Acceptance and Commitment Therapy, Hematopoietic Cell Transplantation Recipient
Conditions
Keywords
cancer patients, hematopoietic cell transplantation, ACT-based intervention, web-based intervention, meaning-making, subjective well-being, psychological flexibility, randomized controlled trial, single-case experimental design
Brief summary
This trial aimed to test internet-based Acceptance and Commitment Therapy (ACT) intervention to induce a meaning-making process in cancer patients following hematopoietic cell transplantation (HCT). ACT includes identifying personal values and engaging in activities consistent with these values, developing acceptance, as well as focusing on the present moment or performing activities with greater awareness. In total, 192 patients following the first (autologous or allogeneic) HCT will be randomly assigned in equal numbers to either the ACT intervention or an education session. Participants in both conditions will take part in 14-day training (about 5-10 minutes a day). The outcomes will be measured at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. Moreover, 6-9 additional participants will be randomly assigned to pre-intervention measurement length (1-3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The researchers hypothesized that ACT intervention would foster a meaning-making process and thus reduce distress induced by the discrepancy between global and situational meaning as compared to education.
Detailed description
This trial evaluates the feasibility, acceptability, and preliminary efficacy of self-help internet-based Acceptance and Commitment Therapy (ACT) intervention on meaning-related distress as well as secondary outcomes in patients following hematopoietic cell transplantation (HCT). Randomized controlled trial (RCT) will be enhanced with a single-case experimental design (SCED). Recruitment will take place at a single center, after elective admission to the bone marrow transplantation and oncohematology unit due to HCT before the start of conditioning treatment. Recruitment will take place on average on the 2nd day after admission. Every two days, the transplant coordinator and physician (members of the research team) will review the lists of patients enrolled for HCT. Those who meet the inclusion criteria will be initially informed of the purpose of the study and invited for an extensive briefing by a recruiter (member of the research team). Patients will also be allowed to ask any remaining questions about the aim of the study and the study procedures. After receiving an extensive briefing, all patients who give written informed consent will proceed with baseline. Data will be collected via a self-reported survey on a mobile device. Clinical data will be obtained from the medical records. All participants will receive written user instructions for the daily sessions and measurements. In RCT, participants will be randomly assigned in a double-blinded manner to ACT intervention and education conditions at a ratio of 1:1 by a trial coordinator (member of the research team). Randomization will be stratified by type of transplant. Participants and researchers analyzing data will be blind to the allocation of the participants to the conditions. Participants allocated to the ACT intervention will receive online ACT-based intervention within 14 days after hospital discharge. Each day's intervention will consist of an educational and practical part (standard ACT activity) followed by a debrief. On some days, participants will also receive additional exercise (optional). The whole intervention will be tailored to the context of the disease and treatment. During the same period, participants allocated to the education will receive an online guide to post-HCT recommendations. The intervention/education will be discontinued by participants at any time without any negative consequences. During the intervention/education, participants will fill in a short questionnaire assessing potential mediator variables each day, at the beginning of every online session. Participants will receive daily reminders about the intervention/education. Also, direct technical support will be available 24/7. If participants fail to complete study assessments, motivational reminders will be sent by email. If participants drop out or stop using the intervention, they will be asked for the reason(s) why they decided to quit the intervention and/or study. In SCED, all participants will take part in the online ACT intervention and daily surveys at the 2nd and 3rd post-intervention assessments. Feasibility will be examined via attrition and adherence rates, as well as questions about intervention engagement. Acceptability will be measured by intervention satisfaction and evaluation (attractiveness and easiness).
Interventions
BEHAVIORALAcceptance and Commitment Therapy
ACT intervention will start on the second day after hospital discharge and will take 14 days (+ day 0 with organizational information). Each day, participants will receive a web-based intervention consisting of educational and practical tasks/activities. Participants will learn to recognize moments of choice (actions that lead towards values or away from them) and to use attention flexibly to free themselves from the power of thoughts, to open up and accept emotions, and to be able to determine what is important and take action in line with values. All of the tasks will be available in written form and audio. The ACT intervention is built from standard ACT exercises.
BEHAVIORALEducation
Education will start on the second day after hospital discharge and will take 14 days (+ day 0 with organizational information). Each day, participants will receive information about post-transplant prescriptions along with exercises to support the implementation. Participants will learn about nutrition, personal hygiene, preventing infections, coping with fatigue, resuming activity, rest and sleep, engaging in social interactions, and sexual health. The content is prepared based on available guides for HCT recipients.
