PROJECT SUMMARY/ABSTRACT Young adulthood (YA) is a critical time in shaping life trajectories related to educational, financial, and family goals, among others. Unfortunately, cancer diagnosis/treatment and its psychosocial sequelae disrupt this critical period for some YAs. This life goal disturbance is related to poorer psychological outcomes, particularly among YAs; however, goal revision and reprioritization lead to more positive psychological outcomes. Thus, goal negotiation is a critical part of survivorship. Understanding psychosocial determinants of positive psychological and behavioral outcomes is critical for developing effective behavioral interventions. Within the rich positive psychology literature, the construct of hope is one particularly relevant factor for YA cancer survivors; hope has been defined as a positive cognitive state based on a sense of successful goal-directed determination and planning to meet these goals. In the general population and in cancer survivors, hope is related to better quality of life (QOL), mental health, health behaviors, and coping with illness/cancer. Our team pioneered an mHealth intervention (i.e., app-based with phone-based counseling) called Achieving Wellness After Kancer in Early life (AWAKE) aimed at increasing hope among YA survivors, thereby re-engaging them in long-term life goals across domains (e.g., vocational, familial) and ultimately increasing QOL. In an 8-week pilot RCT of 56 YAs recruited from 2 cancer centers, AWAKE demonstrated feasibility (95% retention), acceptability (e.g., high satisfaction), and promising trends in changes in hope, QOL, depressive symptoms, and health behaviors (e.g., substance use) in YA survivors. This proposal builds on our prior work to update AWAKE (e.g., its technology), enhance its reach, and increase our ability to examine its effects. Our specific aims are to: 1) conduct formative research examining YA cancer survivor preferences on phone-based counseling with app support to enhance AWAKE; and 2) test the feasibility, acceptability, and preliminary efficacy of AWAKE vs. attention control (AC) via an 8-week RCT of 150 YA cancer survivors. The proposed research is innovative in its use of a novel intervention target – hope – as a mechanism for addressing goal- disruption and QOL among YA survivors, and its use of novel mHealth components and population-based recruitment strategy (via social media) that are particularly relevant to YA survivors and those with potentially limited access to healthcare. This proposal is responsive to RFA-CA-20-028 and has potential high impact due to the number of YA cancer survivors for whom AWAKE may be relevant, AWAKE’s potential utility in reducing cancer-related morbidity and disrupted life goals, and its reach/scalability. Our team is uniquely- qualified to conduct this research, based on our complementary skills and expertise and our collaborative history. Findings will provide the foundation for future research examining AWAKE’s efficacy, generalizability, and scalability, and will also catalyze research to address limitations in cancer survivorship care via mHealth.

PROJECT NARRATIVE We aim to refine and pilot test an 8-week phone- and app-based intervention (AWAKE) to promote hope, and thereby mitigate life disruption caused by cancer diagnosis and treatment, among young adults (YAs); our proposal involves (Aim 1) formative research among YA survivors and healthcare providers; and (Aim 2) an RCT of AWAKE vs. attention control among 150 YA cancer survivors. The proposed research is innovative in its use of: 1) a novel intervention target – hope – as a mechanism for addressing goal-disruption and QOL among YA survivors; and 2) novel mHealth components and population-based recruitment strategy (via social media) that are particularly relevant to YA survivors and those with potentially limited access to healthcare. This proposal has potential high impact due to the number of YA cancer survivors for whom AWAKE may be relevant, AWAKE’s potential utility in enhancing hope and quality of life among YAs, and its reach/scalability.