Participants in the ACT intervention arm will learn new adaptive ways to cope with difficulties (including difficult thoughts or feelings).

Participants in the Education arm will become familiar with post-HCT recommendations. This will be a minimally enhanced usual care.

ACT intervention will start on the second day after hospital discharge and will take 14 days (+ day 0 with organizational information). Each day, participants will receive a web-based intervention consisting of educational and practical tasks/activities. Participants will learn to recognize moments of choice (actions that lead towards values or away from them) and to use attention flexibly to free themselves from the power of thoughts, to open up and accept emotions, and to be able to determine what is important and take action in line with values. All of the tasks will be available in written form and audio. The ACT intervention is built from standard ACT exercises.

Acceptance and Commitment Therapy

Education will start on the second day after hospital discharge and will take 14 days (+ day 0 with organizational information). Each day, participants will receive information about post-transplant prescriptions along with exercises to support the implementation. Participants will learn about nutrition, personal hygiene, preventing infections, coping with fatigue, resuming activity, rest and sleep, engaging in social interactions, and sexual health. The content is prepared based on available guides for HCT recipients.

Education

Aleksandra Kroemeke, PhD

Małgorzata Sobczyk-Kruszelnicka, MD

This trial aimed to test internet-based Acceptance and Commitment Therapy (ACT) intervention to induce a meaning-making process in cancer patients following hematopoietic cell transplantation (HCT). ACT includes identifying personal values and engaging in activities consistent with these values, developing acceptance, as well as focusing on the present moment or performing activities with greater awareness. In total, 192 patients following the first (autologous or allogeneic) HCT will be randomly assigned in equal numbers to either the ACT intervention or an education session. Participants in both conditions will take part in 14-day training (about 5-10 minutes a day). The outcomes will be measured at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. Moreover, 6-9 additional participants will be randomly assigned to pre-intervention measurement length (1-3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The researchers hypothesized that ACT intervention would foster a meaning-making process and thus reduce distress induced by the discrepancy between global and situational meaning as compared to education.

This trial evaluates the feasibility, acceptability, and preliminary efficacy of self-help internet-based Acceptance and Commitment Therapy (ACT) intervention on meaning-related distress as well as secondary outcomes in patients following hematopoietic cell transplantation (HCT). Randomized controlled trial (RCT) will be enhanced with a single-case experimental design (SCED).

Recruitment will take place at a single center, after elective admission to the bone marrow transplantation and oncohematology unit due to HCT before the start of conditioning treatment. Recruitment will take place on average on the 2nd day after admission. Every two days, the transplant coordinator and physician (members of the research team) will review the lists of patients enrolled for HCT. Those who meet the inclusion criteria will be initially informed of the purpose of the study and invited for an extensive briefing by a recruiter (member of the research team). Patients will also be allowed to ask any remaining questions about the aim of the study and the study procedures. After receiving an extensive briefing, all patients who give written informed consent will proceed with baseline. Data will be collected via a self-reported survey on a mobile device. Clinical data will be obtained from the medical records. All participants will receive written user instructions for the daily sessions and measurements.

In RCT, participants will be randomly assigned in a double-blinded manner to ACT intervention and education conditions at a ratio of 1:1 by a trial coordinator (member of the research team). Randomization will be stratified by type of transplant. Participants and researchers analyzing data will be blind to the allocation of the participants to the conditions. Participants allocated to the ACT intervention will receive online ACT-based intervention within 14 days after hospital discharge. Each day's intervention will consist of an educational and practical part (standard ACT activity) followed by a debrief. On some days, participants will also receive additional exercise (optional). The whole intervention will be tailored to the context of the disease and treatment. During the same period, participants allocated to the education will receive an online guide to post-HCT recommendations. The intervention/education will be discontinued by participants at any time without any negative consequences. During the intervention/education, participants will fill in a short questionnaire assessing potential mediator variables each day, at the beginning of every online session. Participants will receive daily reminders about the intervention/education. Also, direct technical support will be available 24/7. If participants fail to complete study assessments, motivational reminders will be sent by email. If participants drop out or stop using the intervention, they will be asked for the reason(s) why they decided to quit the intervention and/or study.

In SCED, all participants will take part in the online ACT intervention and daily surveys at the 2nd and 3rd post-intervention assessments.

