A Guided Written Disclosure Intervention to Promote Post-traumatic Growth in Cancer Patients GUIDED WRITTEN DISCLOSURE

2016-07-06 23:08:21 | BioPortfolio


This study aims to investigate the efficacy of Guided Written Disclosure Protocol (GWDP) in promoting post-traumatic growth through a process of meaning reconstruction in cancer patients at the end of chemotherapy. Also, the intervention (GWDP) intends to reduce distress symptoms (i.e. intrusive thoughts, avoidance, depression and anxiety).


Study aims The primary aim of this study is to assess the efficacy of the Guided Written Disclosure Protocol in promoting post-traumatic growth in stage I-III breast and colon cancer patients at the end of their adjuvant chemotherapy.

The secondary aims of the study include

- Evaluating the efficacy of the GWDP in terms of intrusive thoughts and avoidance reduction

- Assessing the efficacy of the GWDP in terms of reduction of depression and anxiety

- Investigating the relationship between constructed meaning and post-traumatic growth.

Methods Study design The study is a randomized controlled trial. Eligible patients who give their consent to participate in the study will be randomized to receive the GWDP intervention (experimental group) or a control intervention (control group).

Participants Participants will be recruited in the Oncological Day Hospitals (DH) of the Scientific Research and Care Institute (IRCCS) Santa Maria Nuova Hospital of Reggio Emilia - Oncology Unit

Eligibility criteria will be assessed by reviewing the patients' medical record and verified at the time of recruitment.

Randomization Eligible patients, who agree to participate in the study, will be randomly assigned to the GWDP condition or to the control condition with an allocation ratio 1:1, stratified by the oncological DH. Randomization is carried out through a central phone randomization center using computer generated random numbers.

After the registration of the patient basic information, the trial center will attribute a unique code to the included patient, and communicate to the professional the allocated condition. This code will be reported in all the forms related to each patient.

The interventions The experimental intervention (GWDP) consists of three 20-minutes writing sessions in which instructions are provided to patients that have experienced the traumatic event of cancer diagnosis and therapies. Initially, participants are invited to recall chronologically the facts concerning the traumatic event, and then to label the emotions related to those facts, appraise immediate changes in priorities, reflect on their current feelings, and on coping mechanisms they have learned. Moreover, they are asked to reflect on how the experience of cancer has changed their view about life and themselves, teaching them to cope with other difficulties that may arise in the future.

Below, investigators report a synthesis of the tasks concerning each of the three writing sessions. Participants are asked to:

1. describe memories concerning cancer illness in a chronological order, with an objective and detached attitude.

2. describe: (a) thoughts and emotions perceived during the illness experience; (b) the impact of illness on their daily lives, and how it has changed their attitudes toward life.

3. focus on their actual situation, think about the entire illness experience, and report on the following aspects:

- their present thoughts and feelings, and how those differ from the ones felt during the illness experience.

- to what extent they have come to terms with, understand and appreciate themselves to have dealt successfully with the illness.

- what they have learned from illness in terms of personal insights, knowledge and skills, and how these resources could be useful in their future.

- how they will cope with other similar events in the future.

Participants are asked to find a quiet place and time in their home to write without being disturbed. The first writing session will be performed by two weeks from the initial assessment (T0), and the following two sessions once every two weeks.

Original instructions were translated into Italian, and adapted to the specific traumatic experience of cancer diagnosis and treatment.

The control condition consists of three 20-minutes writing sessions in which participants are requested to write about events of their daily routine happened during the past week; they are also asked to focus on facts, with an objective and detached attitude. An active control intervention is used to account for both general (i.e., due to a written general description) and specific effects (i.e., due to a written emotional expression, together with a cognitive reframing) of the writing task.

As for the experimental group, participants are asked to find a quiet place and time to write without being disturbed. It was used the same time interval between sessions as for the GWDP.

One day before each writing session, patients in both conditions will be contacted on the telephone by the researcher, who will check their understanding of instructions included in the booklet, and remind them to perform the writing task. Failure to contact the patient will be recorded in the patient form.

