Emotion Regulation Flexibility and Electronic Patient-Reported Outcomes : A Framework for Understanding Symptoms and Affect Dynamics in Pediatric Psycho-Oncology
Emotion dysregulation is regarded as a driving mechanism for the development of mental
health problems and psychopathology. The role of emotion regulation (ER) in the management of
cancer distress and quality of life (QoL) has recently been recognized in psycho-oncology. The latest
technological advances afford ways to assess ER, affective experiences and QoL in child, adolescent
and young adult (CAYA) cancer patients through electronic patient-reported outcomes (ePRO) in
their daily environment in real-time. Such tools facilitate ways to study the dynamics of affect and
the flexibility of ER. However, technological advancement is not risk-free. We critically review the
literature on ePRO in cancer existing models of ER in pediatric psycho-oncology and analyze strength,
weaknesses, opportunities and threats of ePRO with a focus on CAYA cancer research and care.
Supported by personal study-based experiences, this narrative review serves as a foundation to
propose a novel methodological and metatheoretical framework based on: (a) an extended notion of
ER, which includes its dynamic, adaptive and flexible nature and focuses on processes and conditions
rather than fixed categorical strategies; (b) ePRO as a means to measure emotion regulation flexibility
and affect dynamics; (c) identifying early warning signals for symptom change via ePRO and building
forecasting models using dynamical systems theory