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Research is needed to inform tailoring supportive strategies for promoting physical activity (PA) in the context of behavioral treatment of obesity. We aimed to identify baseline participant characteristics and short-term intervention response predictors associated with adherence to the study-defined PA goal in a mobile health (mHealth) weight loss trial.A secondary analysis was conducted of a 12-month weight loss trial (SMARTER) that randomized 502 adults with overweight or obesity to either self-monitoring of diet, PA, and weight with tailored feedback messages (n = 251) or self-monitoring alone (n = 251). The primary outcome was average adherence to the PA goal of ≥150 min/week of moderate- and vigorous-intensity aerobic activities (MVPA) from Fitbit Charge 2™ trackers over 52 weeks. Twenty-five explanatory variables were considered. Machine learning methods and linear regression were used to identify predictors of adherence to the PA goal.The sample (N = 502) was mostly female (80%), White (83%) with the average age of 45 ± 14.4 years and body mass index of 33.7 ± 4.0 kg/m2. Machine learning methods identified PA goal adherence for the first week as the most important of long-term PA goal adherence. In the parsimonious linear regression model, higher PA goal adherence for the first week, greater PA FB messages opened, older age, being male, higher education, being single and not having obstructive sleep apnea were associated with higher long-term PA goal adherence.To our knowledge, this is the first study using machine learning approaches to identify predictors of long-term PA goal adherence in a mHealth weight loss trial. Future studies focusing on facilitators or barriers to PA among young and middle-aged adults and women with low PA goal adherence are warranted.

Introduction: Social support (SS) is predictive of symptom distress among patients with breast cancer (BC) during the treatment and post-treatment phases. There is evidence of racial and economic disparities in SS seen among patients with cancer. Little is known about how race and income influence SS among patients with BC. Objectives: 1) To describe SS in women with early-stage BC prior to or at their first chemotherapy treatment (i.e., baseline); 2) To examine how SS varies by race, income level, ability to meet basic financial needs at baseline; and 3) To examine the association between SS and symptom distress at baseline. Methods: This secondary analysis employed a descriptive, correlational, comparative design with data from the baseline time point of SEMOARS: The Symptom Experience, Management and Outcomes According to Race and Social Determinants of Health (R01-MD012245), a multi-site, repeated, multi-method study comparing the symptom experience and management in Black and White women with early-stage BC. Inclusion criteria were female, Black or White race, age at least 18 years and prescribed chemotherapy for BC stages 1–3. Measures included self-reported race; income level measured by annual income (low: < $29,999; medium: $30,000 to $69,999, high: ≥ $70,000) and affordability of basic needs (single item: yes or no). The Interpersonal Support Evaluation List includes four subscales (possible range 0-30), assessing the perceived availability of support (emotional, tangible, self-esteem, and belonging). The Symptom Distress Scale measures the current experiences of 11 symptoms and their severity (possible range: item:1-5; total score:13-65). Descriptive, comparative, correlational, and regression analyses were used. Results: Participants (N=248; mean age 52.9±12.3 years) were 58.9% White and 41.1%, Black, 54% married/partnered, 57.3% employed, 70.8% had some college education, and 98% insured. Half of the sample (50.5%) reported high income, 30.3% reported medium income, and 19.2% low income. One-fifth (18.5%) reported an inability to afford basic needs. Income and race are moderately correlated, with Black patients more likely to have low income (39.5% vs. 7.6) and less likely to have high income (22.4% vs. 66.7%) (Cramer’s V=.472; p Discussion: For this cohort, Black race, low income, and inability to afford basic needs were associated with lower levels of baseline SS. Regardless of race and income, poor baseline emotional, tangible, and self-esteem SS were significantly correlated with increased symptom distress. Future Directions: SS is a predictive marker of symptom distress as patients begin BC chemotherapy. Interventions to increase SS in Black and/or low-income women with BC at the patient, clinic, and community level are needed. Coefficients of associations for individual social support subscales with symptoms distress adjusting for race and income level [UnTable-Footnote]–Notes: n=175; SS: social support; race was categorized as (0= Black; 1= White); †income level was categorized as (0=medium and high; 1=low: reference) Citation Format: Hiba Abujaradeh, Susan Mazanec, Susan M. Sereika, Adam M. Brufsky, Catherine M. Bender, Mary C. Connolly, Margaret Q. Rosenzweig. Racial and Economic Disparities in Social Support and Symptom Distress among Women Diagnosed with Early-Stage Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-05.

This secondary analysis examined (1) factors associated with willingness to participate in clinical research for cognitive health among individuals with cognitive impairment and their care partners, and (2) concordance regarding such willingness between individuals with cognitive impairment and their care partners (dyads). Neuropsychological factors and willingness to participate in clinical research were collected using self-reported questionnaires. Participants' sociodemographic and clinical information was extracted from the University of Pittsburgh Alzheimer's Disease Research Center record. Binary logistic regression and Cohen's kappa coefficient analyses were performed. Greater trust in medical researchers ( p = 0.031, B = 0.127) and more severe cognitive impairment ( p = 0.009, B = −0.289) were associated with willingness to participate in clinical research among individuals with cognitive impairment. Dyadic agreement on willingness to have the individual with cognitive impairment enroll in clinical research was poor to fair (κ = 0.380). Findings suggest that individuals with cognitive impairment with greater trust in health professionals are more likely to agree to clinical research participation. Nurses and other health care providers who counsel individuals with cognitive impairment and their care partners should work to build trusting relationships with participants and be mindful of how increased trust can alter power dynamics between participants and health care professionals. [ Research in Gerontological Nursing, 15 (2), 76–84.]

