A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study

Fladeboe, Kaitlyn; O’Donnell, Maeve B.; Barton, Krysta S.; Bradford, Miranda C.; Steineck, Angela; Junkins, Courtney C.; Yi‐Frazier, Joyce P.; Rosenberg, Abby R.

doi:10.1002/cncr.33830

Cited by 27 publications

(41 citation statements)

References 34 publications

(52 reference statements)

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“…Prioritizing appropriate communication training (EPEC, 2019; The Conversation Project, 2020; Vital Talk, 2021), and incorporating ACP discussions into routine care alongside the use of a structured ACP guide, may greatly improve patient-centered EoL care. A recent study found integrating ACP using pages of VMC into an existing resilience-coaching intervention for AYAs with advance cancer both feasible and acceptable (Fladeboe et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions

et al. 2021

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Objectives To determine whether engaging in advance care planning (ACP) using a formal tool, Voicing My CHOiCES (VMC), would alleviate adolescent and young adults (AYAs) anxiety surrounding ACP and increase social support and communication about end-of-life care preferences with family members and health care providers (HCPs). Methods A total of 149 AYAs aged 18–39 years receiving cancer-directed therapy or treatment for another chronic medical illness were enrolled at seven US sites. Baseline data included prior ACP communication with family members and HCPs and measures of generalized anxiety, ACP anxiety, and social support. Participants critically reviewed each page of VMC and then completed three pages of the document. ACP anxiety was measured again immediately after the completion of VMC pages. One month later, participants repeated anxiety and social support measures and were asked if they shared what they had completed in VMC with a family member or HCP. Results At baseline, 50.3% of participants reported that they previously had a conversation about EoL preferences with a family member; 19.5% with an HCP. One month later, 65.1% had subsequently shared what they wrote in VMC with a family member; 8.9% shared with an HCP. Most (88.6%) reported they would not have had this conversation if not participating in the study. No significant changes occurred in social support. There was an immediate drop in anxiety about EoL planning after reviewing VMC which persisted at 1 month. Generalized anxiety was also significantly lower 1 month after reviewing VMC. Significance of results Having a document specifically created for AYAs to guide ACP planning can decrease anxiety and increase communication with family members but not necessarily with HCPs. Future research should examine ways ACP can be introduced more consistently to this young population to allow their preferences for care to be heard, respected, and honored, particularly by their healthcare providers.

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Section: Discussionmentioning

confidence: 99%

Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions

et al. 2021

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“…conducted directed content analysis with Dedoose qualitative analysis software, version 7.0.23 (SocioCultural Research Consultants LLC) using an a priori codebook based on questions from the interview guide and informed by previous PRISM trials. 39 Once the codebook was finalized, the same coders sequentially coded each transcript into code categories. Consensus meetings refined codes and resolved discrepancies.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Resilience Training for Hospital Employees in the Era of COVID-19

et al. 2022

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IMPORTANCE Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described. OBJECTIVETo assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience. DESIGN, SETTING, AND PARTICIPANTSA pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system. INTERVENTION The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/ chronic illness, was adapted to support health care workers and staff ("PRISM at Work"). It included 6 weekly 1-hour group sessions. MAIN OUTCOMES AND MEASURES Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates. RESULTS A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = −2.40; 95% CI, −3.28 to −1.51), anxiety (β = −2.04; 95% CI, −2.74 to −1.34), and burnout-exhaustion (β = −0.37; 95% CI, −0.56 to −0.18) improved after the program. CONCLUSIONS AND RELEVANCEResults of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.

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“…Based on other studies assessing the feasibility of an intervention for children and their parents, the following feasibility criteria were pre-defined: Eligibility: ≥70% of patients are eligible for the intervention [ 48 , 49 ]. Recruitment: ≥50% of patients approached are recruited [ 50 , 51 , 52 ]. Retention: ≥75% of participants are retained in the intervention after one year [ 49 , 51 ].…”

Section: Methodsmentioning

confidence: 99%

“… Retention: ≥75% of participants are retained in the intervention after one year [ 49 , 51 ]. Attendance: ≥70% of participants attend the planned visits (initial evaluation and follow-up visits) [ 50 , 51 ]. Completion of study measures: acceptable if ≥70% of participants complete the measures and feasible if ≥85% of participants do so [ 48 , 51 ].…”

Section: Methodsmentioning

confidence: 99%

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Early Nutritional Intervention to Promote Healthy Eating Habits in Pediatric Oncology: A Feasibility Study

et al. 2022

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This study aims to describe the feasibility of a nutritional intervention that promotes healthy eating habits early after cancer pediatric diagnosis in patients and their parents. Participants were recruited 4 to 12 weeks after cancer diagnosis as part of the VIE study. The one-year nutritional intervention included an initial evaluation and 6 follow-up visits every 2 months with a registered dietician. The feasibility assessment included rates of retention, participation, attendance, completion of study measures, and participants’ engagement. A preliminary evaluation of the intervention's impact on the participants’ dietary intakes was conducted. A total of 62 participants were included in the study (51.6% male, mean age = 8.5 years, mean time since diagnosis = 13.2 weeks). The retention and attendance rates were 72.6% and 71.3%, respectively. Attendance to follow-up visits declined over time, from 83.9% to 48.9%. A majority of participants had high participation (50.8%) and high engagement (56.4%). Measures of body-mass-index or weight-for-length ratio and dietary 24-h recalls were the procedures with the highest completion rates. Participants with refractory disease or relapse were less likely to complete the intervention. Post-intervention, participants (n = 21) had a lower sodium intake compared to the initial evaluation. These results suggest that a nutritional intervention that involves patients and parents early after a pediatric cancer diagnosis is feasible.

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A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study

Cited by 27 publications

References 34 publications

Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions

Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions

Assessment of Resilience Training for Hospital Employees in the Era of COVID-19

Early Nutritional Intervention to Promote Healthy Eating Habits in Pediatric Oncology: A Feasibility Study

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