Feasibility will be examined via attrition and adherence rates, as well as questions about intervention engagement. Acceptability will be measured by intervention satisfaction and evaluation (attractiveness and easiness).

This trial is enhanced by a single-case experimental design (SCED), in which all study participants will receive the same intervention (i.e., intervention study model: single group). In SCED, there is no masking. The estimated total number of participants to be enrolled in SCED is 6-9.

The Effect of an Online ACT Intervention on Meaning-Making Process in Cancer Patients Following Hematopoietic Cell Transplantation

The Effect of an Online Acceptance and Commitment Intervention on Meaning-Making Process in Cancer Patients Following Hematopoietic Cell Transplantation: a Randomized Controlled Trial Enhanced With a Single-case Experimental Design

The full protocol, dataset, statistical codes, and outputs will be made available at the Open Science Framework (OSF). Anonymized participant-level datasets will be publicly available, however, without demographics and clinical data due to privacy or ethical restrictions (the possibility of identification of participants).

The data will be stored for at least 5 years after the end of the project unless other regulations lengthen the need to store the data or it is not necessary due to other reasons (e.g. documentation of research results).

The GMVS measures meaning-related distress. It is a 12-item questionnaire (from the original, the item "health" was removed due to the context of the study) that assesses belief (5 items) and goal violations (7 items) in response to stressors on a 5-point scale ranging from 1 (not at all) to 5 (very much). The overall score is calculated by summing the scores of all 12 items, with a possible range of 12-60. Higher scores indicate greater meaning-related distress (greater global meaning violation).

The B-IPQ measures cognitive and emotional representations of illness. It is an 8-item questionnaire that assesses cognitive illness representation, emotional illness representation, and illness comprehensibility representation on a 0-10 point scale. The total score is calculated by summing the scores of all 8 items, with a possible range of 0-80. Higher scores indicate more threatening perception of the illness.

The MLQ measures meaning in life. It is a 10-item questionnaire that assesses the Presence of meaning in life and the Searches for meaning in life on a 7-point scale ranging from 1 (absolutely untrue) to 7 (absolutely true). The subscale scores are calculated by summing the scores of relevant items (5 per subscale), with a possible range of 5-35. Higher scores indicate a greater Presence of meaning in life and Search for meaning in life, respectively.

The CompACT-9 measures psychological flexibility. It is a 9-item questionnaire that assesses Openness to Experience, Behavioral Awareness, and Valued Action on a 7-point scale ranging from 0 (strongly disagree) to 6 (strongly agree). The overall score is calculated by summing the scores of all 9 items, with a possible range of 0-36. Higher scores indicate higher psychological flexibility (greater openness to experience and willingness to experience internal events such as thoughts, feelings, sensations, etc. without trying to control or avoid them; greater behavioral awareness and mindful attention to current actions; greater engagement in valued actions and meaningful activity).

The CSE measures a perceived self-efficacy for coping with challenges and threats. This study used 6 items tailored to the context of the study (2 per subscale: Problem-focused Coping, Emotion-focused Coping, and Social Support Coping) assessed on a 5-point scale ranging from 1 (not at all) to 5 (strongly). The overall score is calculated by summing the scores of all 6 items, with a possible range of 6-30. Higher scores indicate greater coping self-efficacy.

The CBI is a 10-item questionnaire that assesses deliberate meaning-making coping on a 6-point scale ranging from 0 (not at all) to 5 (to a very degree). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-45. Higher scores indicate greater deliberate searching for meaning.

The intrusive ruminations subscale of the ERRI measures automatic meaning-making coping. It is a 10-item subscale that assesses intrusive ruminations on a 4-point scale ranging from 0 (not at all) to 3 (often). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-30. Higher scores indicate greater automatic searching for meaning.

The C-PTGI-SF measures psychological well-being in cross-sectional assessment, as well as posttraumatic growth (element of meanings made) in multiple assessments. It is a 10-item questionnaire that assesses psychological well-being on a 6-point scale ranging from 0 (not at all) to 5 (to a very great degree). The total score is calculated by summing the scores of all 10 items, with a possible range of 0-50. Higher scores indicate better well-being.

The MLC evaluates meanings made. It is a 3-item tool that assesses sense made, benefit finding, and sense of identity change on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The overall score is calculated by summing the scores of all 3 items, with a possible range of 3-15. Higher scores indicate greater meanings made.

