Effect of journaling on person-centric outcomes in adolescents and young adults receiving specialist palliative care (WRITE-in-AYAs): A mixed-methods randomized controlled trial protocol

Background and Aim Adolescents and young adults (AYAs) with advanced cancer experience significant physical, psychological, and existential distress, often compounded by developmental challenges. In low-and middle-income countries, there is a paucity of contextually relevant, low-cost psychosocial interventions within palliative care. Journaling has shown promise in improving emotional well-being but remains underexplored in this population. We aim to evaluate the effectiveness of guided journaling on person-centered outcomes among AYAs receiving specialist palliative care (SPC) and to explore their experiences with journaling.Methods WRITE-in-AYAs is a phase 3, non-blinded, mixed-methods randomized controlled trial from a tertiary care centre in India. AYAs with advanced cancer will be randomized (1:1) to guided journaling plus usual SPC or usual SPC alone. The intervention will include guided journaling over four weeks. The primary outcome will be the change in quality of life, measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being at day 7. Secondary outcomes will include changes in quality of life at one month and psychological distress, measured using the Hospital Anxiety and Depression Scale at day 7 and one month. Qualitative findings will explore perceived benefits, challenges, and meaning-making associated with journaling. Qualitative data will be obtained through semi-structured interviews and analysed thematically.Discussion This study will generate contextually relevant evidence from quantitative data and AYAs' lived experiences to inform a scalable, low-cost psychosocial intervention. This will inform patient-centred psychosocial care specific to AYAs receiving palliative care in resource-constrained settings.