Objective To explore trajectories of breastfeeding exclusivity and perceived insufficient milk (PIM) over the first 8 weeks postpartum among primiparous women and the association of these trajectories with prepregnancy body mass index (BMI). Design Secondary analysis of data from a randomized controlled trial. Setting Recruitment for the primary study was conducted in Pittsburgh, Pennsylvania. Participants One hundred twenty-two primiparous women with intention to exclusively breastfeed. Methods We used group-based trajectory modeling to classify participants into breastfeeding exclusivity and PIM trajectory groups. We used logistic regression to explore the predictive relationship between prepregnancy BMI and breastfeeding exclusivity and PIM trajectory group memberships. Results We identified two trajectories each for breastfeeding exclusivity and PIM over the first 8 weeks postpartum. For breastfeeding exclusivity, one group (n = 60, 49%) had low initial probability of exclusive breastfeeding with linear decline in likelihood of exclusivity over time. The other group (n = 62, 51%) had greater initial probability of exclusive breastfeeding, which remained constant over time. For PIM, one group (n = 41, 34%) had consistently greater probability of endorsing PIM at each time point, whereas the other group (n = 81, 66%) had consistently low probability of endorsing PIM over time. Prepregnancy BMI did not predict group membership in breastfeeding exclusivity, χ2(1) = 2.8, p = .094, or PIM, χ2(1) = 0.72, p = .397. Conclusion Breastfeeding exclusivity and PIM appeared to be relatively stable phenomena in the postpartum period among a sample of predominately White primiparous women who intended to breastfeed. We did not find a clear association with prepregnancy BMI.

Background and Objectives Type 2 diabetes (T2DM) and mild cognitive impairment (MCI) are common late-life physical and cognitive health conditions. Illness perceptions, an individual’s personal beliefs about the conditions, should be explored in the context of disease characteristics (physical or cognitive). This secondary analysis explored illness perceptions with a priori hypotheses about control (perceived controllability) and coherence (perceived understanding) dimensions among persons with T2DM and MCI, treating each as an exemplar of late-life physical and cognitive health conditions. We also explored whether age, education, and comorbid conditions moderate the relationships between T2DM or MCI condition groups and illness perceptions. Research Design and Methods This cross-sectional, descriptive study examined baseline data collected from 146 T2DM to 90 MCI participants in 2 independent studies. The 9-item Brief Illness Perception Questionnaire was used to identify the similarities and differences in illness perceptions among persons with T2DM and MCI. We performed hierarchical linear regression controlling for identified covariates. Results We found that T2DM and MCI participants had significantly different illness perceptions, including perceptions of personal control (b = −0.943, p = .009), treatment control (b = −1.619, p < .001), and coherence (b = −1.265, p = .001), after controlling for covariates. The results suggest that persons with MCI were likely to believe that their condition is less controllable (through their own strategies or medical treatment) and less understandable compared with their T2DM counterparts. Such associations remained statistically significant when the interactions were added to the models. Discussion and Implications As T2DM and MCI are prevalent late-life conditions, health care professionals should consider individuals’ subjective perceptions about their conditions in the context of disease characteristics when counseling secondary prevention strategies for disease management. Further research on illness perceptions in other conditions is needed to ensure the replicability of our findings.

Background Birthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population. Methods This ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37–40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7–366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling. Discussion This is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME. Trial registration ClinicalTrials.gov: NCT04258709.

This analysis examined whether a community-based intervention produced measurable improvements in dietary habits. MOVE UP combined translational, evidence-based weight management and healthy aging interventions using a non-randomized design. This 13-month intervention included 32 group sessions, explicit calorie and physical activity goals, self-monitoring, and nutrition education. Participants were ( N = 297) older adults (mean = 68.0 years) with overweight and obesity. Diet was measured using Rate Your Plate (RYP)-Heart. Changes in scores from baseline to 5, 9, and 13 months were assessed using mixed models. MOVE UP successfully shifted eating patterns from baseline (mean = 50.9) to 5 months (mean = 55.1) ( p < .0001) adjusted for age, sex, and race. Improvements persisted through 9 (mean = 54.7) and 13 months (mean = 55.0) ( p < .0001). Although participants were not prescribed a specific diet, RYP-Heart indicated positive dietary shifts. Community-implemented behavioral weight loss interventions may assess the modifiability of dietary habits with a simple, easy-to-administer tool.

This study aimed to test the efficacy of self-monitoring and feedback (SM+FB) versus SM without FB (SM) in a behavioral weight-loss intervention at 6 months.This was a randomized clinical trial. Eligibility criteria included the following: ≥18 years of age, BMI ≥ 27 and ≤43, smartphone user, and ability to engage in moderate physical activity. All participants received a 90-minute 1:1 counseling session, a Fitbit Charge 2, and a digital scale for SM. SM+FB participants were provided access to a customized smartphone application that provided three daily FB messages. The primary outcome was percentage of weight change from 0 to 6 months.The sample (N = 502) was 45 (SD 14.4) years old, BMI was 33.7 (SD 4.00) kg/mThere was no significant between-group difference in weight loss at 6 months.

