Acceptability, Feasibility, and Efficacy Potential of a Multimodal Acceptance and Commitment Therapy Intervention to Address Psychosocial and Advance Care Planning Needs among Anxious and Depressed Adults with Metastatic Cancer

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP). Objective: The study leveraged acceptance and commitment therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multimodal intervention (M-ACT) designed to address the psychosocial and ACP needs of anxious and depressed adults with metastatic cancer. The study evaluated M-ACT\u27s acceptability, feasibility, and efficacy potential. Design: The study was designed as a single-arm intervention development and pilot trial. Setting/Subjects: The trial enrolled 35 anxious or depressed adults with stage IV cancer in community oncology clinics, with a referred-to-enrolled rate of 69% and eligible-to-enrolled rate of 95%. Measurements: M-ACT alternated four in-person group sessions with three self-paced online sessions. Acceptability and feasibility were assessed through enrollment, attendance, and satisfaction ratings. Outcomes and theorized intervention mechanisms were evaluated at baseline, midintervention, postintervention, and two-month follow-up. Results: Participant feedback was used to refine the intervention. Of participants starting the intervention, 92% completed, reporting high satisfaction. One-quarter did not begin M-ACT due to health declines, moving, or death. Completers showed significant reductions in anxiety, depression, and fear of dying and increases in ACP and sense of life meaning. In this pilot, M-ACT showed no significant impact on pain interference. Increases in two of three mechanism measures predicted improvement on 80% of significant outcomes. Conclusions: The M-ACT intervention is feasible, acceptable, and shows potential for efficacy in community oncology settings; a randomized trial is warranted

Leveraging Values to Promote Adherence to Endocrine Therapy among Breast Cancer Survivors: A Mixed-Methods Investigation

Background: Improving medication adherence represents one of the greatest behavioral challenges in medicine. Personal values are an under-examined source of motivation for adhering to medication. This secondary analysis leverages a mixed-method approach to understanding a novel, online, values-based intervention (‘REACH’) for promoting endocrine therapy (ET) adherence among breast cancer survivors, using data from a randomized trial. Methods: Breast cancer survivors with challenges taking ET (n=88) were randomized 1:1 to ET Education+Values (REACH) or Education-only online interventions. This report focuses on the three values strategies used in REACH to promote ET adherence: affirming health-related values, using values-based perspective-taking to motivate adherence, and creating a personalized cue-to-action values sticker for participants’ ET pillbox. Responses to these strategies were analyzed using Linguistic Inquiry and Word Count (LIWC) and structured exit interviews. Further, in both conditions, positive and negative affective states were repeatedly evaluated. Affective responses to REACH were used to predict objective ET adherence. Results: During REACH values exercises, LIWC showed greater use of positive emotion words than negative emotion words, and thematic coding of interviews identified mostly positive responses to values content. Compared to Education, REACH quantitatively led to less tense and sad and more loving states. Within REACH, a large spike in guilt and drop in enthusiasm occurred after the perspective-taking values exercise, with strong recovery after the values sticker exercise. Greater area-under-the-curve for guilt predicted lower subsequent ET adherence. Conclusions: Distinct approaches to linking domain-relevant values to ET adherence produced different affective responses, which in turn predicted ET adherence, informing theory and practice

Leveraging Personal Values in an Endocrine Therapy Adherence-Promoting Trial for Breast Cancer Survivors: A Mixed-Methods Investigation

Background: Improving medication adherence represents one of the greatest behavioral challenges in medicine. Personal values are an under-examined source of motivation for adhering to medication. This secondary analysis leverages a mixed-method approach to understanding a novel, online, values-based intervention (‘REACH’) for promoting endocrine therapy (ET) adherence among breast cancer survivors, using data from a randomized trial. Methods: Breast cancer survivors with challenges taking ET (n=88) were randomized 1:1 to ET Education + Values (REACH) or Education-only online interventions. This report focuses on the three values strategies used in REACH to promote ET adherence: affirming health-related values, using values-based perspective-taking to motivate adherence, and creating a personalized cue-to-action values sticker for participants’ ET pillbox. Immediate responses to these values strategies were analyzed using Linguistic Inquiry and Word Count (LIWC) and in both conditions, using repeated assessment of positive and negative affective states. Long-term responses to these strategies were evaluated using structured study exit interviews. Affective responses to REACH were used to predict objective ET adherence. Results: Compared to Education, REACH led to less tense and sad. and more loving states in the immediate term. Convergently, during REACH values exercises, LIWC identified greater use of positive emotion words than negative emotion words. Thematic coding of exit interviews identified generally positive responses to values content in the longer-term with a small minority of negative responses. Conclusions: Distinct approaches to linking domain-relevant values directly to ET adherence were associated with generally positive affective responses, informing theory and practice