Sponsors
National Science Centre, Poland
University of Social Sciences and Humanities, Warsaw
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Intervention model description
This trial is enhanced by a single-case experimental design (SCED), in which all study participants will receive the same intervention (i.e., intervention study model: single group). In SCED, there is no masking. The estimated total number of participants to be enrolled in SCED is 6-9.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Qualification for the first autologous or allogeneic HCT due to hematologic malignancies or solid tumors * Age ≥ 18 years * Signed written informed consent * Ability to read and write in Polish * Daily access to the Internet by computer and/or mobile device
Exclusion criteria
* Major psychiatric or cognitive disorder that would impede providing informed consent and study participation * Inability to cooperate and give informed consent * Hearing, seeing, or movement impairment that precludes participation * Current participation in any form of psychotherapy * No access to the Internet * No access to a computer and/or mobile device * Inability to use a computer and/or mobile device and the Internet
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Distress (Global Meaning Violation Scale; GMVS) | Change from baseline to immediately, 1 month and 3 months after intervention | The GMVS measures meaning-related distress. It is a 12-item questionnaire (from the original, the item health was removed due to the context of the study) that assesses belief (5 items) and goal violations (7 items) in response to stressors on a 5-point scale ranging from 1 (not at all) to 5 (very much). The overall score is calculated by summing the scores of all 12 items, with a possible range of 12-60. Higher scores indicate greater meaning-related distress (greater global meaning violation). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global meaning (Meaning in Life Questionnaire; MLQ) | Change from baseline to immediately, 1 month and 3 months after intervention | The MLQ measures meaning in life. It is a 10-item questionnaire that assesses the Presence of meaning in life and the Searches for meaning in life on a 7-point scale ranging from 1 (absolutely untrue) to 7 (absolutely true). The subscale scores are calculated by summing the scores of relevant items (5 per subscale), with a possible range of 5-35. Higher scores indicate a greater Presence of meaning in life and Search for meaning in life, respectively. |
| Psychological flexibility (Comprehensive Assessment of Acceptance and Commitment Therapy Processes-9; CompACT-9) | Change from baseline to immediately, 1 month and 3 months after intervention | The CompACT-9 measures psychological flexibility. It is a 9-item questionnaire that assesses Openness to Experience, Behavioral Awareness, and Valued Action on a 7-point scale ranging from 0 (strongly disagree) to 6 (strongly agree). The overall score is calculated by summing the scores of all 9 items, with a possible range of 0-36. Higher scores indicate higher psychological flexibility (greater openness to experience and willingness to experience internal events such as thoughts, feelings, sensations, etc. without trying to control or avoid them; greater behavioral awareness and mindful attention to current actions; greater engagement in valued actions and meaningful activity). |
| Coping self-efficacy (Coping Self-Efficacy Scale; CSE - selected items) | Change from baseline to immediately, 1 month and 3 months after intervention | The CSE measures a perceived self-efficacy for coping with challenges and threats. This study used 6 items tailored to the context of the study (2 per subscale: Problem-focused Coping, Emotion-focused Coping, and Social Support Coping) assessed on a 5-point scale ranging from 1 (not at all) to 5 (strongly). The overall score is calculated by summing the scores of all 6 items, with a possible range of 6-30. Higher scores indicate greater coping self-efficacy. |
| Deliberate meaning-making (Core Beliefs Inventory; CBI) | Change from baseline to immediately, 1 month and 3 months after intervention | The CBI is a 10-item questionnaire that assesses deliberate meaning-making coping on a 6-point scale ranging from 0 (not at all) to 5 (to a very degree). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-45. Higher scores indicate greater deliberate searching for meaning. |
| Automatic meaning-making (Event-Related Rumination Inventory; ERRI - intrusive ruminations subscale) | Change from baseline to immediately, 1 month and 3 months after intervention | The intrusive ruminations subscale of the ERRI measures automatic meaning-making coping. It is a 10-item subscale that assesses intrusive ruminations on a 4-point scale ranging from 0 (not at all) to 3 (often). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-30. Higher scores indicate greater automatic searching for meaning. |
| Post-traumatic growth (the current standing Post-Traumatic Growth Inventory-Short Form; C-PTGI-SF ) | Change from baseline to immediately, 1 month and 3 months after intervention | The C-PTGI-SF measures psychological well-being in cross-sectional assessment, as well as posttraumatic growth (element of meanings made) in multiple assessments. It is a 10-item questionnaire that assesses psychological well-being on a 6-point scale ranging from 0 (not at all) to 5 (to a very great degree). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-50. Higher scores indicate better well-being. |
| Meanings made (Meaning of Loss Codebook; MLC) | Change from baseline to immediately, 1 month and 3 months after intervention | The MLC evaluates meanings made. It is a 3-item tool that assesses sense made, benefit finding, and sense of identity change on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The overall score is calculated by summing the scores of all 3 items, with a possible range of 3-15. Higher scores indicate greater meanings made. |