Background: Adding feedback messages (FB) to self-monitoring (SM) may reinforce behavior change. However, socio-environmental conditions (e.g., limited access to parks and low walkability) may limit one’s ability to respond to FB focused on physical activity (PA). Hypothesis: Residents of high walkability neighborhoods will achieve higher PA levels at 12 months than those in low walkability neighborhoods regardless of whether FB was randomly assigned. Methods: This is a secondary analysis of a 12-month behavioral weight loss trial, where adults with overweight or obesity were randomized to SM+FB (n=251) or SM alone (n=251). The SM+FB group received a smartphone pop-up message every other day tailored to their PA data. Assessment included neighborhood walkability via Smart Walk Score (low [ Results: Participants (N=502) were primarily white (82.5%), female (79.5%), well-educated (16.4±2.8 years), mean age of 45±14.4 years with a body mass index (BMI) of 33.10±3.93 kg/m 2 . Compared to those from neighborhoods with high walkability, participants from neighborhoods with low walkability were more likely to be White (75.3% vs. 87.8%, P ==.0003) and older (41.4±14.7 vs. 47.7±13.6 years, P P =.170) or steps (b±SE=-816.48±484.83, P =.092) over 12 months. lnMVPA (b±SE=0.12±0.10, P =.244) and steps (b±SE=415.05±344.50, P =.228) were on average similar between walkability groups. Both lnMVPA (b 6mo ±SE=0.003±0.07, P =.968; b 12mo ±SE=-0.23±0.08, P =.009) and steps (b 6mo ±SE=-416.18±195.68, P =.034; b 12mo ±SE=-1443.75±227.49, P P =.047) and marginally greater number of steps (b±SE=674.84±392.91, P =.086) than SM group. There were no significant interactions for group and time or group, time, and walkability ( P ≥.05). Conclusion: On average, FB had a small but significant positive impact on PA over 12 months, but neighborhood walkability did not moderate the treatment effect of FB on PA. The small effect of FB on PA may have limited our ability to detect moderation of neighborhood walkability on the treatment effects of FB on PA. Future studies need to replicate this analysis in a trial with larger treatment effects and a more diverse sample.

Introduction: Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear. Purpose: To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models. Results: Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P Conclusions: Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination. Support: NIH R01HL107370.

Introduction: Suboptimal sleep health is highly prevalent and multiple dimensions of poor sleep have been identified as obesity predictors. Prior sleep interventions have not demonstrated a convincing effect on reducing obesity but this may be due to focusing on a single sleep dimension. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) is an efficacious, individually tailored behavioral intervention aimed at improving multiple dimensions of sleep. However, TranS-C has not been tested in adults with excess weight and suboptimal sleep health. Purpose: This single group, pre-test, post-test pilot study conducted in adults with excess weight and suboptimal sleep health examined the feasibility and impact of a remotely delivered, 8-week TranS-C intervention on a composite sleep health score and individual sleep health dimensions. Methods: The six dimensions of sleep addressed in TranS-C were regularity, satisfaction, alertness, timing, efficiency, and duration. Pre- and post-intervention individual sleep dimensions were assessed using validated questionnaires and Fitbit-derived accelerometry data, with values dichotomized into ‘good’ or ‘poor’ for each sleep dimension. A composite sleep health score was calculated as the count of the ‘good’ individual dimensions (possible range 0-6). Effect sizes were calculated as standardized within-subject mean differences ( d ) to describe the intervention effect on the composite score and individual dimensions. We conducted post-intervention semi-structured interviews and used thematic analysis to analyze the qualitative data. Results: Participants (N = 7) were mostly female (71.4%) and white (71.4%) with a mean age of 41.0 ± 17.2 years and mean body mass index of 33.2 ± 3.8 kg/m 2 . Mean composite sleep health score pre-TranS-C was 3.6 ± 1.3 (range 2-5) compared to a mean post-TranS-C composite sleep health score of 4.7 ± 0.8 (range 4-6) ( d = 1.27). Improvements were seen in all individual dimensions except timing with effect sizes ranging from 0.38 to 1.46. During the semi-structured interviews, participants stated that they found the intervention to be informative, liked receiving the sessions remotely, and thought it improved their sleep. However, participants mentioned that some of the modules were not very helpful because information was repetitive or the information did not apply to them, and they suggested that the intervention be delivered in fewer sessions. Conclusions: TranS-C was acceptable for participants with overweight or obesity and suboptimal sleep health and had a large, positive effect on the composite sleep health score. Future refinement of the intervention will include reducing the number of sessions by identifying the most relevant modules and eliminating repetitive information. Continued refinement of the intervention will focus on the content addressing the timing dimension of sleep.

