Promoting Resilience in Stress Management (PRISM): A randomized controlled trial of a psychosocial intervention for adolescents and young adults with advanced cancer.

Abstract

10009 Background: Adolescents and Young Adults (AYAs) with advanced cancer report poor quality of life (QOL), high psychological distress, and minimal engagement in their healthcare decisions. We assessed the effect of a novel resilience coaching program with embedded elements of advance care planning (Promoting Resilience in Stress Management for Advanced Cancer, PRISM-AC) on AYA outcomes. Methods: We conducted a multisite randomized trial of PRISM-AC vs Usual Care (UC) among English-speaking AYAs aged 12-24 years and diagnosed with advanced cancer within 2 weeks before enrollment. PRISM-AC consists of 4 core sessions targeting AYA-endorsed “resilience resources” (skills in stress-management, goal setting, cognitive reframing and meaning-making) plus an optional session focused on elements of advance care planning (i.e., communication preferences and priorities). Participants completed surveys at baseline, 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome was QOL (Pediatric Quality of Life scale) at 3-months; secondary outcomes included 3-month changes in resilience (Connor-Davidson Resilience scale) and hope (Snyder Hope scale) and trajectories of QOL, anxiety and depression (Hospital Anxiety and Depression Scale) over 12-months. We explored PRISM-AC’s impact on AYA-engagement in critical healthcare conversations as documented in the electronic health record. We applied linear mixed effects regression models to examine the association between PRISM and changes in patient-reported outcomes. Results: We enrolled and randomized 195 AYAs (96 UC, 99 PRISM) between April/2019 and January/2024. They were mean aged 16.5 years (SD 3.9), mostly White (63%), non-Hispanic (59%), and publicly insured (53%). At 3-months, PRISM-AYAs reported significantly more improved resilience [mean change-score +1.3 (5.9) vs -1.4 (7.5), p=0.038] and hope [+2.4 (10.4) vs -2.8 (11.2), p=0.001] than UC-AYAs, although we detected no significant differences between study arms in QOL, anxiety, or depression. Over the 12-month study period, PRISM-AYAs reported progressively more improvements in QOL and anxiety, with significant differences at later time points [i.e., PRISM-associated improvements in QOL at 6 months: +3.4 (95% CI 0.1, 6.6, p=0.043) and 12 months: +6.8 (95% CI 3.3, 10.3, p<0.001)]. Over time, PRISM-AYAs also appeared to participate more in key healthcare discussions. Conclusions: A novel resilience coaching intervention led to immediately improved resilience and hope, and longer-term improvements in quality of life among AYAs with advanced cancer. Clinical trial information: NCT03668223 .