Abstract
Background: Confrontation of mortality in young adults (YAs) with advanced cancer often leads to significant feelings of grief over the loss of opportunity to achieve lifetime goals and milestones as well as other cancer-related losses. Literature on the palliative care needs of YAs with advanced cancer suggests that an intervention targeting well-being may provide significant benefit to this patient population. Promotion of positive emotions may be helpful in enhancing well-being in YAs with advanced cancer by helping them focus on the pleasures that life still has to offer. Gratitude, one such positive emotion, is characterized by the affirmation of goodness in life. Gratitude interventions have been shown to improve well-being in patients experiencing traumatic life events and to be negatively correlated with anxiety and depression. It can be cultivated in a short time frame and lends itself well to a self-directed journaling intervention. Because of their known comfort with and usage of the Internet to seek information and build community, an Internet-delivered gratitude intervention may best meet the needs of YAs with advanced cancer.
Objective: The purpose of this study is to determine the feasibility and acceptability of an online gratitude intervention for YAs with advanced cancer and to evaluate its preliminary effects on gratitude, mindful observation, positive and negative affect and emotional experience, and psychological well-being, when compared with a waitlist-control group.
Design and Methods: This study was a randomized, prospective, waitlist-controlled feasibility study informed by the Broaden and Build Theory of Positive Emotion. Participants were recruited through social networking sites (Facebook and Twitter) and other online forums. Participants gave consent and completed pre-intervention measures online. Those in the experimental group kept a daily, online gratitude journal for 21 days. Automated daily emails were sent to remind participants to journal. All participants completed follow-up measures after 21 days and again 30 days later.
Results: Overall 26 potential participants expressed interest in the study, and 19 participants were enrolled using exclusively online recruitment methods. Geographic diversity was excellent, but the sample lacked racial and gender diversity. Attrition was 15.8%. Average number of journal entries was 14, with an average word count of 186. Post-intervention, the experimental group saw significant improvement in gratitude (p=0.043), mindful observation (p=0.012), negative emotion (p=0.042), negative affect (p=0.007), self-acceptance (p=0.011), and personal growth (0.035). Large overall effect sizes were seen for gratitude, mindful observation, negative emotion, and negative affect. The control group saw significant improvement in positive relations with other (p=0.041). At the 30-day follow-up overall effect sizes remained large for gratitude, mindful observation, negative emotion, and negative affect. A large effect size was also seen at 30-days for personal growth.
Conclusion: The results of the MyGratefulSelf study provide support for the ongoing exploration of the Internet as a way to reach young adults with cancer and engage them in them in clinical and behavioral research studies. The Internet may be and effective resource for engagement of young adults if used as a tool for social networking and community engagement rather than a virtual bulletin board. Additionally, the MyGratefulSelf study adds to the current literature of the efficacy of gratitude interventions by demonstrating a significant impact on well-being in a highly distressed clinical population, however the results are limited in generalizability dues to the small sample size. Future, fully powered studies should expand on the MyGratefulSelf system to promote better engagement and enhance its positive effects.
