. 2019 Aug 2;18:65. doi: 10.1186/s12904-019-0449-y

Table 2.

Summary of RCTs examining the effectiveness of an EW task in palliative care/advanced disease samples

Study characteristics	Setting, task and assessments	Measures and results
Bruera (2008)* N = 24 Population: Advanced Cancer Gender: EW: 75% female; Control: 66% female Median age: EW: 55.4; Control: 54.3 Ethnicity: EW: 92% White, 8% African American; Control: 58% White, 25% African American, 17% Hispanic	Setting: Inpatient and outpatient palliative care clinic Task: EW: Trauma (n = 12); Control: everyday behaviours and habits (n = 12) Four sessions for 20 min over two weeks Assessments: Baseline and before and after each writing session	Measures: STAI assessed anxiety levels before and after each writing session Results: STAI median scores (range): EW: Pre-writing State Anxiety = 34.5 (25–41); Post-intervention State Anxiety = 40 (26–44); Control: Pre-writing State Anxiety = 35 (20–48); Post-intervention State Anxiety = 37 (20–44)
De Moor (2002) N = 42 Population: Renal cell carcinoma Gender: 85.7% male Mean age: 56.4 Ethnicity: Not reported	Setting: Lab-based Task: EW: Cancer-related emotions (n = 21); Control: Health behaviours (n = 21) Four sessions for 20 min over four weeks Assessments: Immediately post-intervention and at four, six, eight, and 10 weeks	Measures: PSQI assessed sleep quality; POMS assessed depression, anxiety and fatigue; IES assessed distress Results: Follow-up scores showed that the EW group (M = 6.8, SE = 0.6) reported less sleep disturbance at follow-up compared with the control group (M = 8.7, SE = 0.7) but no differences were found for depression (EW: M = 7.4, SE = 1.1; Control: M = 6.6, SE = 1.2), anxiety (EW: M = 6.9, SE = 0.8; Control: M = 7.0, SE = 0.9), distress (EW: M = 17.4, SE = 1.7; Control: M = 14.6, SE = 1.8) and fatigue (EW: M = 9.5, SE = 1.0; Control: M = 9.6, SE = 1.1)
Low (2010) N = 62 Population: Metastatic breast cancer Gender: All female Mean age: 53.8 (SD = 10.8, range = 29–78) Ethnicity: 87% White	Setting: Home based Task: EW: Cancer-related emotions (n = 31); Control: Facts about cancer diagnosis and treatment (n = 31) Four sessions for 20 min over three weeks Assessments: Baseline and three months post-intervention	Measures: PSQI assessed sleep quality; CES–D assessed depression; IES assessed distress Results: Follow-up scores showed no differences between the EW and control groups for sleep (EW: M = 7.1, SE = 0.51; Control: M = 6.6, SE = 0.51), depression (EW: M = 12.8, SE = 1.47; Control: M = 13.2, SE = 1.48) and distress (EW: M = 8.7, SE = 0.94; Control: M = 10.1, SE = 0.96)
Mosher (2012) N = 86 Population: Advanced breast cancer Gender: All female Mean age: EW: 57.4 (SD = 12.5); Control: 58.5 (SD = 11.7) Ethnicity: 81.4% White, 7% African American, 5.8% Hispanic, 5.8% Other	Setting: Home based Task: EW: Cancer-related emotions (n = 44); Control: Previous day’s activities (n = 42) Four sessions for 20 min over four-seven weeks Assessments: Eight weeks post-intervention	Measures: PSQI assessed sleep quality; CES-D assessed depression; HADS-A assessed anxiety; DT assessed general distress; FACIT-F assessed fatigue Results: Follow-up scores showed no differences between the EW and control groups for sleep (EW: M = 8.42, SE = 0.39; Control: M = 7.83, SE = 0.39), depression (EW: M = 17.99, SE = 1.35; Control: M = 17.87, SE = 1.38), anxiety (EW: M = 7.15, SE = 0.48; Control: M = 7.87, SE = 0.49), distress (EW: M = 4.53, SE = 0.36; Control: M = 4.37, SE = 0.37) and fatigue (EW: M = 30.38, SE = 1.17; Control: M = 32.58, SE = 1.20)

Study characteristics

Setting, task and assessments

Measures and results

Bruera (2008)*

N = 24

Population: Advanced Cancer

Gender: EW: 75% female; Control: 66% female

Median age: EW: 55.4; Control: 54.3

Ethnicity: EW: 92% White, 8% African American; Control: 58% White, 25% African American, 17% Hispanic