Introduction: Self-monitoring (SM) is the core of behavioral weight loss. Efficacy evidence for mHealth to improve SM adherence and impact weight loss outcomes is limited. Purpose: Examine associations among diet, weight, and physical activity (PA) SM and adherence to diet, fat and PA goals on weight loss at 12 mos in adults with overweight or obesity. Methods: SMARTER was a single-site, 2-arm weight loss trial. We randomized adults with (BMI) 27-43 kg/m 2 to diet, weight, and PA SM plus tailored feedback messages (SM+FB, n=251) or SM alone (n=251). The SM+FB group received feedback messages via the SMARTER app on diet daily, PA every other day and weight weekly. The study provided Fitbit Charge 2™ for PA, smart scales for weight and Fitbit app for diet. Participants received individualized daily calorie/fat goals (based on sex & weight) and incremental weekly PA goals to reach ≥300 min/wk of moderate- and vigorous-intensity PA. Staff measured weight at baseline, 6 and 12 mos. Diet SM was the % of days with ≥50% of calorie goal recorded. Weight SM was the % of days with weight recorded. PA SM was % of days with ≥500 steps. Calorie goal adherence was % of days with ≥85% and Results: The sample (N=502) was 82% white (n=414), 79% female (n=399), on average 45.0±14.4 years of age with a mean BMI of 33.7±4.0 kg/m 2 . Treatment arms were similar on % days of weight and PA SM and % days adherent to calorie, fat and PA goals (p≥.05); however, the SM+FB group had greater % days of SM diet than the SM group (58.9 [24.7, 84.9] vs. 41.1 [14.0, 81.9]; P=.01). Weight loss at 12 mos was significantly associated (reported as b [95% CI]) with higher % of days of SM diet (-0.10 [-0.13, -0.08]), weight (-0.12 [-0.14, -0.09]) and PA (-0.10 [-0.13, -0.07]) and % days adherent to calorie (-0.06 [-0.11, -0.01]) and fat goals (-0.11 [-0.20, -0.02]) and average % days adherent to PA goals (-0.04 [-0.06, -0.02]). The effect of treatment assignment and its interactions with SM of diet, weight and PA and adherence to calorie, fat and PA goals on weight loss at 12 mos were not significant. Conclusions: In this study, SM of lifestyle behaviors and adherence to diet and PA goals were associated with better weight loss at 12 months and did not depend on treatment group assignment, suggesting that the mHealth intervention did not enhance adherence sufficiently to affect weight loss outcomes.

Background Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses’ motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses’ demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses’ motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses’ motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions This study's findings provide valuable information regarding the bivariate relationships between nurses’ personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses’ motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.

Purpose: The purpose of the study was to investigate the feasibility and acceptability of phone-delivered cognitive behavioral therapy (CBT) combined with an adjunctive smartphone application CBT MobileWork-DM© to improve self-management of type 2 diabetes mellitus (T2DM). Methods: Participants were 12 patients with T2DM on antihyperglycemic medication and had an A1C level of 8 or greater. A randomized controlled pilot study assessed treatment as usual (TAU) T2DM care versus a phone-delivered CBT (6, 8, or 12 weekly sessions) augmented with a CBT skills practice smartphone application. The CBT telehealth intervention addressed T2DM self-management and diabetes distress. Electronic and self-report medication taking, diabetes-related distress, and A1C were assessed at baseline and post-intervention. Results: After 16 weeks, a decrease in A1C and distress levels was observed in all 3 CBT phone groups and TAU group. The group with the most improvement was the 12-week CBT group, which had the greatest mean decrease in A1C (−2.33) and diabetes distress (−31.67). The TAU group exhibited a mean decrease of −2.15 and −21 for A1C and diabetes distress, respectively. The overall rate of completion for phone CBT sessions across the 3 CBT groups was 83%. Conclusion: This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable. Patients demonstrated improvements in both T2DM management and distress.

A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine biweekly nurse telephone sessions on health topics. Lower-extremity exercise was assessed by e-diary; fitness walking was assessed by accelerometer and e-diary; blood pressure was assessed by automated monitor; function was assessed by performance-based tests and questionnaires; and pain, self-efficacy, and outcome expectancy were assessed by questionnaires. Self-reported lower-extremity exercise and fitness walking, function, pain, self-efficacy, and outcome expectancy showed significant group or group by time effects favoring intervention. The intervention did not improve physical activity by accelerometer and blood pressure. Mean minutes of fitness walking fell short of the 150 min/week goal.

Metastatic breast cancer (MBC) carries unique disease burdens with potential for poor-quality end-of-life (EOL) care. It is the purpose of this article to explore the association of poor-quality EOL care indicators according to key tumor, demographic, social, and clinical factors. End-of-life quality indicators were based on Emanuel and Emanuel's good death model in conjunction with Earle et al (2003). A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double-verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics. Total sample was N = 167 women, with 14.4% (n = 24) Black and 85.6% (n = 143) White. Mean (SD) age was 55.3 (11.73) years. Overall, MBC survival was 3.12 years (SD, 3.31): White women, 41.2 months (3.4 years), and Black women, 19 months (1.6 years). A total of 64.1% (n = 107) experienced 1 or more indicators of poor-quality EOL care. Patients more likely to experience poor-quality EOL care were older (P = .03), estrogen negative (P = .08), human epidermal growth factor receptor 2 negative (P = .07), from more deprived neighborhoods (P = .02), married (P = .05), and with physical (P = .001) and mental (P = .002) comorbidities. Understanding sociodemographic and clinical factors associated with poor EOL MBC care may be useful for proactive patient navigation.