The PHQ-4 is a 4-item questionnaire that assesses symptoms of anxiety (2 items) and depression (2 items) on a 4-point scale ranging from 0 (not at all) to 3 (nearly every day). The subscale scores are calculated by summing the scores of 2 items, with a possible range of 0-6. Higher scores indicate higher levels of anxiety and depression symptoms, respectively. The total PHQ-4 score complements the subscale scores as an overall measure of symptom burden, as well as functional impairment and disability.

The R-UCLA measures perceived social isolation. This study used 5 items that assess the emotional and social aspects of loneliness on a 4-point scale ranging from 1 (never) to 4 (often or always). The total score is calculated by summing the scores of all 5 items, with a possible range of 5-20. Higher scores indicate greater loneliness.

A direct question about loneliness from the Community Life Survey is used. The statement is assessed on a 4-point scale ranging from 1 (never) to 4 (often or always). A higher score indicates greater loneliness.

The EORTC QLQ-C30 measures the health-related quality of life of cancer patients. It is a 30-item questionnaire that assesses physical, role, social, emotional, and cognitive functioning, as well as various symptoms, financial impact, and global quality of life. Twenty-eight items are rated on a 4-point scale ranging from 1 (not at all) to 4 (very much), while 2 items are rated on a 7-point scale ranging from 1 (very poor) to 7 (excellent). The overall score is calculated by summing the scores of all items, with a possible range of 0-100. Higher scores indicate better function and a higher quality of life.

Daily subjective health is measured by a single-item statement "Generally, I can say my health today was ..." on a 5-point scale ranging from 1 (bad) to 5 (excellent). Higher scores indicate greater daily physical health.

The Daily Positive and Negative Affect Scale is a 4-item questionnaire that consists of two positive (happy, cheerful) and two negative adjectives (sad, gloomy) rated on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The subscale scores are calculated by summing the scores of relevant items, with a possible range of 2-10. Higher scores indicate higher daily positive or negative affect.

The ERRI-daily form measures deliberate and automatic meaning-making coping. It is a 4-item tool that assesses deliberate and intrusive ruminations on a 4-point scale ranging from 0 (not at all) to 3 (to a very great degree). The subscale scores are calculated by summing the scores of relevant items (2 per subscale), with a possible range of 0-6. Higher scores indicate greater deliberate or automatic searching for meaning.

The MLC-daily form measures daily meanings made. It is a 3-item tool that assesses daily sense made, benefit finding, and sense of identity change on a 5-point scale ranging from 1 (not at all) to 5 (to a very great degree). The overall score is calculated by summing the scores of all 3 items, with a possible range of 3-15. Higher scores indicate greater daily meanings made.

The CompACT-daily form is a 4-item tool that assesses daily psychological flexibility (i.e. daily Openness to experience - 2 items, daily Behavioral awareness - 1 item, and daily Valued action - 1 item) on a 7-point scale ranging from 0 (strongly disagree) to 6 (strongly agree). The overall score is calculated by summing the scores of all 4 items, with a possible range of 0-24. Higher scores indicate higher daily psychological flexibility (i.e. greater daily openness to experience and willingness to experience internal events such as thoughts, feelings, sensations, etc. without trying to control or avoid them; greater daily behavioral awareness and mindful attention to current actions; greater daily engagement in valued actions and meaningful activity).

National Science Centre, Poland

University of Social Sciences and Humanities, Warsaw

PhD, Associate professor

Combines face-to-face ACT sessions with non-face-to-face activities and resources (mobile applications)

Waitlist group. After the second assessment of the two ACT groups (at post-treatment) this group will receive the face to face ACT intervention.

In the group ACT+app, experiential exercises are carried out, metaphors, discussions and assignments are used to promote awareness and flexibility about the thoughts and emotions associated with cancer and interleaved non-contact activities, which will serve as support for each of the modules. The non-contact activities will consist of assigning tasks, practices (mindfulness, breathing), reminder systems, recording, reinforcement and monitoring. Resources such as short texts, videos, audio files and recording systems will be used

Acceptance and commitment therapy + app

In the group ACT, experiential exercises are carried out, metaphors, discussions and assignments are used to promote awareness and flexibility about the thoughts and emotions associated with cancer

Acceptance and commitment therapy

Enrique Aranda, PhD

Introduction: emotional and physical alterations frequently appear in cancer patients. In this sense, interventions based on acceptance and commitment therapy (ACT) show their efficacy to improve these symptoms through increased psychological flexibility, however, there is little evidence of the efficacy of ACT using combined modality (face-to-face + app), despite the fact that this application modality may have beneficial effects in this group of patients, who may see their participation in the interventions limited as a consequence of the disease.

