hair cortisol samples.. Phase 1: Survivors reported feeling socially isolated as they grappled with lingering symptoms that interfered with their return to normalcy. Fears about recurrence triggered bodily hypervigilance. Survivors desired wellness programs that 1) target their whole-body experience, 2) promote social connectedness, and 3) manage fear of recurrence. Phase 2: Thirty-seven survivors enrolled. Participants completed a median of 7/8 sessions, and 76.9% completed ≥6/8 sessions; 65% provided a hair sample. Survivors demonstrated improvements in stress coping (d = .67), uncertainty tolerance (d = .71), and anxiety (d = .41) at program completion.. Findings suggest promising feasibility and efficacy of this program in addressing posttreatment survivorship challenges, particularly fears of uncertainty. A cancer care model that adopts early integration of this program posttreatment has the potential to improve survivors' emotional, social and physical well-being.
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http://dx.doi.org/10.1080/08870446.2020.1849699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160021PMC
November 2020

Development and Refinement of a Telehealth Intervention for Symptom Management, Distress, and Adherence to Adjuvant Endocrine Therapy after Breast Cancer.

J Clin Psychol Med Settings 2021 09 21;28(3):603-618. Epub 2020 Nov 21.

Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Yawkey, Suite 10B, Boston, MA, 02114, USA.

Adjuvant endocrine therapy (AET) prevents recurrence after early stage, hormone sensitive breast cancer; however, adherence to AET is suboptimal, and efficacious interventions are severely lacking. Barriers to adherence are well established; however, interventions, thus, far have failed to produce meaningful changes in adherence and have generally not followed guiding principles of psychosocial intervention development. The purpose of this paper is to describe the iterative development, using the National Institutes of Health Stage Model for Behavioral Intervention Development, of an evidence-based, patient-centered, telehealth intervention to enhance adherence, improve symptom management, and reduce distress for patients taking AET after breast cancer, with a focus on (1) a small open pilot study which informed modifications and refinement of the intervention based on quantitative and qualitative patient feedback about feasibility and acceptability and (2) the underlying theoretical and empirical rationale for each component of the finalized intervention. Clinical implications and directions for future research are discussed.
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http://dx.doi.org/10.1007/s10880-020-09750-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137723PMC
September 2021

Feasibility and preliminary efficacy of a positive psychology-based intervention to promote health behaviors in heart failure: The REACH for Health study.

J Psychosom Res 2020 12 29;139:110285. Epub 2020 Oct 29.

Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Objective: Most patients with heart failure (HF) struggle to adhere to health behaviors, and existing health behavior interventions have significant limitations. We developed a 12-week, phone-delivered, combined positive psychology (PP) and motivational interviewing (MI) intervention to promote well-being and adherence to physical activity, diet, and medications. In this three-arm, randomized trial, we assessed the feasibility, acceptability, and preliminary efficacy of the intervention compared to treatment as usual and MI-alone conditions in 45 patients with HF and suboptimal health behavior adherence.

Methods: Participants in the PP-MI or MI-alone conditions completed weekly phone sessions for 12 weeks. Those in PP-MI completed weekly PP exercises and set health behavior goals, while those in the MI-alone condition learned about HF-specific health behaviors and identified potential behavior changes. Primary study outcomes were feasibility (sessions completed) and acceptability (0-10 ratings of PP exercise ease and utility). The intervention's impact on psychological and behavioral outcomes was assessed using mixed effects regression analyses.

Results: Participants in the PP-MI condition completed 73% of sessions and rated PP exercises as easy to complete (mean = 7.5 [SD 1.7] out of 10) and subjectively useful (mean = 7.5 [SD 1.6] out of 10). Compared to the control conditions, PP-MI led to medium effect-size improvements in positive affect (Cohen's d = 0.32-0.77), moderate to vigorous physical activity (d = 0.41-0.74), and medication adherence (d = 0.48-0.78).

Conclusion: This PP-MI intervention was feasible, well-accepted, and associated with promising improvements in well-being and health behavior outcomes. Larger trials are needed to examine this intervention's impact on health behavior adherence and other important outcomes (NCT03220204).
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http://dx.doi.org/10.1016/j.jpsychores.2020.110285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719591PMC
December 2020

Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer: A Randomized Clinical Trial.

JAMA 2020 10;324(14):1406-1418

Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care.

Objective: To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking.

Design, Setting, And Participants: This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018.

Interventions: Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline).

Main Outcome And Measures: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates.

Results: Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2).

Conclusions And Relevance: Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research.

Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.
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http://dx.doi.org/10.1001/jama.2020.14581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094414PMC
October 2020

A pilot study of a mind-body stress management program for student veterans.

Complement Ther Clin Pract 2020 Aug 6;40:101221. Epub 2020 Jul 6.

Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, USA; Harvard Medical School, USA.

