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Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.

ABSTRACT: OBJECTIVE:Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence (FOR), and one of the most salient facets is the worry that a recurrence of cancer could cause one's death. The primary goal of the present study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR, positing pursuit of meaningful goals as a theoretically driven putative mediator. To replicate published tests of similar gratitude-eliciting interventions, positive affect (PA) was also considered as an outcome. METHOD:Sixty-seven women with early stage breast cancer were randomly assigned to either a 6-week online gratitude intervention or a 6-week online control condition. Outcomes were assessed at pre- and posttreatment, as well as 1 month and 3 months after the end of treatment. The mediator, meaningful goal pursuit, was measured via assessments over the 6-week intervention period. RESULTS:Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition. Moreover, this effect was significantly mediated by meaningful goal pursuit (and not by PA). The gratitude intervention was also found to prevent declines in PA observed in the control condition. CONCLUSIONS:Overall, findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR. (PsycINFO Database Record

SUBMITTER: Otto AK

PROVIDER: S-EPMC6805141 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.

Otto Amy K AK Szczesny Elana C EC Soriano Emily C EC Laurenceau Jean-Philippe JP Siegel Scott D SD

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20160811 12

<h4>Objective</h4>Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence (FOR), and one of the most salient facets is the worry that a recurrence of cancer could cause one's death. The primary goal of the present study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR, positing pursuit of meaningful goals as a theoretically driven putative mediator. To replicate published tests of s ...[more]

PMID: 27513475

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Project description:BackgroundFear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS) yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, "FoRtitude," to reduce FoR using cognitive behavioral skills training and telecoaching.MethodsBCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years post-primary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomized to three cognitive behavioral skill (Relaxation, Cognitive restructuring, Worry practice) versus an attention control condition (health management content; HMC), and to telecoaching (motivational interviewing) versus no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory (FCRI) at baseline, 4 and 8 weeks. FCRI scores over time were compared using mixed-effects models. All statistical tests were 2-sided.ResultsFCRI scores decreased statistically significantly from baseline to post-intervention (T0=53.1 [SD = 17.4], T2=41.9 [SD = 16.2]; p < 0.001). The magnitude of reduction in FCRI scores was comparable across CBT and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score = 26.6 [SD = 7.2] vs. 21.0 [SD = 10.5]; p < 0.001).ConclusionsBCS experienced statistically significant reductions in FoR post-intervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR is needed. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.

Project description:BackgroundFear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS.MethodsPost-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis.ResultsSatisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress.ConclusionsGroup-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.

Dataset Information

Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.

Publications

Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.

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