Previvors Recharge: A Resilience Program for Cancer Previvors

It is estimated that approximately 5-10% of all diagnosed cancers are caused by Hereditary Cancer Syndromes (HCS) that are associated with germline mutations (inherited genetic mutations passed directly from a parent to a child that create a genetic predisposition to certain types of cancer). Recent epidemiologic models indicate that 1 in 279 people may be carriers of one of the most common HCS, and advances in genetic testing continue to identify new inherited mutations. Individuals with an HCS (Previvors) have up to an 80% lifetime risk of developing cancer and are at an increased risk of developing multiple primary cancers during their lifetime, often with onset at an early age. Previvors face multiple forms of adversity, including a multitude of annual cancer screenings and the uncertainty of not only their own health but the health of affected family members. Previvors also regularly experience “scanxiety” while anticipating, undergoing, and awaiting the results of screenings. While interventions to promote resilience among Previvors would address an important unmet public health need, existing solutions have a number of gaps that limit effectiveness, widespread dissemination, and applicability to Previvors. The proposed research will employ a participatory design approach to create and examine the acceptability and preliminary effects of PREcharge, a resilience-boosting solution specifically designed for Previvors and delivered primarily via bi-directional text messaging. PREcharge will use proven approaches to behavior change tailoring to increase resilience by promoting a positive mindset, strong social connections, and a deep sense of meaning and purpose while also proactively addressing scanxiety. The design and development of PREcharge will be informed by extensive and ongoing end-user input from 10 Previvor advisors as well as 6 experts in this area. One hundred and twenty-nine Previvors will be recruited for a 30-day pilot test. Phase I milestones will include: 1) acceptability of the program, as evidenced by overall mean ratings of at least 4 out of 5 on a widely used acceptability measure and obtaining 75% endorsement that users would recommend the program to a fellow Previvor; (2) engagement as evidenced by continued receipt of text messages and one or more interactions with the online tools by at least 70% of participants; and (3) benefit from the program, evidenced by statistically significant pre-post improvement on the Connor Davidson Resilience Scale. Pilot participants who fail to sustain engagement will be asked to provide feedback on how PREcharge could be improved. The data from this pilot test will lay the foundation for the further development of tailored text- messaging solutions to improve resilience outcomes among the expanding population of Previvors. This type of easily disseminable, potentially cost-effective, and highly tailored solution would overcome the limitations of existing interventions and provide a framework for messaging on other key behaviors (e.g., health care provider communication) in the future.