Hope and benefit finding: Results from the PRISM randomized controlled trial

Abstract

Background: Adolescents and Young Adults (AYAs) with cancer are at risk for poor psychosocial outcomes, perhaps because they have not acquired skills to navigate adversities of illness. In a recent phase II randomized controlled trial (RCT), the “Promoting Resilience in Stress Management” (PRISM) intervention was associated with improved patient-reported resilience, quality of life and distress. In this planned analysis of secondary aims, we hypothesized PRISM would also improve targeted coping skills of hopeful thinking, benefit-finding, and goal-setting. Methods: We conducted this parallel RCT at Seattle Children’s Hospital from Jan/2015-Oct/2016. English-speaking AYAs (13–25 years-old) with cancer were randomized one-to-one to PRISM or usual care (UC). PRISM teaches stress-management, goal-setting, cognitive-reframing, and meaning-making skills in four sessions delivered in-person every other week. Participants completed surveys at enrollment and 6-months later. Mixed effects linear regression models evaluated associations between PRISM and benefit-finding (Benefit-Finding Scale for Children), hopeful thinking (Hope Scale), and an exploratory outcome of goal-setting (queried with open-ended items about participant’s goals, measured qualitatively by 3 blinded reviewers). Results: Of N=92 AYAs (48 PRISM, 44 UC), 73% were 13–17 years-old, 43% female, and 62% diagnosed with leukemia or lymphoma. PRISM was associated with improved benefit-finding and hope with moderate-to-large effect sizes: Benefit-finding: +3.1 points, 95% CI 0.0,6.2, d=0.4, p=0.05; Hope: +3.6 points, 95% CI 0.7,6.4, d=0.6, p=0.01. We did not detect changes in goal-setting (−0.5 points, 95% CI −1.2,0.3, d=−0.3, p=0.23). Conclusions: PRISM was associated with improvements in benefit-finding and hopeful thinking, two adaptive coping skills which may mitigate long-term psychosocial risk.

Resilience in adolescents and young adults with cystic fibrosis: A pilot feasibility study of the promoting resilience in stress management intervention

“…The PRISM intervention has been successfully researched in other AYAs with serious and chronic illnesses such as cancer and diabetes, in which the diagnosis is usually established later in life . On the other hand, the diagnosis of CF is usually established during infancy and it is one of the most common life‐shortening diseases with increased morbidity which might reflect to their emotional status very early in life.…”

“…The promoting resilience in stress management (PRISM) intervention is a brief, disease nonspecific, skills‐based intervention developed for AYAs with chronic or serious illness. PRISM has demonstrated feasibility among populations of AYAs with cancer and diabetes, and a phase 2 randomized controlled trial comparing PRISM to usual care among AYAs with cancer suggested PRISM is also associated with higher patient‐reported resilience, quality of life, hope, and benefit‐finding, and with lower risk of psychological distress 6 months after enrollment …”

Exploratory analysis of treatment response trajectories in the PRISM trial: Models of psychosocial care

“…Eligible participants for the phase II, parallel, 1:1 RCT were enrolled between January 2015 and October 2016. Participants provided written informed consent, and the Seattle Children's Hospital Institutional Review Board approved this study (IRB protocol no.…”

“…Promoting Resilience in Stress Management (PRISM) is a novel, brief, developmentally appropriate, skill‐based intervention targeting the “resilience resources” of stress management, goal setting, cognitive reframing (evaluating and reappraising negative cognitions and self‐talk), and benefit finding (finding meaning and benefit from adversity) . In a phase II randomized controlled trial (RCT) testing the efficacy of PRISM compared with psychosocial usual care (UC) in AYAs with cancer, PRISM was associated with improved patient‐reported resilience, hope, benefit finding, and cancer‐specific quality of life and decreased psychological distress …”

“…Previous publications of the phase II PRISM RCT focused on intention to treat analyses comparing change in total instrument scores of PRISM vs UC, and PRISM was associated with moderate‐to‐large effect sizes . Here, we report results of a post hoc exploratory analysis of the phase II PRISM RCT in which we examined and classified individual patient responses of patient reported outcomes (PROs) over time in order to better understand how and why PRISM works.…”