Valued Living intervention to increase advance care planning and well-being in depressed and anxious adults with advanced cancer: Randomized trial in community oncology clinics.

Abstract

Adults with advanced cancer often experience low engagement with advance care planning (ACP) and high levels of depression, anxiety, and fear of death/dying. Access to specialist palliative care is limited. This study tests Valued Living, a novel online acceptance-based group intervention designed to increase ACP and improve psychological/spiritual well-being among adults with advanced cancer screening positive for depression or anxiety. Valued Living was delivered online by social workers in community oncology settings. Adults with advanced solid tumor cancer (N = 240) and significant depression or anxiety symptoms were randomized 1:1 within cohorts to Valued Living or usual care (UC). Valued Living provided five weekly group sessions by videoconference plus self-paced online modules. Primary outcome was the total number of ACP behavioral steps completed of 12 potential steps (e.g., selecting health care proxy, advanced directives) by 3.5-month follow-up. Secondary outcomes included fear of death, rigid cognitive avoidance of death, depression, anxiety, and spiritual well-being. Valued Living participants completed 1.27 more ACP steps (95% CI, 0.36-2.18; d = 0.36; p = .006) than UC. Largest condition differences were identifying (97.4% vs. 84.2%) and documenting a health care proxy (83.3% vs. 64.9%). Valued Living participants improved more in cognitive avoidance of death (d = 0.36; p = .005), and spiritual well-being (d = 0.42; p < .001) but not fear of death or anxiety. The online Valued Living intervention, implemented by social workers in community oncology clinics, increased ACP and well-being among depressed and anxious adults with advanced cancer. Findings support this supportive care approach for the growing population living with advanced cancer. The trial registration is ClinicalTrials.gov NCT04773639.