High quality advanced cancer care includes goals of care (GOC) discussions and should be tailored according to clinical diagnosis, patient characteristics, and in concordance with patient’s goals. Metastatic breast cancer (MBC) and treatment has heterogeneity according to subtype which makes the timing of initiating and continuing GOC discussions challenging. With an ever-increasing array of therapy, women with advanced stage disease are unique survivors in that they receive relatively aggressive cancer care to not only palliative symptoms but extend survival time. It is the purpose of this paper to explore the prevalence, pattern, and likelihood of having a GOC discussion according to key tumor, demographic, social, and clinical factors. A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics. Total sample was N=167 women, with 14.4% (n=24) Black and 85.6% (n=143) White. Mean age was 55.3 years (SD 11.73). Overall, MBC survival was 3.12 years (SD 3.31), White women 41.2 (3.4 years) months, and Black women 19 (1.6 years) months. A total of 87.4% (n=146) participated in one or more GOC discussions. GOC discussions were more likely among those who were referred to palliative care (p

The purpose of this study was to describe older adults’ social network and support during a physical activity intervention and its association with physical activity. Mixed methods were used for this secondary analysis of existing data from a physical activity intervention. Seventy-three participants who completed a session by telephone on using support comprised the sample. Participants reported on average approximately eight individuals in their social network. Half reported support for physical activity from a spouse/partner, adult child, or friend. Those who perceived support for self-reported physical activity tended to have greater improvements on average from baseline for mean daily minutes of physical activity than those with no perceived support. Four-fifths developed a plan for a spouse/partner, friend, adult child, or sibling to provide physical activity support. Participants reported that the session was helpful and increased their confidence in using support; over one-quarter intended to use support after the intervention ended.

BACKGROUND Sedentary behavior (SB) is prevalent after abdominal cancer surgery, and interventions targeting perioperative SB could improve postoperative recovery and outcomes. We conducted a pilot study to evaluate the feasibility and preliminary effects of a real-time mobile intervention that detects and disrupts prolonged SB before and after cancer surgery, relative to a monitoring-only control condition. OBJECTIVE To evaluate the feasibility and preliminary effects of a perioperative SB intervention on objective activity behavior, patient-reported quality of life and symptoms, and 30-day readmissions. METHODS Patients scheduled for surgery for metastatic gastrointestinal cancer (n = 26) were enrolled and randomized to receive either the SB intervention or activity-monitoring only. Both groups used a Fitbit smartwatch and companion smartphone app to rate daily symptoms and to collect continuous objective activity behavior data starting from at least 10 days before surgery through 30 days post-discharge. Participants in the Intervention group also received prompts to walk after any SB bout that exceeded a prespecified threshold, with less frequent prompts on days that patients reported more severe symptoms. Participants completed end-of-study ratings of acceptability, and we also examined adherence to assessments and to walking prompts. In addition, we examined effects of the intervention on objective SB and step counts, patient-reported quality of life and depressive and physical symptoms and readmissions. RESULTS Accrual (74%), retention (88%), and acceptability ratings were relatively high. However, adherence to assessments and engagement with the SB intervention decreased significantly after surgery and did not recover to preoperative levels after postoperative discharge. All participants exhibited significant increases in SB and symptoms and decreases in steps and quality of life after surgery, and participants randomized to the SB intervention unexpectedly had longer maximum SB bouts relative to the control group. No significant benefits of the intervention with regard to activity, quality of life, symptoms, or readmission were observed. CONCLUSIONS Perioperative patients with metastatic gastrointestinal were interested in a real-time SB intervention and rated the intervention as highly acceptable, but engagement with the intervention and with daily symptom and activity monitoring decreased significantly after surgery. There were no significant effects of the intervention on step counts, patient-reported quality of life or symptoms, or postoperative readmissions and there was an apparent adverse effect on maximum SB. Results highlight the need for additional work to modify the intervention to make reducing SB and engaging with mobile health technology after abdominal cancer surgery more feasible and beneficial. CLINICALTRIAL NCT03211806

Women with advanced cancer experience significant barriers to achieving high-quality care and maximizing their physical and emotional health. Our novel serious game, Strong Together, aims to teach women with advanced cancer self-advocacy skills needed to improve their symptom burden, quality of life, and patient-centered care.This is a single-center, multi-site randomized clinical trial of the Strong Together intervention among 336 women within three months of an advanced breast or gynecologic cancer diagnosis. Randomization occurs to the 3-month Strong Together serious game or enhanced care as usual group. The aims are to: (1) evaluate the effects of the intervention on patient self-advocacy (primary outcome); (2) evaluate the effects of the intervention on quality of life, symptom burden, and patient-centered care (secondary outcomes); and (3) evaluate the behavioral and game mechanisms that influence the efficacy of the intervention.female, age ≥ 18 years; diagnosis of advanced breast or gynecologic cancer within the past 3 months; Eastern Cooperative Oncology Group score of 0-2; English literacy; and ≥ 6-month life expectancy. Patient-reported outcome measures are collected at baseline, 3-months, and 6-months.This protocol is the first large-scale intervention aimed at promoting self-advocacy in women with advanced cancer. Understanding the ability of serious games to impact patient outcomes provides critical information for researchers, clinicians, and stakeholders aiming to improve patient-centered care.NCT04813276.

