Solution-Focused Brief Therapy for Adolescent and Young Adult Cancer Patients in China: A Pilot Randomized Controlled Trial

Background. Adolescent and young adult (AYA) cancer patients have the worst treatment and survivorship outcomes when compared with their pediatric and adult counterparts. Notably, this age disparity in cancer care is robust across the world including both developed and developing countries, such as China. In China, about 125,000 AYAs are diagnosed with cancer every year, and a significant proportion of newly diagnosed AYAs experience moderate to high psychological distress. If not properly treated, psychological distress is linked with treatment disengagement, risk health behaviors, and suicidality. Solution-focused brief therapy (SFBT) is a strength-based, hope-engendering, and evidence-based therapeutic approach for psychological distress. Notably, SFBT has been found reporting greater treatment effect for Asian populations versus their Western counterparts. Given the significant potential, this study represents the first to empirically test the treatment effect of SFBT for psychological distress among AYA cancer patients in China. Methods. This pilot randomized-controlled-trial (RCT) enrolled 50 Chinese AYA cancer patients and randomly assigned participants into treatment group (SFBT) or control group (treatment-as-usual, TAU). Participants in treatment group completed 4 weeks of SFBT sessions whereas participants in the control group completed 4 TAU sessions that mimic the frequency and intensity of the treatment group. The primary outcome was psychological distress measured by the Chinese version of Brief Symptom Inventory (CBSI-18) and the secondary outcome was hope measured by the Chinese version of the Herth-Hope-Index (CHHI). Analysis of Covariance (ANOVA) was used to evaluate the treatment effect of SFBT versus TAU, with immediate post-treatment scores as the dependent variable, pre-test scores and important demographic and clinical characteristics of patients as the covariates, and treatment condition as the fixed factor. Between-group effect sizes were calculated using small-sample size corrected Hedges’ g to evaluate the practical significance. Results. ANCOVA revealed Chinese AYA patients with cancer receiving SFBT reported a significantly greater reduction in psychological distress compared to those in TAU, F(1)=25.20, p<0.001. Additionally, AYA cancer patients receiving SFBT reported significantly greater reduction in sub-scores of depression, F(1)=6.87, p<0.01, anxiety, F(1)=16.62, p<0.001, but not in somatization, F(1)=1.98, p=0.166. Consistent with SFBT’s change theory of using positive emotions, AYA cancer patients receiving SFBT reported significantly greater improvement in level of hope than their counterparts in TAU, F(1)=27.96, p<0.001. Between group effect size estimation revealed SFBT’s clinically meaningful improvement in AYA cancer patients’ psychological distress, g=0.740, p<0.01, depression, g=0.377, p<0.05, anxiety, g=0.626, p<0.01, and hope, g=1.53, p<0.001. Conclusions and Implications. This study evaluated a brief, evidence-based, and strength-based psychosocial intervention for psychological distress among Chinese AYA patients with cancer. Findings revealed SFBT’s treatment effect being statistically significant and clinically meaningful. The inclusion of positive emotions, i.e., hope, as part of the investigation also highlighted the significance of oncology social workers promoting positive emotions among AYA patients with cancer.