Procedures of recruitment and assessment Recruitment and baseline assessment (T0). One or more health care professionals (oncologists, nurses or psychologists) will participate as recruiters and evaluators. They will be trained by the Steering Committee about study aims and procedures, and provided with study materials. The preferred method of recruitment involves the oncologist in informing eligible patients, who attend DH for their medical consultation. In case of impediments to recruitment (e.g., oncologists' lack of motivation for involvement in the study, medical consultation scheduled beyond eight months after the end of chemotherapy, patients' unavailability at the time of medical appointment), a letter will be sent to eligible patients presenting general information about the study. Three to seven days later, a member of the study staff will call the patient by phone to give further information, and to verify his/her availability to participate.

Patients interested in the intervention will meet a health care professional, who will explain both the study aims and the writing tasks, providing them with the information sheet, and collecting socio-demographic data and health information (i.e., age, sex, educational level, marital status, time since diagnosis, disease site and stage, and treatment received). Patients, who agree to participate, will give their written consent. The health care professional will administrate baseline questionnaires, and then will contact the trial center for randomization. Finally, the booklet concerning the intervention, according to allocation group, will be provided to the participant. Anonymity will be guaranteed for both written texts and outcomes assessment.

Post-intervention and follow- up assessments (T1 and T2). Participants will be re-assessed for the study outcomes three months after baseline (T1), with a time tolerance of ± 15 days, whenever is possible during any medical consultation. In this occasion, the booklet containing the patient's written texts will be returned. Follow-up evaluation (T2) will be performed six months after the post-intervention assessment (with the same time tolerance of ± 15 days), whenever is possible during any medical consultation.

Hypotheses Main hypothesis. Investigators expect that, after the intervention, participants in the GWDP group will have higher scores on the Post-Traumatic Growth Inventory as compared to the control group.

Meaning construction is deemed as the mechanism underlying the restructuring of more adaptive schemas that lead to growth. Therefore, investigators expect that increased levels of PTG could be moderated by constructed meaning, measured by the Constructed Meaning Scale.

Secondary hypothesis. Investigators hypothesize that, after the intervention, participants in the GWDP group will have lower scores on the Impact of Events Scale as compared to the control group. Investigators also predict that participants in the GWDP group will have lower scores on the Hospital Anxiety and Depression Scale as compared with the control group.

Sample size A prospective power analysis revealed that the current study would require 250 participants to achieve 80% power. The predicted effect size (Hedges's g = 0.36) is estimated according to a recent meta-analysis on the effect of psychological interventions on post-traumatic growth.

Data analysis A preliminary analysis will be performed to compare, at baseline, the differences of clinical and demographic data between the two groups (GDWP intervention vs. control intervention). After that, a 2 X 3 mixed factorial design ANOVA will be performed for each dependent variable (Post-traumatic growth, and distress measures). The "between" factor is intervention with two levels (yes/no) and the "within" factor is time with three levels (T0/T1/T2). Adjusted analysis of variance with sociodemographic and health variables as covariant will be performed. Finally, the potential moderating role of constructed meaning on the effect of GWDP will be according to the MacArthur approach.

Ethical issues The data collection and the intervention will be performed in accordance with the ethical standards of the local Ethical committee, which have approved the protocol.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Supportive Care


Breast Cancer


GWDP, Control


Arcispedale S. Maria Nuova-IRCCS
Reggio Emilia




Arcispedale Santa Maria Nuova-IRCCS

Results (where available)

View Results


Published on BioPortfolio: 2016-07-06T23:08:21-0400

Clinical Trials [4513 Associated Clinical Trials listed on BioPortfolio]

Diet and Breast Cancer Prevention Trial

This randomized controlled trial tests the hypothesis that a reduction in intake of dietary fat will reduce the incidence of breast cancer. Women with more than 50% of the breast occupied ...

APBI Versus EBRT Therapy After Breast Conserving Surgery for Low-risk Breast Cancer

To assess the role of interstitial brachytherapy alone compared to whole breast irradiation in a defined low-risk group of invasive breast cancer or ductal carcinoma in situ concerning loc...