Method / design: Cancer patients will be randomly assigned to one of the following groups: (1) face-to-face ACT + app group, (2) face-to-face ACT group, and (3) group receiving usual treatment. The planned interventions last between 8 and 10 weeks and include experiential exercises, metaphors, discussions, and homework assignments to promote awareness and flexibility about thoughts and emotions associated with cancer. In the group that uses the app, exercises (mindfulness, breathing), reminder systems, recording, reinforcement and monitoring will also be provided. It is estimated that a total of 112 participants (38 per group) will be necessary, and four evaluations will be carried out: T0 (pre-treatment), T1 (post-treatment, T2 (follow-up at three months) and T3 (follow-up at six months). months).

Hypothesis : The primary results that are expected to be obtained are a significant increase in the psychological flexibility of patients receiving treatment, with greater flexibility in the group receiving the combined intervention, evaluated with the AAQ-II. Furthermore, as secondary outcomes, it is expected to obtain significant improvements in anxiety and depression (HADS), quality of life (EORTC QLQ C-30), Fatigue (BFI), Insomnia (ISI) and post-traumatic growth (PTGI-SF).

Hypothesis: the efficacy of the ACT-based intervention in cancer patients may be increased if the benefits of using a modality that combines face-to-face and not face-to-face are added to it.

This study is a three-arm randomized clinical trial, with a pre-post-follow-up repeated measures intergroup design.

Efficacy of a Combined ACT+ App Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients

Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: a Randomized Controlled Clinical Trial

Acceptance and Action Questionnaire- II (AAQ-II). This instrument is designed to assess experiential avoidance and psychological inflexibility through 7 items that are answered with a Likert-type scale from 1 (never true) to 7 (always true) and a higher score indicates greater experiential avoidance (Bond et al., 2011).

Hospital Anxiety and Depression Scale (HADS). This scale is used to assess anxiety and depression in a hospital settings. It is made up of 14 items (7 for anxiety and 7 for depression), which are answered on a scale from 0 to 3, with maximum values of 21 in each of the subscales

EORTC QLQ C-30 (version 3), this is an instrument developed to assess the quality of life in cancer patients using 30 questions that refer to the quality of life experienced by the patient during the last week. The first twenty-eight items include questions about different symptoms and are answered on a scale that ranges from 1 (not at all) to 4 (a lot), while the last two ask patients about the perception of their global health and quality of life in a scale from 1 (terrible) to 7 (excellent). The different items are grouped into functional scales (physical / role / emotional / cognitive / social and global) and symptom scale (fatigue / nausea and vomiting / dyspnea / sleep problems / loss of appetite / constipation / diarrhea and financial impact ).

Brief Fatigue Inventory (BFI), is an instrument developed to assess fatigue in cancer patients that consists of 10 items with a Likert-type scale that assesses fatigue experienced in the last 24 hours from 0 (no fatigue) to 10 (worst fatigue imaginable). It also includes a scale to assess the degree to which fatigue has interfered with the patient's daily life in the last 24 hours, with a scale ranging from 0 (does not interfere) to 10 (completely inferred). The recommended cut-off points in cancer patients are: 1-3 (mild); 4-7 (moderate) and 8-10 (severe)

Insomnia Severity Index (ISI). This instrument is designed to assess the severity of insomnia experienced through 5 items that are scored on a scale from 0 (not at all) to 4 (very severe / very dissatisfied / very much). The sum of the scores given by the subject to the different items are added together and a total score is obtained that ranges from 0-28. The recommended cut-off points are as follows: 0-7 (absence of clinical insomnia), 8-14 (subclinical insomnia), 15-21 (moderate clinical insomnia), and 22-28 (severe clinical insomnia).

