Project Overview
The “Wellness Coaching for Cancer Survivors” program was an intervention aimed at providing individualized HWC services to cancer survivors anywhere along the cancer continuum throughout a mid-Atlantic state in a community-based setting. The project was a collaboration between a community-based cancer agency and two mid-Atlantic universities, using certified health coaches [28]. Approval was obtained by both Institutional Review Boards.
Setting
Cancer survivors anywhere along the cancer continuum from early diagnosis through long-term survivorship were recruited for the study through the community-based cancer agency’s locations. The community-based cancer agency is a statewide non-profit community organization that provides cancer survivors and their caregivers and/or family with counseling support groups, educational workshops, exercise and nutrition groups, and other programs free of charge to help cope with and manage the emotional aspect of cancer.
Study Design and Participants
A single group pretest-posttest design was utilized for this study. Participants were recruited through flyers, email, and an advertisement in the agency’s weekly newsletter. Those who showed interest were contacted by the research coordinator to complete a phone screen to determine eligibility. Participants were considered eligible if they (1) were over the age of 18, (2) had been previously diagnosed with cancer at any time in the past, and (3) were able to read and complete an online questionnaire. There were no exclusion criteria independent of the inclusion criteria. If eligibility criteria were met, informed consent was obtained. Baseline and 3-month post-program follow-up assessments were completed online using a REDCap database.
Program
Six individual HWC sessions were provided over a three-month period to cancer survivors. Sessions were led by certified health coaches and followed the standard treatment model used by the host institution [28]. The first session was a 90-minute in-person session and held at one of the community locations. The remaining five sessions were approximately 30-minutes in length and conducted either in-person, telephonically, or through a secure video conferencing platform, as designated by participant preference. Sessions were tailored to the individual, allowing them to talk about the most important aspects of their health and what behaviors they were most interested in changing during the next three months.
Data Collection
Following the phone screen, participants were sent an email with an individualized link to the surveys, collected in REDCap [29]. Surveys were completed in the same manner approximately three months later and sent immediately following their final HWC session.
Instruments
Physical Activity Readiness Questionnaire (PAR-Q) [30]. The PAR-Q consists of seven questions assessing whether a person is physically ready to engage in physical activity, or whether they should consult a doctor before beginning an exercise program. The PAR-Q questions were verbally asked during the phone screen. In the event someone failed the PAR-Q, they were asked to contact their primary care provider and obtain medical clearance. Until permission was gained through a healthcare provider, participants were not allowed to be coached around exercise or physical activity.
Demographics and Health Coaching Questionnaire. Demographic information included gender, age, race, ethnicity, marital status, education, and income. Medical information included cancer type, stage, and date of diagnosis, as well as whether the participant had surgery, chemotherapy, or radiation to treat their cancer. The Health Coaching Questionnaire included general physical activity and sleep habits as well as additional information regarding smoking or intake of alcohol.
Perceived Stress Scale (PSS) [31]. The PSS is a 10-item measure used to determine participants’ psychological perception of stress within the last month. Positive questions are reverse scored and scores are summed for a total perceived stress score. The higher the score, the more stress the participant perceives experiencing (baseline 𝛼: 0.87).
Functional Assessment of Cancer Therapy: General, Version 4 (FACT-G) [32]. The FACT-G is a 27-item questionnaire measuring four facets of cancer related QoL: physical well-being, social and family well-being, emotional well-being, and functional well-being. It provides scores for each individual subscale, as well as a total score. Higher scores indicate higher reported health related QoL (baseline 𝛼: physical = 0.80; social = 0.86; emotional = 0.87; functional = 0.86; total = 0.91).
Hospital Anxiety and Depression Scale (HADS) [33]. This 14-item scale assesses anxiety and depression separately and categorizes symptoms as “normal”, “borderline abnormal”, or “abnormal”. In this study, this scale was included as a screening tool to help determine if the participant needed to be referred to a mental health professional before beginning the program (baseline 𝛼: anxiety = 0.88; depression = 0.89).
Rapid Eating Assessment for Patients Short Form (REAP-S) [34]. This 16-item questionnaire assesses various eating habits. The higher the score, the healthier a person’s overall eating habits (baseline 𝛼: 0.75).
International Physical Activity Questionnaire – Short Form (IPAQ) [35]. The IPAQ is a seven-question measure assessing the number of bouts of vigorous physical activity, moderate physical activity, and/or walking a person does on average in a seven-day period in their leisure time as well as how many minutes they spend during each bout. The questionnaire also assesses how many minutes per day a person spends sitting. Bouts per week, minutes per week, and MET-minutes of moderate-vigorous and total physical activity was calculated and assessed.
Pittsburg Sleep Quality Index (PSQI) [36]. The PSQI measures various aspects of sleep and sleep patterns in adults. Nine questions determines subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month. Scores of 5 or above are indicative of poor sleep (baseline 𝛼: 0.71).
Statistical Analysis
Analyses were conducted on the baseline sample (N=51) using IBM SPSS version 26 [37]. Variable distributions were inspected, and a 5% winsorization technique was applied to preserve out-of-range rank order values in the distribution while limiting their influence [38]. Demographic information was analyzed using means and standard deviations for continuous variables and frequency or percentages for categorical variables. Our analyses examined the overall effects of the program on eliciting change in the various behaviors from baseline to program completion. To do so, estimated marginal means models were computed for each instrument and corresponding sub-scales. Model effects were further decomposed using pairwise comparisons. In addition, Cohen’s d, a distribution-based effect size measure, was calculated for each outcome variable between baseline and program completion. Cohen’s d effect sizes can be interpreted as 0.20 as a small effect, 0.50 as a medium effect, and 0.80 as a large effect [39].