Emotional disclosure as a therapeutic intervention in palliative care: a scoping review protocol

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China

BACKGROUND

To explore whether emotional expressivity and the patterns of language use could predict benefits from expressive writing (EW) of breast cancer (BC) patients in a culture that strongly discourages emotional disclosure.

METHODS

Data were obtained from a recent trial in which we compared the health outcomes between a prolonged EW group (12 sessions) and a standard EW group (four sessions) (n = 56 per group) of BC patients receiving chemotherapy. The Chinese texts were tokenized using the THU Lexical Analyser for Chinese. Then, LIWC2015 was used to quantify positive and negative affect word use.

RESULTS

Our first hypothesis that BC patients with higher levels of emotional expressivity tended to use higher levels of positive and negative affect words in texts was not supported (r = 0.067, p = 0.549 and r = 0.065, p = 0.559, respectively). The level of emotional expressivity has a significant effect on the quality of life (QOL), and those who used more positive or fewer negative affective words in texts had a better QOL (all p < 0.05). However, no significant difference was identified in physical and psychological well-being (all p > 0.05). Furthermore, the patterns of affective word use during EW did not mediate the effects of emotional expressivity on health outcomes (all p > 0.05).

CONCLUSIONS

Our findings suggest that the level of emotional expressivity and the pattern of affective word use could be factors that may moderate the effects of EW on QOL, which may help clinicians identify the individuals most likely to benefit from such writing exercises in China.

Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors

BACKGROUND

Emotional disclosure is the therapeutic expression of emotion. It holds potential as a means of providing psychological support. However, evidence of its efficacy in palliative settings is mixed. This may be due to variation in intervention characteristics.

AIM

To derive a greater understanding of the characteristics of potentially effective emotional disclosure-based interventions in palliative care by:(1) Developing a taxonomy of emotional disclosure-based interventions tested in people with advanced disease and(2) Mapping and linking objectives, outcomes, underlying mechanisms, and implementation factors.

DESIGN

A scoping review drawing on Intervention Component Analysis to combine evidence from studies' methods, results, and discussion sections.

DATA SOURCES

Six databases were searched to May 2020 including CINAHL, PsycINFO, and MEDLINE. Studies of emotional disclosure in adults with advanced disease were included. Study quality was appraised using an established tool.

RESULTS

Seven thousand seven hundred ninety-two unique records were screened, of which 25 primary studies were included. Intervention characteristics were grouped into classes within three domains: topic of disclosure, format, and dose. Evidence was not available to determine which, if any, of the characteristics is most effective. Thematic synthesis of evidence from methods and discussion sections identified factors to consider in tailoring an emotional disclosure-based intervention to this setting, including: population characteristics (e.g. time since diagnosis), providing a safe environment, and flexibility in format.

CONCLUSIONS

This review approach facilitated a clearer understanding of factors that may be key in developing emotional disclosure-based interventions for palliative populations. Intervention Component Analysis has potential for application elsewhere to help develop evidence-based interventions.

Let It Out (LIO) study: protocol for a mixed-methods study to optimise the design and assess the feasibility of an online emotional disclosure-based intervention in UK hospices

INTRODUCTION

The current COVID-19 pandemic has forced hospices to look for more ways to support people remotely, including psychological support. Emotional disclosure-based interventions hold potential as a way of providing support remotely. However, evidence of their efficacy in people with terminal illness is mixed. Reviews have highlighted this may be due to interventions not being tailored to the unique needs of this population. In response to this, we are developing Let It Out (LIO), an online, self-guided emotional disclosure-based intervention tailored for people living with terminal illness.

AIMS

The primary objective of the study is to optimise the design of the LIO intervention. Secondary objectives include assessing its acceptability and feasibility; exploring potential impact on well-being; identifying potential adverse effects; and informing choice of outcome measures for potential future evaluation.

METHODS AND ANALYSIS

A single arm, mixed-methods, multisite, longitudinal study. Up to 40 people living with a terminal illness under the care of hospices in England and Scotland will receive the online LIO intervention. LIO consists of 3, self-guided expression sessions over 2 weeks. The primary outcome measures are (1) a structured feedback form completed by participants after the final expression session; and (2) semi-structured interviews and focus groups with ≤15 patient participants, ≤30 hospice staff and ≤15 informal carers. These quantitative and qualitative data will be triangulated via process evaluation to inform optimisation of the intervention design. Secondary outcome measures include validated measures of physical and psychological health collected at baseline and after the final expression session (immediately, 1, 4 and 8 weeks after); and data on recruitment, retention and fidelity.

ETHICS AND DISSEMINATION

The study is approved by the University College London Research Ethics Committee (reference: 15281/002). The findings will be shared through peer-reviewed scientific journals and conferences, and traditional, online and social media platforms.