The “Promoting Resilience in Stress Management” (PRISM) intervention for adolescents and young adults: A pilot randomized controlled trial.

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176 Background: Adolescents and Young Adults (AYAs) with cancer are at risk for poor psychosocial outcomes, perhaps because they have yet to learn the skills needed to navigate the burdens of illness. We aimed to determine if a novel, brief, age-appropriate, skills-based intervention would improve psychosocial outcomes. Methods: “Promoting Resilience in Stress Management” (PRISM) is a manualized, brief intervention targeting stress management, goal-setting, cognitive reframing, and meaning-making. It consists of 4, 30-60 minute, in-person, 1:1 sessions plus a facilitated family-meeting. English-speaking AYAs (ages 12-25 years) with new or newly recurrent cancer were randomized to receive either PRISM or non-directive usual psychosocial care. Participants completed patient-reported outcome (PRO) surveys at the time of enrollment and 6 months later. We used mixed effects regression modeling to estimate associations between PRISM and the primary outcome (patient-reported resilience, measured by the Connor-Davidson Resilience Scale [CDRISC-10]) and secondary outcomes (health-related quality of life [PedsQL 4.0 Quality of Life Inventory], hope [Snyder Hope Scale], and psychological distress [Kessler-6 Psychological Distress Scale]) at 6 months. Results: N = 100 AYAs enrolled (78% of approached, n = 50 PRISM, n = 50 usual care) and 92 completed baseline responses (48 PRISM and 44 usual care). Of those who completed baseline, 73% were aged 13-17 years and 27% aged 18-25 years, and 43% were female. Attrition was similar in each arm and primarily due to medical complication and/or death; n = 36 (72%) PRISM and n = 38 (76%) usual care participants completed 6-month PROs. After adjusting for baseline scores, PRISM was associated with improvements in all instruments: Resilience (+2.3, 95% CI 0.7,4.0), quality of life (+6.3 (95% CI -0.8, 13.5), hope (+2.8, 95% CI 0.5, 5.1), and distress (-1.6, 95% CI -3.3, 0.0). Conclusions: A targeted intervention targeting skills for AYAs with cancer was effective in improving patient-centered outcomes. Clinical trial information: NCT02340884.