Project Summary This K99/R00 Pathway to Independence Award's overall goal is to develop and assess the feasibility and preliminary efficacy of a web-based resilience-building intervention to address patients with advanced cancer and their family caregivers’ appraisals of advance care planning (ACP) and individual and dyadic coping. ACP is a process to facilitate decision-making for future medical care. By supporting individuals in understanding and sharing their values and goals, ACP can help patients meet their goals for health care treatment, decrease the emotional burden of decision-making for family caregivers, and increase satisfaction with end-of-life care and quality of death. Avoidance of ACP can delay the introduction of palliative and hospice care and risk patients receiving costly and aggressive care that not only is goal- discordant but also increases family caregivers’ anxiety and depression. The rationale for a web-based resilience-building intervention is that patients and family caregivers can be empowered to accurately appraise and use appropriate coping strategies for ACP by increasing their resilience skills. Building resilience has shown promising results in reducing cancer distress in adolescents and young adults with cancer and their parents. The proposed study is guided by the Systemic Transactional Model and utilizes a dyadic intervention approach. The training goals of the proposed study are to (1) develop expertise in dyadic study design and intervention development for people with cancer and their caregivers; (2) gain specialized knowledge in digital positive psychology interventions; (3) gain skills in leading randomized controlled trials and dissemination and implementation science; and (4) secure a tenure-track position. The Specific Aims for the K99 phase are to (1) identify the ACP deliberation process among 20 dyads of patients with advanced cancer and family caregivers and (2) conduct usability testing among 9 dyads to refine the content and design of the web-based resilience-building intervention. The Specific Aims for the R00 phase are to (1) assess the feasibility and acceptability of the web-based resilience-building intervention among patients with advanced cancer and their family caregivers through a randomized clinical trial in a cancer center setting; (2) evaluate the preliminary efficacy of the intervention compared to usual care on changes in the completion of advance directives (primary outcome) and on patient and caregiver resilience, individual and dyadic coping, anxiety, and depression (secondary outcomes); and (3) explore the dyadic effects of resilience within patients with advanced cancer and their family caregivers on individual and dyadic coping, anxiety, and depression, using the Actor-Partner Interdependence Model. The expected outcomes are identification and development of the essential components of the web-based intervention (K99 phase) and data that provides a strong foundation for further development of the intervention for R01 applications and future research (R00 phase).

Project Narrative Patients with advanced cancer have not fully benefited from advance care planning due to the high levels of anxiety and depression experienced and other barriers that affect their appraisals and coping. Despite the protective effects of resilience, there have been few clinical trials improving the resilience skills of patients with advanced cancer and their family caregivers to help initiate advance care planning discussions and sustain engagement. This research will provide new insights through using a dyadic intervention approach to advance care planning while developing and evaluating a web-based resilience- building intervention to improve the completion of advance directives, resilience, coping, anxiety, and depression for patients with advanced cancer and their family caregivers.