Expressive Writing and Adjustment to Metastatic Breast Cancer

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DESCRIPTION (provided by applicant): Nearly two decades of research with primarily healthy samples have documented that writing about one's emotions associated with negative events over several brief sessions can enhance physical and psychological well-being. Promising studies with predominantly early-stage cancer patients suggest that expressive writing produces health benefits such as reduced pain and medical visits for cancer-related morbidities. Research to date has not examined the potential benefits of expressive writing for women with metastatic breast cancer who confront a growing dependence on others, cognitive and physical decline, and the ultimate prospect of death. Data suggest that most advanced cancer patients desire to share their cancer-related thoughts and feelings with others and view emotional and existential concerns as very important. Yet, some patients feel constrained in discussing their cancer-related experiences, and very few formal interventions have been developed to help cancer patients cope with end-of-life concerns. In this study, 74 women with Stage IV breast cancer will be randomly assigned to one of two conditions: 1) emotional disclosure writing intervention, or 2) control writing. Women in the emotional disclosure writing condition will write about their deepest thoughts and feelings regarding their breast cancer experience, whereas women in the control writing condition will write about their daily activities in a detailed manner. Women in both conditions will be asked to complete four, 20-minute writing sessions that are administered via telephone. Assessments will be conducted before the intervention and at 8 weeks post- intervention. Primary outcomes include indices of distress (i.e., depressive symptoms and demoralization), and secondary outcomes include a sense of meaning in life and peace, pain severity, sleep disturbance, fatigue, and functional impairment. We hypothesize that women assigned to the emotional disclosure writing condition will experience better psychological and physical health at follow-up relative to controls. We also hypothesize that the writing intervention will be most beneficial for women who feel constrained in discussing their cancer experience with others. This study will provide new information regarding the feasibility and utility of a telephone- administered expressive writing intervention for advanced cancer patients. Consistent with the mission of the National Cancer Institute, this research aims to promote public health by reducing adverse outcomes of cancer and its treatment and enhancing patients' well-being. Results of this project have the potential to inform future studies of emotional disclosure interventions for cancer patients and clinical practice.