Background: Student veterans are an at-risk population given the challenges of military experience, reintegration to civilian life, and attending college. Therefore, there is a need for innovative programs to support student veterans. The present study sought to determine the acceptability and effectiveness of a 10-week mind-body stress reduction intervention for student veterans, or Resilient Student Warrior.

Materials And Methods: Eighty-six student veterans took part in the 10-week mind-body stress reduction course, Resilient Student Warrior.

Results: Results showed a significant improvement in reports of stress reactivity, mindfulness, sleep disturbance and coping skills for stress (p < 0.05), but not self-efficacy, perceived stress, depressive or post-traumatic stress disorder symptoms. The intervention was reported as helpful by 96% of participants, with 95% of participants stating they would recommend the course to others.

Conclusion: Future studies should further assess the effectiveness of mind-body interventions among the student veteran population.
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http://dx.doi.org/10.1016/j.ctcp.2020.101221DOI Listing
August 2020

How Do Positive Psychological Constructs Affect Physical Activity Engagement Among Individuals at High Risk for Chronic Health Conditions? A Qualitative Study.

J Phys Act Health 2020 09 4;17(10):977-986. Epub 2020 Sep 4.

Background: Positive psychological constructs (eg, optimism, positive affect) may help people engage in physical activity, though the details of these relationships and their directionality have not been studied in depth in people with cardiovascular risk factors. The objectives of this study were to use qualitative research to explore the relationships of positive psychological constructs with physical activity among people with metabolic syndrome.

Methods: Participants with metabolic syndrome and low physical activity from an academic medical center completed semistructured phone interviews about associations between physical activity and positive psychological constructs, and perceptions about benefits, motivation, and barriers to physical activity.

Results: The participants (n = 21) were predominantly older (mean age = 63 y) white (95.2%) women (61.9%). Engaging in physical activity was commonly associated with enjoyment, energy, relaxation, accomplishment, and determination. Experiencing positive psychological constructs like enjoyment, energy, connectedness, optimism, and determination also helped them engage in physical activity. Perceived benefits, facilitators, and barriers of physical activity engagement were noted.

Conclusions: The participants at high risk for chronic diseases described many specific positive psychological constructs that both promote and result from physical activity. Testing ways to increase positive psychological constructs may be a novel way to help people at high risk of chronic diseases become more active.
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http://dx.doi.org/10.1123/jpah.2019-0295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930134PMC
September 2020

Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer.

J Pain Symptom Manage 2021 03 31;61(3):488-494. Epub 2020 Aug 31.

Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.

Context: Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited.

Objectives: To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL.

Methods: We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL.

Results: Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms.

Conclusion: Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.08.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914132PMC
March 2021

A Pilot Mind-Body Resiliency Intervention Targeting Fear of Recurrence among Cancer Survivors.

J Psychosom Res 2020 Aug 10;137:110215. Epub 2020 Aug 10.

Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America.

Objective: Interventions for fear of recurrence (FOR) of cancer have nominal effects, perhaps due to limited integration of empirically supported skills. This pilot trial tested the acceptability and feasibility of a multimodal, mind-body resiliency intervention targeting FOR among survivors of various cancers.

Methods: Early stage cancer survivors 3-30 months post-treatment were recruited to participate in an eight-session in-person mind-body resiliency group intervention that taught relaxation skills, cognitive-behavioral techniques, healthy lifestyle behaviors, mindfulness meditation, and positive psychology skills all targeted for FOR. Primary outcomes were feasibility (enrollment rate, session attendance, survey completion, skills practice) and acceptability (enjoyableness, convenience, helpfulness, relevance). Patient-reported outcomes (FOR, uncertainty intolerance, cancer-related uncertainty, perceived stress, resiliency, positive affect, and coping skills) were collected at baseline, post-intervention, +1 month, and +3 months. Exit interviews assessed survivors' reported benefits.

Results: Participants (N = 4 groups, 23 survivors, enrollment response rate = 58%) included survivors of seven common cancer types who were on average 12 months post-treatment. Attendance was high (M = 6.1 sessions), and 96% of survivors completed all surveys. Sustained increases in relaxation skills practice 3+ days/week were reported (baseline = 16%, post-intervention = 76%, +3 months = 71%). Most sessions (87%) were rated as highly or very highly acceptable. Moderate-to-large (d = 0.87) improvements in FOR severity were observed post-intervention (p < .01) and across assessments (p < .01), with similar changes observed in other patient-reported outcomes. Exit interviews revealed behavioral, cognitive, emotional, and existential benefits.

Conclusions: The targeted mind-body resiliency intervention shows promising acceptability, feasibility, and favorable changes in FOR and coping skills practice. Further adaptation and testing in a randomized trial are warranted. ClinicalTrials.govRegistration Number: NCT03695406.
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http://dx.doi.org/10.1016/j.jpsychores.2020.110215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873146PMC
August 2020
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