UNIVERSITY OF CALGARY Speaking Their Language:

UNIVERSITY OF CALGARY
Speaking Their Language:
A Randomized Pilot Study of Synchronous Online Chat Groups for Young Adults with Cancer
by
Michael Lang
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTERS OF SCIENCE
GRADUATE PROGRAM IN COMMUNITY HEALTH SCIENCES
CALGARY, ALBERTA
JULY, 2015
© Michael Lang 2015

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Abstract
Background: In Canada, over 7,000 adolescents and young adults or “AYA” (ages 18 to 39
years) are diagnosed with cancer annually. Few evidence-based psychosocial interventions exist
for this population.
Methods: We conducted a randomized pilot study to compare a new AYA-specific
psychotherapy model to a standard psycho-educational model, using CancerChatCanada (CCC)
synchronous online chat groups.
Results: 34 AYAs in Alberta participated in the study and all feasibility targets were met.
Participants rated the new AYA model more suitable and it appeared to improve important group
processes and psychosocial outcomes. A power calculation providing sample size estimation for
an RCT indicated that more than 90 participants would be needed to demonstrate differential
efficacy between groups.
Discussion: This randomized study design is feasible with some important modifications.
Conclusion: Online synchronous chat groups can be used to provide psychosocial care for
AYAs. Future RCTs could provide evidence of efficacy for age-specific psychotherapy models.
Words: 150

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Acknowledgements
I would like to acknowledge Dr. Janine Giese-Davis for the incredible mentorship and teaching
concerning all aspects of this thesis. Dr. Joseph Dort for “giving me a shot” and his perspective
and support during my time at the U of C. Dr. Marilynne Hebert for her involvement and
guidance concerning the qualitative aspects of this thesis and Dr. Joanne Stephen for cultivating
such a wonderful online chat platform and helpful research team at CancerChatCanada. Finally, I
would like to acknowledge all the incredible study participants who filled out many surveys to
help me better understand their chat group experience and ultimately, help improve psychosocial
care for other young adults with cancer.

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Dedication
To my wife, Bonnie. Thanks for feeding me when I forget to eat, and loving me when I don’t
deserve it.

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Table of Contents
Abstract........................................................................................................................................... ii!
Dedication...................................................................................................................................... iv!
Table of Contents............................................................................................................................ v!
List of Tables ................................................................................................................................. ix!
List of Figures and Illustrations ...................................................................................................... x!
List of Symbols, Abbreviations and Nomenclature....................................................................... xi!
Epigraph........................................................................................................................................ xii!
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1.1 Outline of Candidature.......................................................................................................... 1!
1.2 Background........................................................................................................................... 1!
1.3 Rationale ............................................................................................................................... 2!
1.4 Primary Research Question and Study Aims........................................................................ 3!
1.5 Study Design......................................................................................................................... 4!
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2.1 Introduction........................................................................................................................... 6!
2.2 The Field of Psychosocial Oncology .................................................................................... 6!
2.2.1 Importance of Psychosocial Interventions for People with Cancer.............................. 7!
2.2.2 Types of Psychosocial Interventions and their Purpose ............................................... 7!
2.2.3 Technology-based Psychosocial Interventions in Cancer Care.................................... 9!
2.3 Adolescent and Young Adult Psychosocial Oncology ....................................................... 10!
2.3.1 Emerging Definitions of AYA ................................................................................... 11!
2.3.2 Unique Aspects of AYA Psychosocial Care .............................................................. 11!
2.3.3 Rationale for Developing Online Interventions Specifically for AYAs .................... 12!
2.3.4 Rationale for Group Psychotherapy with AYAs ........................................................ 13!
2.4 Therapeutic Models of Online Psychosocial Interventions for AYAs ............................... 14!
2.4.1 Group Psychotherapy ................................................................................................. 14!
2.4.2 Psycho-Educational Group Psychotherapy (CCC Standard Model) .......................... 15!
2.4.3 Narrative-informed Emotion-focused Group Psychotherapy (Modified Model)....... 17!
2.4.3.1 Awareness, Contextualization and Symbolization of Emotions....................... 18!
2.4.3.2 Narrative Construction, Transformation of Story Outcomes and Identity
Reconstruction ................................................................................................... 19!
2.4.3.3 Potential Differential Psychosocial Outcomes of NIEFP in AYAs.................. 19!
2.5 Theoretical Evaluation of Online Group Psychotherapy Interventions (Study Aim #1).... 20!
2.5.1 Evaluating Content Sensitivity ................................................................................... 20!
2.5.2 Evaluating Changes in Group Processes .................................................................... 20!
2.6 Outcome Evaluation of Online Psychosocial Interventions (Study Aim #2) ..................... 21!
2.6.1 Distress, Depression and Anxiety in AYAs ............................................................... 21!
2.6.2 Loneliness in AYAs ................................................................................................... 22!
2.6.3 Trauma in AYAs ........................................................................................................ 22!
2.6.4 Posttraumatic Growth in AYAs.................................................................................. 23!
2.6.5 Coping Self-Efficacy in AYA’s ................................................................................. 23!
2.7 Objectives of External Pilot Studies in Online RCT Interventions (Study Aim #3) .......... 24!
2.7.1 Recruitment and Retention ......................................................................................... 24!