Expressive Writing & Adjustment to Colorectal Cancer

描述(由申请人提供)： 表现性写作是一种理论驱动的行为医学干预措施，旨在通过增加对创伤事件的认知和情感处理来促进健康和福祉。许多研究表明，在相对健康的非临床人群中，在严格控制的实验室条件下写作，表现性写作对健康有好处。一些先导性研究已经提供了富有表现力的写作对适应癌症有好处的提示性证据，但这些研究中的大多数都没有理想的设计。这项拟议的研究旨在：(1)确定对最近接受结直肠癌治疗的人进行简短、廉价的表达写作干预的可行性；(2)确定影响可行性的人口和心理社会因素；(3)确定表达写作对改善一系列与健康相关的生活质量的潜在有效性(例如，抑郁症状、身体功能和症状、社会情绪发育)；以及(4)确定可能影响写作干预效果的人口统计和心理社会因素。我们将采用三组前置设计，将183名最近接受L期结肠癌或直肠癌治疗的女性和男性随机分配到三种情况中的一种：表达写作、控制写作或不写作。数据将通过写作干预前不久以及干预后一个月和三个月后进行的有组织的面对面访谈来收集。主要结果包括可行性指标(例如，应计和留存率、程序的可接受性和对书面指示的遵守情况)和生活质量变量(一般和癌症相关变量、心理抑郁和社会情绪成长)。调节变量包括心理社会变量(例如，社会约束、侵入性思想)以及社会人口和医学因素。主持人分析将集中于探索谁从表现力写作中受益以及为什么受益。例如，我们预测，对于那些：(A)没有足够的社会支持，或者在与他人讨论自己的癌症时感到受到限制，以及(B)对自己的癌症有侵入性想法的人来说，富有表现力的写作将是最有益的，因为写作的安全情感表达应该可以缓冲这种不请自来的想法对生活质量结果的负面影响。可行性和有效性数据将被用来为未来随机对照试验的发展提供信息。

DESCRIPTION (provided by applicant): Expressive writing is a theory-driven behavioral medicine intervention that is designed to enhance health and well-being through increased cognitive and emotional processing of traumatic events. Many studies have shown the health benefits of expressive writing in relatively healthy, non-clinical populations writing under highly controlled laboratory conditions. A few pilot studies have provided suggestive evidence of benefits of expressive writing on adjustment to cancer, but most of these studies have had less than ideal designs. The proposed study aims to: (1) Determine the feasibility of applying a brief, inexpensive expressive writing intervention to individuals recently treated for CRC; (2) Identify demographic and psychosocial factors that influence feasibility; (3) Determine the potential efficacy of expressive writing for improving a range of healthrelated quality of life outcomes (e.g., depressive symptoms, physical functioning and symptoms, social-emotional growth); and (4) Identify demographic and psychosocial factors that may influence the efficacy of the writing intervention. We will use a three-group, pre-post design, in which 183 women and men recently treated for Stage l-lll colon or rectal cancer will be randomly assigned to one of three conditions: expressive writing, control writing, or no writing. Data will be collected through structured, face-to-face interviews conducted shortly before the writing intervention and again at one and three months after the intervention. Primary outcomes include feasibility indicators (e.g., accrual and retention rates, acceptability of procedures, and adherence to writing instructions) and quality of life variables (general and cancer-specific, psychological depression, and social-emotional growth). Moderator variables include psychosocial variables (e.g., social constraints, intrusive thoughts) as well as socio-demographic and medical factors. Moderator analyses will focus on exploring who benefits from expressive writing and why. For instance, we predict that expressive writing will be most beneficial for people with CRC who: (a) have inadequate social support, or who feel constrained in discussing their cancer with others, and (b) have intrusive thoughts about their cancer, because the safe emotional expression of writing should buffer them from the negative effects of such unbidden thoughts on quality of life outcomes. Feasibility and efficacy data will be used to inform the development of a future randomized controlled trial.