Post-traumatic Growth Inventory-short version (PTGI-SF), is an instrument designed to evaluate the positive change that people who are subjected to a traumatic event may experience, using 10 items that respond to a Likert-type scale from 0 (no I have experienced that change) to 5 (I have experienced that change to a great extent), with higher scores showing greater positive change

Universidad de Córdoba

Francisco Garcia Torres

Lecturer

Behaviors and Mental Disorders

All Conditions

Quality of Life

All Drugs and Chemicals

Nicotine

In addition to usual care, participants in the ACT group will receive ACT intervention. ACT intervention will be conducted in an individual-based format with four weekly sessions. The first session is a face-to-face format and the other three sessions are online live format.

Participants in the control group will receive usual care in the study setting delivered by clinical staff. The rationale for adopting usual care as a control group is not only because it is more commonly used but also for practical and ethical considerations, as usual care is what is already being delivered clinically, therefore the results of the study can support any necessity of changes to clinical practice or not.

The components of ACT intervention will include six processes to foster parental PF according to the ACT framework.

Session one - Generate creative hopelessness and build acceptance. The objective is to help parents know about the ACT intervention and realize the experiential avoidance or emotional control strategies do not work, finally turn attention to more useful strategies.

Session two - Create space for your thought. The objective is to help parents create a distance from their thoughts and facilitate parents' ability of not being trapped by thoughts.

Session three - Focus on here and now. The objectives to facilitate parents' experiences of observing self and contact with the present moment but not trapped in the past or future.

Session four - Commit actions in line with the value. The objectives to help parents identify their inner value and take value-based actions even facing the challenges in current difficulties of their children with cancer.

ACT intervention

Usual care in this study setting includes providing general information, education, psychological support, and consultation.

Usual care

Xiaohuan Jin

Cho Lee Wong, PhD

Wenying Yao, Bachelor

The current study aims to develop a theoretically driven ACT intervention and examine its effects among parents of children with cancer. The objectives are:

1. To examine the effects of ACT intervention on parental QOL and psychological distress (symptoms of anxiety, depression and stress) in parents of children with cancer.
2. To examine the effects of ACT intervention on parental negative experience, experiential avoidance and psychological flexibility in parents of children with cancer.
3. To examine the effects of ACT intervention on psychological adjustment of children with cancer.

A pilot study will be used to evaluate the feasibility and acceptability of ACT intervention protocol in Chinese parents of children with cancer. A two-arm parallel randomized controlled trial (RCT) will be used to evaluate the effects of ACT intervention in parents of children with cancer.

Eligible participants will be randomly assigned into a 1:1 allocation ratio to the ACT group or control group using block randomization with random mixture blocks of 4, 6 and 8. This can avoid the greater frequency of assignments to either group and lead to more balanced treatment groups in size and key outcome-related characteristics over time while reducing the predictability of assignment from the preceding assignment. A sequence list of two group labels (1 = ACT group, 2 = Control group) will be generated using a computerized generation randomization tool by an independent statistician who is blinded to the meaning of group labels will not involve the other part of the study. The group allocation assignment labels will be contained in opaque sealed envelopes and concealed to all researchers and participants involved in this study until the research investigator has completed the assessments of the participant and obtained written consent during the recruitment.

Considering the nature of the study, blinding of participants and ACT interventionists will be impossible. The research assistants involved in data collection and data entry as well as health routine care providers in the units of study hospital will be blinded to the group allocation.

To prevent possible contamination, the ACT intervention for parents in the ACT group will be conducted in a meeting room in the staff area which is geographically separate from the patient area. Besides, the participants are required not to show ACT intervention materials to, nor discuss the intervention contents with other parents in the unit.

Acceptance and Commitment Therapy for Parents of Children With Cancer

Effects of Acceptance and Commitment Therapy on Promoting Parental Quality of Life and Reducing Psychological Distress in Parents of Children With Cancer: A Randomized Controlled Trial Protocol

PedsQL Parent HRQL Scale is adopted to assess parental quality of life. PedsQL Parent HRQL Scale consists of 20 items with 4 subscales of physical functioning, emotional functioning, social functioning, and cognitive functioning. Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (almost always). Higher scores indicate higher quality of life.

Change = (One week after the intervention score - baseline score)

PedsQL Parent HRQL Scale is adopted to assess parental quality of life. PedsQL Parent HRQL Scale consists of 20 items with 4 subscales of physical functioning, emotional functioning, social functioning, and cognitive functioning. Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (almost always). Higher scores indicate higher quality of life.