Background Hand-expression, collection, and storage of breast milk during pregnancy (i.e., antenatal milk expression or AME) is a safe, potentially effective practice to reduce early, undesired infant formula supplementation among women with diabetes. The feasibility and potential impact of AME on lactation outcomes in the United States (U.S.) and among non-diabetic birthing people is unknown. Methods The purpose of this study was to examine the feasibility of a structured AME intervention among nulliparous birthing people in the United States. We recruited 45 low-risk, nulliparous individuals at 34–366/7 weeks of gestation from a hospital-based midwife practice. Participants were randomized to AME or a control group receiving lactation education handouts. Interventions were delivered at weekly visits at 37–40 weeks of pregnancy. The AME intervention involved technique demonstration and feedback from a lactation consultant and daily independent practice. Lactation outcomes were assessed during the postpartum hospitalization, 1–2 weeks postpartum, and 3–4 months postpartum. Results Between December 2016 and February 2018, 63 individuals were approached and screened for eligibility, and 45 enrolled into the study (71%). Of 22 participants assigned to AME, 18 completed at least one AME study visit. Participants reported practicing AME on at least 60% of days prior to their infant’s birth. Most were able to express milk antenatally (15/18), more than half collected and froze antenatal milk (11/18), and 39% (7/18) supplemented their infants with antenatal milk after birth. No major problems were reported with AME. Perinatal and lactation outcomes, including infant gestational age at birth, neonatal intensive care unit admissions, delayed onset of lactogenesis II, and use of infant formula were similar between AME and control groups. Among participants in both groups who were feeding any breast milk at each assessment, breastfeeding self-efficacy increased and perceptions of insufficient milk decreased over the postpartum course. Conclusions In a small group of nulliparous birthing people in the U.S., AME education and independent practice beginning at 37 weeks of pregnancy was feasible. In some cases, AME provided a back-up supply of milk when supplementation was indicated or desired. The relationship between AME and lactation outcomes requires further study with adequately powered samples. Trial Registration This trial was retrospectively registered at ClinicalTrials.gov on May 11, 2021 under the following registration ID: NCT04929301. https://clinicaltrials.gov/ct2/show/NCT04929301.

To compare a general anxiety instrument plus a depression instrument with a specific postpartum anxiety instrument plus a depression instrument to detect postpartum anxiety and to explore trends in daily postpartum anxiety.Prospective, longitudinal cohort study.Academic tertiary center in the mid-Atlantic United States. Study activities were remote.Pregnant women (N = 73) in the third trimester of pregnancy.We administered the State-Trait Anxiety Inventory (STAI), Postpartum Specific Anxiety Scale (PSAS), and Edinburgh Postnatal Depression Scale (EPDS) at 1 and 8 weeks after birth. We used mobile ecological momentary assessment prompts to measure daily anxiety levels (0-10) from 1 to 8 weeks after birth. We defined the presence of anxiety and depression by using the established instrument cutoff scores. We used repeated-measures analysis of variance and dependent-samples t tests to determine the stability of the determined anxiety instruments during the study time frame. We used linear mixed modeling to explore mobile ecological momentary assessment anxiety trends.The PSAS and EPDS detected more participants with anxiety and/or depression (26.8%, 19/71) than the STAI and EPDS (23.9%, 17/71) at 8 weeks after birth. PSAS scores increased from 1 to 8 weeks after birth (p = .003); STAI scores decreased (p = .01). Daily anxiety ratings changed nonlinearly during the study period, were greatest at 2 weeks, declined and stabilized, and then trended upward toward Week 8.Detection of postpartum anxiety in clinical settings can be improved through addition of the PSAS in routine screening. Timing of anxiety assessment should be considered between 6 to 8 weeks after birth.

AIAN women have higher risk for GDM. Early preconception counseling (PC) about healthy lifestyle/weight and mothers’ support could reduce these risks. We describe and compare parallel measures of SS with RH/GDM risk: daughters’ perceived SS from mothers, and mothers’ perceived SS for daughters. Methods: Secondary analysis used baseline data from 113 mother-daughter (M-D) dyads from four sites participating in Stopping GDM, an online randomized trial to reduce risks of GDM. Perceived maternal SS was amounts (0=no support, to 5=a lot of support) and types of SS re: RH, healthy lifestyle behaviors, and seeking PC to prevent GDM (instrumental SS, e.g., help get birth control; informational SS, e.g., on pregnancy/GDM) . M-D independently completed online measures of perceived available maternal SS. We performed descriptive, within-dyad comparative/correlational analyses. Results: AIAN AYA (n=113; mean age 17±3yrs; BMI 29±8.3 kg/m2) and their mothers (n=113; age 44.7±9yrs; 45% had > 2-4 college; 44% married) . AYA reported moderately high levels of maternal SS: total (16±5; range:0-20) ; instrumental (12±4; 0-15) ; informational (4±2; 0-5) . Mothers reported high levels of SS to give their daughters: total (20±1; range:15-20) ; instrumental (15±1; 10-15) ; informational (5±0; 0-5) . Mothers reported significantly higher levels of SS to give their daughters compared to their daughters’ perception of available maternal SS (p Disclosure D. Charron-Prochownik: None. S.M. Sereika: None. A.F. Fischl: None. N. O'Banion: None. K.L. Gonzales: None. L. Chalmers: None. K.R. Moore: Consultant; Novo Nordisk. Funding RNR014831 grant

Purpose The purpose of the study was to examine the associations of self-efficacy, social support, and symptom distress with perceived problem-solving and glycemic control among patients with type 2 diabetes. Method Using baseline data from a parent study, which examined the effect of a problem-solving-focused intervention on medication adherence among patients with type 2 diabetes, this secondary analysis examined the relationships among self-efficacy, social support, symptom distress, problem-solving, and A1C. Of 358 patients enrolled at baseline, 304 (mean age = 64.1 years, 57.2% female) were included in the current analysis. Multiple linear regression was used to identify potential correlates of problem-solving and A1C. Results The results showed that self-efficacy, social support, and symptom distress were independent predictors of problem-solving; they significantly improved the prediction of perceived problem-solving in diabetes management after controlling covariates. Adding problem-solving to the model did not improve the prediction for A1C. Conclusion The current study suggests that self-efficacy, social support, and symptom distress are essential factors associated with patients’ perceived problem-solving in diabetes management. Researchers and clinicians should consider both personal factors and psychosocial factors such as self-efficacy, social support, and symptom distress when examining patients perceived problem-solving and developing tailored interventions to improve diabetes management. In addition, health care providers should consider these important aspects when providing tailored care to this patient population.

