Exploratory analysis of treatment response trajectories in the PRISM trial: Models of psychosocial care

• Published in: Psycho-oncology (Chichester, England) England), 2019-07, Vol.28 (7), p.1470-1476
• Main Authors: Lau, Nancy, Bradford, Miranda C., Steineck, Angela, Junkins, Courtney C., Yi‐Frazier, Joyce P., McCauley, Elizabeth, Rosenberg, Abby R.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adolescent; Adult; Brief interventions; Cancer; Caregivers - psychology; Children; Early intervention; Efficacy; Female; High risk; Hope; Humans; Male; Neoplasms - complications; Neoplasms - psychology; oncology; Pediatrics; Prevention programs; preventive programs; Psychological distress; Psychosocial factors; Psychosocial intervention; Psychotherapy; psycho‐oncology; Quality of life; Quality of Life - psychology; randomized controlled trial; Resilience; Resilience, Psychological; Social Support; Stress management; Stress, Psychological - etiology; Stress, Psychological - prevention & control; Stress, Psychological - psychology; Teenagers; Well being; Young Adult; Young adults
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.5098

Objective Adolescents and young adults (AYAs) with cancer are at high risk of negative psychosocial outcomes. Promoting Resilience in Stress Management (PRISM), a novel, brief, skill‐based intervention, has demonstrated efficacy in improving psychosocial well‐being for AYAs. We utilized data from a recent randomized trial of PRISM versus usual care (UC) to categorize and explore group differences in change trajectories of patient reported outcomes (PROs) over time. Methods One hundred English‐speaking AYAs (aged 12‐25 years old) with cancer were randomized to PRISM versus UC. At enrollment and 6 months later, AYAs completed validated PROs measuring resilience (Connor‐Davidson Resilience Scale [CDRISC‐10]), hope (Hope Scale), benefit finding (Benefit and Burden Scale for Children), cancer‐specific quality of life (Pediatric Quality of Life [PedsQL] Cancer Module), and distress (Kessler‐6). Patient response trajectories were categorized as “improved,” “consistently well,” “consistently at risk,” or “deteriorated” using minimal clinically important differences (MCIDs) or established measure cutoffs for all PROs. Positive response trajectories consisted of the first two categories (“improved” and “consistently well”), and negative response trajectories consisted of the latter two categories (“consistently at risk” and “deteriorated”). Results Across all PROs, more patients in the PRISM arm “improved” in psychosocial well‐being over time, and fewer PRISM recipients “deteriorated” over time. Across all PROs, a greater proportion of PRISM participants (vs UC) experienced positive response trajectories. Across all PROs, a greater proportion of UC participants experienced negative response trajectories. Conclusions PRISM shows evidence of both a prevention effect and an intervention effect. Thus, PRISM may serve as a viable prevention and early intervention model for psychosocial care.