Hope and benefit finding: Results from the PRISM randomized controlled trial

BACKGROUND: Adolescents and young adults (AYAs) with cancer are at risk for poor psychosocial outcomes, perhaps because they have not acquired skills to navigate the adversities of illness. In a recent phase II randomized controlled trial (RCT), the "Promoting Resilience in Stress Management" (PRISM) intervention was associated with improved patient-reported resilience, quality of life, and distress. In this planned analysis of secondary aims, we hypothesized PRISM would also improve targeted coping skills of hopeful thinking, benefit finding, and goal setting. METHODS: We conducted this parallel RCT at Seattle Children's Hospital from January 2015 to October 2016. English-speaking AYAs (12-25 years old) with cancer were randomized one-to-one to PRISM or usual care (UC). PRISM teaches stress-management, goal-setting, cognitive-reframing, and meaning-making skills in four sessions delivered in-person every other week. Participants completed surveys at enrollment and 6 months later. Mixed effects linear regression models evaluated associations between PRISM and benefit finding (Benefit-Finding Scale for Children), hopeful thinking (Hope Scale), and an exploratory outcome of goal setting (queried with open-ended items about participant's goals, measured qualitatively by three blinded reviewers). RESULTS: Of N = 92 AYAs (48 PRISM, 44 UC), 73% were 12-17 years old, 43% female, and 62% diagnosed with leukemia or lymphoma. PRISM was associated with improved benefit finding and hope with moderate-to-large effect sizes-benefit finding: +3.1 points, 95% CI 0.0, 6.2, d = 0.4, and P = 0.05; and hope: +3.6 points, 95% CI 0.7, 6.4, d = 0.6, and P = 0.01. We did not detect changes in goal setting (-0.5 points, 95% CI -1.2, 0.3, d = -0.3, P = 0.23). CONCLUSIONS: PRISM was associated with improvements in benefit finding and hopeful thinking, two adaptive coping skills which may mitigate long-term psychosocial risk.