# Optimizing Feasibility and Acceptability of an Online Expressive Writing Intervention for Survivors of Adolescent and Young Adult Cancer: A Pilot Randomized Trial of Iterative Modifications and Outcomes

## TL;DR

This study tested an online writing program for young adult cancer survivors and found that making the program more flexible and personalized improved how well participants followed it.

## Contribution

The study introduces iterative, theory-driven modifications to an online expressive writing intervention, improving adherence and completion rates for AYA cancer survivors.

## Key findings

- Adherence improved significantly, with 83.3% completing all writing tasks compared to 25.0% in a prior cohort.
- The 6-month follow-up completion rate increased to 72% from 50% in the previous cohort.
- Participants positively received flexible timelines, tailored prompts, and personalized reminders.

## Abstract

To evaluate the feasibility of an online expressive writing (EW) intervention for survivors of adolescent and young adult (AYA) cancer and determine whether iterative, theory‐driven modifications can enhance response, adherence, and completion rates.

In this randomized pilot trial, survivors of AYA cancer were recruited through a hospital‐based AYA oncology clinic and an online community. Forty participants were randomly assigned to the EW intervention or control group. To improve on lower‐than‐expected adherence and completion rates in a previous cohort, the protocol was iteratively revised using the Framework for Reporting Adaptations and Modifications to Evidence‐based Implementation Strategies (FRAME‐IS). Modifications included extending the intervention from 3 to approximately 6 weeks, allowing more flexibility; two prompt choices per session; and proactive, personalized reminders. Response, adherence, and follow‐up survey completion rates at 1, 3, and 6 months were collected via REDCap surveys, and participant feedback was obtained through post‐study interviews.

We achieved a 46% response rate, compared to 40% in the previous cohort. Adherence improved significantly, with 83.3% of participants completing all 3 writing tasks versus 25.0% in the previous cohort (p < 0.001). The 6‐month follow‐up completion rate also increased to 72% from 50% in the previous cohort. Qualitative feedback indicated that the flexible timeline, tailored prompts, and personalized reminders were well received.

Iterative, FRAME‐IS–guided modifications markedly improved the feasibility of the online EW intervention for AYA cancer survivors. These findings support further research to assess the clinical efficacy of EW in enhancing health outcomes and quality of life.