Setting: Inpatient and outpatient palliative care clinic

Task: EW: Trauma (n = 12); Control: everyday behaviours and habits (n = 12)

Four sessions for 20 min over two weeks

Assessments: Baseline and before and after each writing session

Measures: STAI assessed anxiety levels before and after each writing session

Results: STAI median scores (range): EW: Pre-writing State Anxiety = 34.5 (25–41); Post-intervention State Anxiety = 40 (26–44); Control: Pre-writing State Anxiety = 35 (20–48); Post-intervention State Anxiety = 37 (20–44)

De Moor (2002)

N = 42

Population: Renal cell carcinoma

Gender: 85.7% male

Mean age: 56.4

Ethnicity: Not reported

Setting: Lab-based

Task: EW: Cancer-related emotions (n = 21); Control: Health behaviours (n = 21)

Four sessions for 20 min over four weeks

Assessments: Immediately post-intervention and at four, six, eight, and 10 weeks

Measures: PSQI assessed sleep quality; POMS assessed depression, anxiety and fatigue; IES assessed distress

Results: Follow-up scores showed that the EW group (M = 6.8, SE = 0.6) reported less sleep disturbance at follow-up compared with the control group (M = 8.7, SE = 0.7) but no differences were found for depression (EW: M = 7.4, SE = 1.1; Control: M = 6.6, SE = 1.2), anxiety (EW: M = 6.9, SE = 0.8; Control: M = 7.0, SE = 0.9), distress (EW: M = 17.4, SE = 1.7; Control: M = 14.6, SE = 1.8) and fatigue (EW: M = 9.5, SE = 1.0; Control: M = 9.6, SE = 1.1)

Low (2010)

N = 62

Population: Metastatic breast cancer

Gender: All female

Mean age: 53.8 (SD = 10.8, range = 29–78)

Ethnicity: 87% White

Setting: Home based

Task: EW: Cancer-related emotions (n = 31); Control: Facts about cancer diagnosis and treatment (n = 31)

Four sessions for 20 min over three weeks

Assessments: Baseline and three months post-intervention

Measures: PSQI assessed sleep quality; CES–D assessed depression; IES assessed distress

Results: Follow-up scores showed no differences between the EW and control groups for sleep (EW: M = 7.1, SE = 0.51; Control: M = 6.6, SE = 0.51), depression (EW: M = 12.8, SE = 1.47; Control: M = 13.2, SE = 1.48) and distress (EW: M = 8.7, SE = 0.94; Control: M = 10.1, SE = 0.96)

Mosher (2012)

N = 86

Population: Advanced breast cancer

Gender: All female

Mean age: EW: 57.4 (SD = 12.5); Control: 58.5 (SD = 11.7)

Ethnicity: 81.4% White, 7% African American, 5.8% Hispanic, 5.8% Other

Setting: Home based

Task: EW: Cancer-related emotions (n = 44); Control: Previous day’s activities (n = 42)

Four sessions for 20 min over four-seven weeks

Assessments: Eight weeks post-intervention

Measures: PSQI assessed sleep quality; CES-D assessed depression; HADS-A assessed anxiety; DT assessed general distress; FACIT-F assessed fatigue

Results: Follow-up scores showed no differences between the EW and control groups for sleep (EW: M = 8.42, SE = 0.39; Control: M = 7.83, SE = 0.39), depression (EW: M = 17.99, SE = 1.35; Control: M = 17.87, SE = 1.38), anxiety (EW: M = 7.15, SE = 0.48; Control: M = 7.87, SE = 0.49), distress (EW: M = 4.53, SE = 0.36; Control: M = 4.37, SE = 0.37) and fatigue (EW: M = 30.38, SE = 1.17; Control: M = 32.58, SE = 1.20)

Note. * = study not included in the meta-analysis; CES-D = Center for Epidemiologic Studies-Depression Scale [53]; DT = Distress Thermometer [54]; EW = Expressive Writing; FACIT-F = Functional Assessment of Chronic Illness Therapy-Fatigue [55]; HADS-A = Hospital Anxiety and Depression Scale [56]; IES = Impact of Events Scale [57]; M = Mean; POMS = Profile of Mood States [58]; PSQI = Pittsburgh Sleep Quality Index [59]; SS = Standard Error; STAI = State-Trait Anxiety Inventory [60]