Evaluation of a Writing Intervention to Reduce Distress in Patients with Metastatic Cancer

Inclusion Criteria

• Diagnosed with solid tumor cancer at stage III (locally metastatic) or stage IV (distantly metastatic) or solid tumor cancer that has recurred, or actively treated lymphoproliferative cancer (e.g., non-solid tumor cancer)
• Report elevated cancer-related trauma symptoms or fear of cancer progression on the screening measures: Impact of Event Scale (IES-R): mean of 1.5 (or total score of 33) (38), Fear of Progression Questionnaire (FoP-Q) 12-item short version: mean score of 2.5 (or total score of 30)
• Age 18 or older
• No moderate to severe dementia reported by patient or seen during eligibility confirmation in the medical chart
• Are capable at time of consent of understanding and voluntarily consenting themselves to the study, attending EASE sessions, and completing the online sessions at home, confirmed by an Eastern Cooperative Group Performance Status Scale of 0 to 2, a range and cutoff used by many palliative care research groups. Given that the study does not require individuals to leave their home, we will make an exception for individuals endorsing an Eastern Cooperative Group Performance Status scale score of 3 (confined to bed or chair for < 50% of waking hours, able to do only limited selfcare) if they meet all other study criteria, including criteria 6
• Report that they are able and willing to complete all study procedures, including the online assessments and the intervention itself, including being physically able to write by hand or type for 30 minutes at a time and do weekly hour-long EASE sessions via telehealth
• Has access to a computer with internet connection or are willing to use a study-loaned computer tablet for the study duration, and are willing to conduct sessions via telehealth (Zoom or phone as a backup) on the computer * Note: Individuals who lack a working computer or tablet will be eligible as long as they have access to Wi-Fi and are willing to use a study-loaned computer tablet for the duration of the study, a procedure we have piloted previously. If they borrow a study-loaned tablet, the research team will provide study-specific technical instructions and support to participants who need or request it. Subjects who are loaned tablets will be asked to sign a consent clearly informing them when that the study team may track the location of the tablet in the incident it is lost or stolen and that they must return the tablet to the study team within one month after completing the follow up survey. The tablet loan contract will also notify subjects of a change in their study payment schedule. For subjects who are loaned a tablet, the final study payment and bonus will be withheld until we receive the tablet back. If the tablet is not returned or is returned damaged the above payment will be forfeited