Background Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention. Methods Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as "good" or "poor" using questionnaires and actigraphy. A composite score was calculated by summing the number of "good" dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea-hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI. Results Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were -9.3 ± 6.1%, -16.9 ± 13.5%, and -3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, -0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041). Conclusions Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.

Physical activity may improve cognitive function in women with breast cancer. In a cross-sectional study, we explored the relationship between cognitive function and physical activity (actigraph) and cardiorespiratory fitness (sub-maximal graded exercise test) in 73 postmenopausal women with early stage breast cancer prior to the initiation of systemic adjuvant therapy. Cognitive function was assessed with a standardized battery of neurocognitive measures assessing eight domains. Data were analyzed using partial correlations, controlling for age and total hours of actigraph wear-time. Women were, on average, 63.71 (± 5.3) years of age with 15.47 (± 2.48) years of education. For physical activity, greater average number of steps per day were associated with better attention (r = .262, p = .032) and psychomotor speed (r = .301, p = .011); greater average hours of moderate and moderate/vigorous intensity physical activity were associated with better visual memory (r = .241, p = .049; r = .241, p = .049, respectively); and greater average daily energy expenditure was associated with better visual memory (r = .270, p = .027) and psychomotor speed (r = .292, p = .017). For fitness, higher peak maximum VO2 was associated with better concentration (r = .330, p = .006), verbal memory (r = .241, p = .048), and working memory (r = .281, p = .019). These results suggest that higher levels of physical activity and cardiorespiratory fitness are associated with better cognitive function in postmenopausal women with breast cancer. Randomized controlled trials (RCT) to examine whether physical activity improves cognitive function in women with breast cancer are warranted. These RCTs should also determine the mechanisms of the influence of physical activity on cognitive function. CLINICAL TRIALS REGISTRATION NUMBER: NCT02793921; Date: May 20, 2016.

“Homework assignments,” a critical element of Cognitive Behavioral Therapy (CBT) for depression, are a means of CBT skill generalization and maintenance. Yet, homework adherence is often low. We developed CBT MobileWork,© a smartphone application (app) to promote CBT skills practice “as-needed.” We applied a user-centered design in a laboratory setting with 8 depressed patients and 5 therapists for the initial development and testing. We then completed a real-world evaluation of CBT MobileWork© with 15 depressed patients in CBT and their therapists. This report details the prototype development, presents data evaluating feasibility and usability in the lab and real-world, and presents preliminary findings of associated measures. Our data indicates that both patients and therapists reported high levels of satisfaction and rated the application highly usable during testing in both controlled laboratory and under real-world conditions. A moderate association between app use and reductions in depression was found. CBT MobileWork© has preliminary feasibility for CBT skills practice and may benefit patients with CBT homework completion.

Purpose The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. Methods This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. Results Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood ( b = 2.59, P < .001) and diabetes-related distress ( b = 1.40, P < .001) and lower functional outcome ( b = −0.22, P < .001). Older age was associated with lower diabetes-related distress ( b = −0.44, P = .040). Conclusion Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.

The role of problem-solving is not well understood in behavioral weight loss interventions. In a 12-month behavioral weight loss study, we examined whether problem-solving changed over time and the relationships between problem-solving and changes in adherence to calorie, fat, and physical activity (PA) goals and percent weight change. One of the 24 intervention sessions (15th) was devoted to problem-solving. Participants received individualized calorie and fat goals and were given a 150 min/week moderate-to-vigorous PA goal. Adherence to calorie/fat goals and PA goals was calculated at 1, 6, and 12 months using self-reported food intake in a mobile-based weight loss app and accelerometer data, respectively. Weight was measured via a digital scale at baseline, and 6 and 12 months. A general linear model was used to compare problem-solving across time points; post hoc linear mixed modeling was used to examine the relationships between problem-solving and changes in adherence to lifestyle goals and percent weight change. The sample (N = 150) was mostly female (90.7%), white (80.70%), with a mean age of 51.1 ± 10.2 years, and a mean body mass index of 34.1 + 4.6 kg/m2. The mean total score of problem-solving at baseline was 81.2 ± 12.3. Problem-solving total and subscale scores did not significantly change over time. Baseline problem-solving was not significantly associated with changes in adherence to lifestyle goals and percent weight change (P > 0.05). A behavioral weight loss study did not impact problem-solving, and problem-solving may not influence lifestyle adherence and weight changes. Future work needs to examine problem-solving in larger and more diverse samples.

