Pathways, a Hope-Based Intervention to Support Personal Goal Pursuit, Mental Health, and Quality of Life during Advanced Lung Cancer Treatment

ABSTRACT To realize the survival benefits of medical advances in the treatment of advanced cancer (AC), psychosocial and palliative care for the over 600,000 people living with AC in the U.S. must be equipped with evidence- based approaches to address psychosocial concerns driving mental health and quality of life in this new treatment era. Personal goal disruption is one such concern and evidence-based strategies to address it are lacking, especially the context of significant prognostic uncertainty and prolonged survival now characterizing a diagnosis of AC. The long-term goal of this research is to improve AC patient mental health and quality of life during cancer treatment. The overall objectives in this application are to (i) test the efficacy of a novel psychosocial intervention called “Pathways” to address goal disruption during AC treatment; and (ii) evaluate intervention mediators and identify potential moderators of intervention efficacy. The central hypothesis is that Pathways will reduce goal disruption and thereby improve mental health and quality of life during AC treatment. The rationale for this project is that Pathways, a brief, hope-based intervention delivered primarily at the point of AC patient care by a range of healthcare providers (e.g., nurse, occupational therapist, social worker) has demonstrated feasibility and acceptability to advanced lung cancer patients, with encouraging preliminary effects on goal disruption, mental health, and quality of life outcomes. Thus, preliminary data suggest it is a promising approach to address goal disruption and improve mental health and quality of life in AC treatment. The central hypothesis will be tested through two specific aims: 1) Test the efficacy of Pathways against enhanced usual care; and 2) Evaluate goal interference as a mediator of intervention effects. There is one exploratory aim: because AC disproportionately affects rural, older underserved populations who have been underrepresented in psychosocial intervention trials, we will use mixed-methods to evaluate the preliminary reach of the Pathways intervention among these subgroups. To accomplish these aims, 234 patients undergoing treatment for advanced lung cancer –the most common advanced cancer associated with the poorest mental health and quality of life outcomes – at the University of Kentucky Markey Cancer Center will be randomized to Pathways or enhanced usual care. The research proposed in this application is innovative because it is testing a novel intervention with respect to intervention focus and intervention delivery at the point of AC care. The proposed research is significant because it will determine the efficacy of an intervention designed to overcome patient access barriers and address significant, prevalent concerns in a large, psychosocially vulnerable cancer population and will inform a planned effectiveness trial. Once efficacy is demonstrated, the effectiveness of the intervention will be tested in both academic and community oncology practices with other AC patient populations, significantly advancing psychosocial and palliative care in this new treatment era and ultimately having a large impact on patient outcomes.