JMIR Publications

ABSTRACT

Background:

Depression and anxiety are prevalent among patients with metastatic breast cancer (MBC), but there are few evidence-based psychological interventions specifically designed for this population.

Objective:

To assess the feasibility, acceptability, and clinical impact of a multi-component positive psychological intervention (PPI), enhanced with an ecological momentary intervention (EMI) for symptom management, for patients with MBC.

Methods:

We recruited patients with MBC from an NCI-designated comprehensive cancer center. Participants completed 5 weekly, virtual individual sessions with a study counselor focused on positive emotion regulation skills. Participants also reported physical and psychological symptoms daily between sessions via SMS messaging. Clinically elevated symptoms triggered a personalized coaching text message tailored to the symptom(s) reported and the skill(s) learned that week. Primary outcomes were intervention feasibility and acceptability. We also examined pre-to-post-intervention changes in depression, anxiety, and positive affect. Finally, a subset of participants completed qualitative exit interviews focusing on their experience in the study; interview data was analyzed using rapid qualitative analysis (RQA).

Results:

We approached 20 MBC patients, established contact with 15 (75%), consented 10 (67%), and retained 9 (90%) through the end of the study. Participants were 55 years old on average (range: 35-75) and identified as non-Hispanic White (50%), non-Hispanic Black (40%), or Hispanic/Latina (10%). Participants attended 92% of intervention sessions (M=50 minutes, range: 36-71 minutes). On average, they completed 85% of daily symptom assessments (range: 46%-100%) and received 23 coaching messages (range: 13-31). Participants reported high perceived intervention feasibility (M=4.81/5), acceptability (M=4.78/5), and appropriateness for patients with MBC (M=4.83/5), above our a priori cut-off of ≥4. All participants (100%) recommended the intervention for other patients with MBC. We observed pre-to-post intervention decreases in depression (d=-0.32) and anxiety (d=-0.27), and increases in positive affect (d=0.30). RQA results demonstrate participants’ positive experiences with the intervention, as well as suggestions for improvement.

Conclusions:

This pilot study supports the feasibility of enrolling and retaining racially and ethnically diverse patients with MBC to this trial, the acceptability of the PPI enhanced with EMI, and preliminary intervention impacts on depression, anxiety, and positive affect. A large-scale randomized controlled trial is needed to assess long-term intervention efficacy for outcomes of interest.