Valued Living intervention to increase advance care planning and well‐being in depressed and anxious adults with advanced cancer: Randomized trial in community oncology clinics

BACKGROUND: Adults with advanced cancer often experience low engagement with advance care planning (ACP) and high levels of depression, anxiety, and fear of death/dying. Access to specialist palliative care is limited. This study tests Valued Living, a novel online acceptance-based group intervention designed to increase ACP and improve psychological/spiritual well-being among adults with advanced cancer screening positive for depression or anxiety. Valued Living was delivered online by social workers in community oncology settings. METHODS: Adults with advanced solid tumor cancer (N = 240) and significant depression or anxiety symptoms were randomized 1:1 within cohorts to Valued Living or usual care (UC). Valued Living provided five weekly group sessions by videoconference plus self-paced online modules. Primary outcome was the total number of ACP behavioral steps completed of 12 potential steps (e.g., selecting health care proxy, advanced directives) by 3.5-month follow-up. Secondary outcomes included fear of death, rigid cognitive avoidance of death, depression, anxiety, and spiritual well-being. RESULTS: Valued Living participants completed 1.27 more ACP steps (95% CI, 0.36-2.18; d = 0.36; p = .006) than UC. Largest condition differences were identifying (97.4% vs. 84.2%) and documenting a health care proxy (83.3% vs. 64.9%). Valued Living participants improved more in cognitive avoidance of death (d = 0.36; p = .005), and spiritual well-being (d = 0.42; p < .001) but not fear of death or anxiety. CONCLUSION: The online Valued Living intervention, implemented by social workers in community oncology clinics, increased ACP and well-being among depressed and anxious adults with advanced cancer. Findings support this supportive care approach for the growing population living with advanced cancer. TRIAL REGISTRATION: The trial registration is ClinicalTrials.gov NCT04773639.