Change = (Three months after the intervention score - baseline score)

Depression Anxiety Stress Scales-21 is adopted to assess the level of depression, anxiety and stress in parents with 21 items and 3 subscales. Each item is rated on a 4-point Likert scale ranging from 0 (never) to 3 (always). Higher scores indicate more severe symptoms of depression, anxiety, or stress.

Change = (One week after the intervention score - baseline score)

Depression Anxiety Stress Scales-21 is adopted to assess the level of depression, anxiety and stress in parents with 21 items and 3 subscales. Each item is rated on a 4-point Likert scale ranging from 0 (never) to 3 (always). Higher scores indicate more severe symptoms of depression, anxiety, or stress.

Change = (Three months after the intervention score - baseline score)

Parent Experience of Child Illness is adopted to assess parental psychological experience of their children with cancer. The scale consists of 25 items with 4 subscales of 'guilt and worry', 'unresolved sorrow and anger', 'long-term uncertainty' and 'emotional resources'. Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (always). Higher scores indicate more difficulties in adjustment to their children with cancer.

Change = (One week after the intervention score - baseline score)

Parent Experience of Child Illness is adopted to assess parental psychological experience of their children with cancer. The scale consists of 25 items with 4 subscales of 'guilt and worry', 'unresolved sorrow and anger', 'long-term uncertainty' and 'emotional resources'. Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (always). Higher scores indicate more difficulties in adjustment to their children with cancer.

Change = (Three months after the intervention score - baseline score)

Acceptance and Action Questionnaire-II is adopted to assess experiential avoidance of parents. AAQ-II consists of 7 items. Each item is rated on a 7-point Likert scale ranging from 1 (never) to 7 (always). A higher score indicates great experiential avoidance.

Change = (One week after the intervention score - baseline score)

Acceptance and Action Questionnaire-II is adopted to assess experiential avoidance of parents. AAQ-II consists of 7 items. Each item is rated on a 7-point Likert scale ranging from 1 (never) to 7 (always). A higher score indicates great experiential avoidance.

Change = (Three months after the intervention score - baseline score)

Comprehensive assessment of Acceptance and Commitment Therapy processes is adopted to assess psychological flexibility of parents. CompACT consists of 23 items to measure three dyadic processes of ACT on 'acceptance and defusion', 'present moment awareness' and 'self as values and committed action'. Each item is rated on a 7-point Likert scale ranging from 0 (never) to 6 (always). Higher scores indicate a lower level of PF.

Change = (One week after the intervention score - baseline score)

Comprehensive assessment of Acceptance and Commitment Therapy processes is adopted to assess psychological flexibility of parents. CompACT consists of 23 items to measure three dyadic processes of ACT on 'acceptance and defusion', 'present moment awareness' and 'self as values and committed action'. Each item is rated on a 7-point Likert scale ranging from 0 (never) to 6 (always). Higher scores indicate a lower level of PF.

Change = (Three months after the intervention score - baseline score)

Strengths and Difficulties Questionnaire is adopted to assess the psychological adjustment of children ages 2 to 17 years old. SDQ consists of 25 items to measure the emotional symptoms and behavioural problems of children. Each item is rated on a 3-point Likert scale ranging from 0 (not true) to 2 (certainly true). A higher score indicates poor psychological adjustment.

Change = (One week after the intervention score - baseline score)

Strengths and Difficulties Questionnaire is adopted to assess the psychological adjustment of children ages 2 to 17 years old. SDQ consists of 25 items to measure the emotional symptoms and behavioural problems of children. Each item is rated on a 3-point Likert scale ranging from 0 (not true) to 2 (certainly true). A higher score indicates poor psychological adjustment.

Change = (Three months after the intervention score - baseline score)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
The Effect of an Online ACT Intervention on Meaning-Making Process in Cancer Patients Following Hematopoietic Cell Transplantation	NCT06266182	Hematopoietic C... Acceptance and ...	Acceptance and ... Education	18 Years -	University of Social Sciences and Humanities, Warsaw
Efficacy of a Combined ACT+ App Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients	NCT05126823	Cancer	Acceptance and ... Acceptance and ...	18 Years - 65 Years	Universidad de Córdoba
Acceptance and Commitment Therapy for Parents of Children With Cancer	NCT04870697	Childhood Cance...	ACT interventio... Usual care	18 Years -	Chinese University of Hong Kong

Spots Global Cancer Trial Database for psychological flexibility