| Anxiety and depressive symptoms (Patient Health Questionnaire-4; PHQ-4) | Change from baseline to immediately, 1 month and 3 months after intervention | The PHQ-4 is a 4-item questionnaire that assesses symptoms of anxiety (2 items) and depression (2 items) on a 4-point scale ranging from 0 (not at all) to 3 (nearly every day). The subscale scores are calculated by summing the scores of 2 items, with a possible range of 0-6. Higher scores indicate higher levels of anxiety and depression symptoms, respectively. The total PHQ-4 score complements the subscale scores as an overall measure of symptom burden, as well as functional impairment and disability. |
| Illness perception (Brief-Illness Perception Questionnaire; B-IPQ) | Change from baseline to immediately, 1 month and 3 months after intervention | The B-IPQ measures cognitive and emotional representations of illness. It is an 8-item questionnaire that assesses cognitive illness representation, emotional illness representation, and illness comprehensibility representation on a 0-10 point scale. The total score is calculated by summing the scores of all 8 items, with a possible range of 0-80. Higher scores indicate more threatening perception of the illness. |
| Loneliness (the Community Life Survey) | Change from baseline to immediately, 1 month and 3 months after intervention | A direct question about loneliness from the Community Life Survey is used. The statement is assessed on a 4-point scale ranging from 1 (never) to 4 (often or always). A higher score indicates greater loneliness. |
| Health-related quality of life (Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer; EORTC QLQ-C3) | Change from baseline to immediately, 1 month and 3 months after intervention | The EORTC QLQ-C30 measures the health-related quality of life of cancer patients. It is a 30-item questionnaire that assesses physical, role, social, emotional, and cognitive functioning, as well as various symptoms, financial impact, and global quality of life. Twenty-eight items are rated on a 4-point scale ranging from 1 (not at all) to 4 (very much), while 2 items are rated on a 7-point scale ranging from 1 (very poor) to 7 (excellent). The overall score is calculated by summing the scores of all items, with a possible range of 0-100. Higher scores indicate better function and a higher quality of life. |
| Daily subjective health (Daily Subjective Health Scale) | RCT: day-by-dy for 14 days during the intervention. SCED: for 7-21 days before intervention, day-by-dy for 14 days during the intervention, for 7 days immediately, 1 month, and 3 months after intervention | Daily subjective health is measured by a single-item statement Generally, I can say my health today was … on a 5-point scale ranging from 1 (bad) to 5 (excellent). Higher scores indicate greater daily physical health. |
| Daily affect (Daily Positive and Negative Affect Scale) | RCT: day-by-dy for 14 days during the intervention. SCED: for 7-21 days before intervention, day-by-dy for 14 days during the intervention, for 7 days immediately, 1 month, and 3 months after intervention | The Daily Positive and Negative Affect Scale is a 4-item questionnaire that consists of two positive (happy, cheerful) and two negative adjectives (sad, gloomy) rated on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The subscale scores are calculated by summing the scores of relevant items, with a possible range of 2-10. Higher scores indicate higher daily positive or negative affect. |
| Daily meaning-making (Event-Related Rumination Inventory-daily form; ERRI-daily form) | RCT: day-by-dy for 14 days during the intervention. SCED: for 7-21 days before intervention, day-by-dy for 14 days during the intervention, for 7 days immediately, 1 month, and 3 months after intervention | The ERRI-daily form measures deliberate and automatic meaning-making coping. It is a 4-item tool that assesses deliberate and intrusive ruminations on a 4-point scale ranging from 0 (not at all) to 3 (to a very great degree). The subscale scores are calculated by summing the scores of relevant items (2 per subscale), with a possible range of 0-6. Higher scores indicate greater deliberate or automatic searching for meaning. |
| Daily meanings made (Meaning of Loss Codebook-daily form; MCL-daily form) | RCT: day-by-dy for 14 days during the intervention. SCED: for 7-21 days before intervention, day-by-dy for 14 days during the intervention, for 7 days immediately, 1 month, and 3 months after intervention | The MLC-daily form measures daily meanings made. It is a 3-item tool that assesses daily sense made, benefit finding, and sense of identity change on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The overall score is calculated by summing the scores of all 3 items, with a possible range of 3-15. Higher scores indicate greater daily meanings made. |
| Daily psychological flexibility (Comprehensive Assessment of Acceptance and Commitment Therapy Processes-daily form; CompACT-daily form) | RCT: day-by-dy for 14 days during the intervention. SCED: for 7-21 days before intervention, day-by-dy for 14 days during the intervention, for 7 days immediately, 1 month, and 3 months after intervention | The CompACT-daily form is a 4-item tool that assesses daily psychological flexibility (i.e. daily Openness to experience - 2 items, daily Behavioral awareness - 1 item, and daily Valued action - 1 item) on a 7-point scale ranging from 0 (strongly disagree) to 6 (strongly agree). The overall score is calculated by summing the scores of all 4 items, with a possible range of 0-24. Higher scores indicate higher daily psychological flexibility (i.e. greater daily openness to experience and willingness to experience internal events such as thoughts, feelings, sensations, etc. without trying to control or avoid them; greater daily behavioral awareness and mindful attention to current actions; greater daily engagement in valued actions and meaningful activity). |
| Loneliness (The Revised UCLA Loneliness Scale; R-UCLA - selected items) | Change from baseline to immediately, 1 month and 3 months after intervention | The R-UCLA measures perceived social isolation. This study used 5 items that assess the emotional and social aspects of loneliness on a 4-point scale ranging from 1 (never) to 4 (often or always). The total score is calculated by summing the scores of all 5 items, with a possible range of 5-20. Higher scores indicate greater loneliness. |
Countries
Poland
Contacts
Primary ContactAleksandra Kroemeke, PhD
Outcome results
None listed