Using expressive writing to improve cancer caregiver and patient health: A randomized controlled feasibility trial

Abstract

PurposeThis study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health, and enhancing ICs’ emotion regulation. MethodFifty-eight breast cancer ICs and patients participated in a randomized controlled feasibility trial of remote EW. ICs were randomly assigned to the EW or control group and completed 3 weekly writing sessions. ICs and patients completed health and emotion regulation assessments at baseline, intervention completion, and 3 months post-intervention. Screening, recruitment, assessment process, randomization, retention, treatment adherence, and treatment fidelity were computed for feasibility. Effect sizes were calculated using the PROMIS Depression Short Form, RAND Short Form 36 Health Survey, Breast Cancer Prevention Trial Hormonal Symptom checklist, healthcare utilization, and the Emotion Regulation Questionnaire for efficacy. ResultsOf the 232 interested individuals, 82 were screened, and 60 enrolled (6 monthly). Two individuals withdrew and 19 were lost to follow-up, leaving 39 individuals. ICs completed at least one assessment and two sessions, and patients completed at least two assessments. All sessions were administered as intended. ICs generally followed instructions (88%–100%), wrote the full time (66.7%–100%), and were engaged (M(SD) = 3.00(1.29)-4.00(0.00)). EW had small-to-medium effects in improving IC health (g = −0.27–0.04) and small-to-large effects in improving patient health (g = −0.28-0.86). EW moderately decreased suppression (g = 0.53–0.54) and slightly increased reappraisal, at least 3 months post-intervention (g = −0.34-0.20). ConclusionsRemote EW may be feasible with cancer ICs and improve cancer IC and patient health. However, it can benefit from additional retention strategies and rigorous testing.Trial registration: CenterWatch Clinical Trials Listing Service (#TX217874); ClinicalTrials.gov (#NCT06123416).