Introduction Recent studies suggest that Alzheimer's disease (AD) biomarker disclosure has no discernable psychological impact on cognitively healthy persons. Far less is known about how such results affect symptomatic individuals and their caregivers. Methods Randomized controlled trial of 82 mild cognitive impairment (MCI) patient and caregiver dyads (total n = 164) to determine the effect of receiving amyloid positron emission tomography results on understanding of, and perceived efficacy to cope with, MCI over 52 weeks of follow-up. Results Gains in the primary outcomes were not consistently observed. Amyloid negative patients reported greater perceived ambiguity regarding MCI at follow-up, while moderate and sustained emotional distress was observed in patients, and to a lesser extent, caregivers, of those who were amyloid positive. There was no corresponding increase in depressive symptoms. Discussion These findings point to the possibility that both MCI patients and caregivers may need emotional support after the disclosure of amyloid scan results.

BACKGROUND Illness perceptions, patients' beliefs about their health condition, may affect medication adherence as well as self-efficacy for managing the condition in type 2 diabetes (T2DM). OBJECTIVES The aims of this study were to investigate the associations between illness perceptions, self-efficacy, and self-reported medication adherence among persons (≥50 years of age) with T2DM and explore whether the number of comorbid conditions moderates these associations. METHODS This secondary analysis of cross-sectional data used baseline data from persons with T2DM. Self-administered questionnaires, including the Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, and the 4-item Morisky-Green-Levine Medication Adherence Scale, were used. We performed hierarchical multiple linear regression analyses. RESULTS Participants (N = 146) were 57.5% female, 67.1% white, and on average 64 years old. Six dimensions of illness perceptions (ie, consequences, personal control, treatment control, identity, concerns, and emotional representations) were associated with self-efficacy for managing T2DM. Five dimensions (ie, timeline, personal control, treatment control, coherence, and emotional representations) were significant predictors of self-reported medication adherence. Whereas the number of comorbid conditions was significantly associated with self-efficacy for managing T2DM in all models (P values < .001), the number of comorbid conditions was not associated with self-reported medication adherence. CONCLUSIONS This study suggests that illness perceptions and comorbid conditions may play a critical role in either self-efficacy or self-reported medication adherence in persons (≥50 years of age) with T2DM. Future research should incorporate an individual's illness perceptions and comorbid conditions into the development of interventions that may improve both self-efficacy and medication adherence in T2DM.

OBJECTIVE/BACKGROUND: Reports of sex differences in subjectively reported impaired mood, sleep quality, daytime function, and excessive daytime sleepiness in people with obstructive sleep apnea (OSA) have been inconsistent. The purpose of this study was to investigate sex differences and the effect of moderation by sex in the relations of OSA severity and these subjective sleep outcomes in participants with type 2 diabetes (T2D) either at high risk for OSA or have OSA. METHODS: This study included a sample (N=350) balanced by sex (50.9% men; 49.1% women) and race (59.7% white, 40.3% non-white), mean age 56.5 (SD=10.5) with T2D [Mean A1C 8.0% (SD=1.8)]. Measures included OSA severity measure of apnea + hypopnea index (AHI) and self-reported sleep questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Quality Questionnaire (FOSQ) plus a measure of mood from the Profile of Mood States (POMS). Relevant individual, social, and health determinants were included as covariates. RESULTS: Reports of sleep quality and daytime function were worse in women than men (p

Purpose Portion control can be an effective weight-loss strategy for people with serious mental illnesses (SMI). This study aimed to examine the feasibility of portion-control intervention (PCI) for people with SMI. Design and methods A randomized experimental design was used. The PCI group received weekly, telephone-delivered behavioral counseling over 12 weeks. Newsletter group received monthly newsletters regarding healthy eating. Descriptive statistics were used to analyze data collected at baseline and at 12 weeks. Findings The acceptability of the PCI and significant decreases in waist circumference among the participants of the PCI group were reported. Practice implications Simple and structured guidelines to manage portion size, akin to those featured in our PCI, can benefit those with SMI.

PURPOSE GOG-259 was a 3-arm randomized controlled trial of two web-based symptom management interventions for patients with recurrent ovarian cancer. Primary aims were to compare the efficacy of the nurse-guided (Nurse-WRITE) and self-directed (SD-WRITE) interventions to Enhanced Usual Care (EUC) in improving symptoms (burden and controllability) and quality of life (QOL). METHODS Patients with recurrent or persistent ovarian, fallopian, or primary peritoneal cancer with 3+ symptoms were eligible for the study. Participants completed baseline (BL) surveys (symptom burden and controllability and QOL) before random assignment. WRITE interventions lasted 8 weeks to develop symptom management plans for three target symptoms. All women received EUC: monthly online symptom assessment with provider reports; online resources; and every 2-week e-mails. Outcomes were evaluated at 8 and 12 weeks after BL. Repeated-measures modeling with linear contrasts evaluated group by time effects on symptom burden, controllability, and QOL, controlling for key covariates. RESULTS Participants (N = 497) reported mean age of 59.3 ± 9.2 years. At BL, 84% were receiving chemotherapy and reported a mean of 14.2 ± 4.9 concurrent symptoms, most commonly fatigue, constipation, and peripheral neuropathy. Symptom burden and QOL improved significantly over time ( P < .001) for all three groups. A group by time interaction ( P < .001) for symptom controllability was noted whereby both WRITE intervention groups had similar improvements from BL to 8 and 12 weeks, whereas EUC did not improve over time. CONCLUSION Both WRITE Intervention groups showed significantly greater improvements in symptom controllability from BL to 8 and BL to 12 weeks compared with EUC. There were no significant differences between Nurse-WRITE and SD-WRITE. SD-WRITE has potential as a scalable intervention for a future implementation study.