| High levels of pain, fatigue and distress, and uncertainty about how to control symptoms |
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Smart phone and mobile app for regular (3x/week) patient-reported ratings of symptoms and coping skills use
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Symptom and coping skills use data transmit to the study team
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Real-time push notifications provide personalized feedback based on patient ratings, including encouragement and reminders for skill used
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Mobile app includes a library of audio and video coping skills resources, making them highly accessible
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Videoconference sessions provide symptom management education, with examples and applications tailored to the patients' symptom needs
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Discuss and problem solve difficulties with coping skills use in session to optimize practice
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| Pain, fatigue and distress specific to colorectal cancer patients (e.g., bowel dysfunction, abdominal pain, treatment-related fatigue and neuropathic pain, stoma -related distress) |
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Relaxation for managing stoma-related and abdominal pain
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Activity pacing to manage fatigue due to CRC and treatment, and the demands of multiple life roles
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Cognitive restructuring unhelpful thoughts about stoma management, body image, with the goal of reducing distress
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Relaxation, pleasant activity planning and coping thoughts to manage bowel dysfunction
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Activity planning to address the impact of a stoma on social functioning
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| High time demands |
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Brief 5 session protocol
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Coping skills practice strategies are brief and straightforward
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Use of mHealth technology and videoconferencing for intervention delivery to address travel barriers and decrease patient burden
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Sessions delivered via videoconferencing at times (e.g., evening, weekend) and locations (e.g., home, work) convenient to the patient
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Use of mobile app for smooth and easy integration into daily life
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Discussion and planning around engaging in home practice within the context of competing demands
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Stress related to managing multiple life roles (e.g., working outside the home, caregiver for young children and/or elderly parents) as well as other stage-of-life challenges (e.g., family planning, concerns about finances and health insurance)
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In session 1, the therapist reviews a menu of potential stage-of-life challenges with participants to tailor coping skills content (e.g., examples, applications) based on the participant's reported needs; examples of skills tailoring include:
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Relaxation for stress associated with finances and the cost of cancer care
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Communication with others (e.g., spouse, children) about symptoms and limitations as well as the importance of daily skills practice
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Activity pacing and planning to manage the demands of multiple roles (e.g., work, caregiver) in the context of cancer and symptom management
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Cognitive restructuring negative thoughts surrounding functional and physical limitations (e.g., taking time off work for treatment, needing to adapt activities, asking for help)
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| Negative cognitions related to having cancer as a younger person and the challenges around meeting stage-of-life demands now and in the future. |
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Negative thoughts in the context of cancer and treatment can lead to increased symptom severity and decreased quality of life
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Therapists will work with participants to identify negative thoughts related to managing a cancer diagnosis as a younger person, including the disruptiveness of treatment and high symptom burden, uncertainty about the future, and the necessity for long-term cancer and other health monitoring and management.
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Participants learn cognitive restructuring to identify unhelpful thoughts (e.g., about their ability to manage cancer symptoms, ability to meet life demands, overall ability to cope) and shift then to more neutral or positive thoughts. Common examples of unhelpful thoughts include “I should be able to manage my symptoms better”; “I should be able to do more (at home, at work)”; “I am never going to feel better”.
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Participants also learn cognitive restructuring and coping thoughts to manage fear of cancer progression or recurrence, anxiety at time of scans and tests
Common examples of anxiety-related thoughts include “my cancer will get worse”; “if my cancer comes back, I don't know what I will do”; “I have to live an extremely healthy lifestyle” -
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Participants receive personalized feedback via push notification based on symptoms and coping skills use that includes encouragement and positive feedback
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