Optimizing Preventative Adjuvant Linac-Based Radiation: the OPAL Trial A Phase II Study of Hypofractionated Partial Breast Irradiation in Women With Early Stage Breast Cancer

The goal of this clinical research study is to learn about the side effects that may occur after radiation is given to breast cancer patients for 2 to 2½ weeks at the part of the breast w...

Radcomp Breast Proton vs Photon

A pragmatic randomized clinical trial of patients with locally advanced breast cancer randomized to either proton or photon therapy and followed longitudinally for cardiovascular morbidity...

Pilot Study Assessing Breast Temperature in Breast Cancer Patients

Our investigators plan to measure the skin on the breast six months after breast reconstruction. The non-reconstructed breast will be used as the control for subject with unilateral recons...

PubMed Articles [21371 Associated PubMed Articles listed on BioPortfolio]

Body Weight and Breast Cancer: Nested Case-Control Study in Southern Brazil.

Current studies have shown that fast weight gain may be more important than body mass index on the incidence of breast cancer. The aim of this study was to evaluate the association between body weight...

Use of antipsychotics and risk of breast cancer: A Danish nationwide case-control study.

Some antipsychotics increases prolactin levels, which might increase the risk of breast cancer. Existing evidence is conflicting and based on sparse data, especially for the increasingly used second-g...

Leucocytes telomere length and breast cancer risk/ susceptibility: A case-control study.

Telomere length in peripheral blood leukocytes (PBL-TL) was proposed as a biomarker of cancer risk. Recent scientific evidence suggested PBL-TL plays a diverse role in different cancers. Inconsistent ...

Adult weight change and the risk of pre- and postmenopausal breast cancer in the Chinese Wuxi Exposure and Breast Cancer Study.

The accumulating evidence indicates that weight gain in adulthood is more predictive of breast cancer risk than absolute body weight. However, the relative impact of timing of weight gain in adulthood...

The Significance of the Stromal Response in Breast Cancer: An Immunohistochemical Study of Myofibroblasts in Primary and Metastatic Breast Cancer.

Gene expression profiling of breast cancer has demonstrated the importance of stromal response in determining the prognosis of invasive breast cancer. The host response to breast cancer is of increasi...

Medical and Biotech [MESH] Definitions

Abnormal accumulation of lymph in the arm, shoulder and breast area associated with surgical or radiation breast cancer treatments (e.g., MASTECTOMY).

Metastatic breast cancer characterized by EDEMA and ERYTHEMA of the affected breast due to LYMPHATIC METASTASIS and eventual obstruction of LYMPHATIC VESSELS by the cancer cells.

A infiltrating (invasive) breast cancer, relatively uncommon, accounting for only 5%-10% of breast tumors in most series. It is often an area of ill-defined thickening in the breast, in contrast to the dominant lump characteristic of ductal carcinoma. It is typically composed of small cells in a linear arrangement with a tendency to grow around ducts and lobules. There is likelihood of axillary nodal involvement with metastasis to meningeal and serosal surfaces. (DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1205)

A deoxycytidine derivative and fluorouracil PRODRUG that is used as an ANTINEOPLASTIC ANTIMETABOLITE in the treatment of COLON CANCER; BREAST CANCER and GASTRIC CANCER.

Carbohydrate antigen elevated in patients with tumors of the breast, ovary, lung, and prostate as well as other disorders. The mucin is expressed normally by most glandular epithelia but shows particularly increased expression in the breast at lactation and in malignancy. It is thus an established serum marker for breast cancer.

More From BioPortfolio on "A Guided Written Disclosure Intervention to Promote Post-traumatic Growth in Cancer Patients GUIDED WRITTEN DISCLOSURE"

Quick Search


Relevant Topics

Anxiety Disorders
Anxiety is caused by stress. It is a natural reaction, and is beneficial in helping us deal with tense situations and pressure. It is deterimental when is becomes an excessive, irrational dread of everyday situations. The most common types of anxiety di...

  Bladder Cancer Brain Cancer Breast Cancer Cancer Cervical Cancer Colorectal Head & Neck Cancers Hodgkin Lymphoma Leukemia Lung Cancer Melanoma Myeloma Ovarian Cancer Pancreatic Cancer ...

Searches Linking to this Trial