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Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP. Methods 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping. Results Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping. Discussion Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).

Adolescent and young adult (AYA) siblings of individuals with autism experience unique challenges that can promote both growth and emotional maladjustment. This study explored sibling and parent reports of siblings' lived experiences and identified learning, stressors, and concerns from those experiences. 20 neurotypical (NT) AYA siblings (ages 13-24), and 21 parents were interviewed. Themes that emerged from the data analysis included: (1) learning, empathy, and compassion (2) relationship between the degree of functional impairment and the nature of the sibling relationship; (3) reluctance to share information about siblings with peers; (4) hypervigilance associated with unpredictable behavior; (5) worries and concerns about the future. These findings contribute to the existing literature on the impact and nature of neurotypical siblings' lived experience.

Aims Tai chi exercise has been shown in a prior randomized controlled trial to improve depression symptoms and quality of life (QoL) in patients with heart failure (HF), but correlates of these improvements are not well known. The purpose of this secondary analysis was to explore whether tai chi is associated with improvements in biopsychosocial and behavioural measures and whether such improvements are correlated with improved depression and QoL. Methods and results Participants were n = 100 adults with chronic systolic HF (mean age = 67.4, SD = 12.0; 64% male; 96% White; New York Heart Association class = 1–3) randomized to a 12 week tai chi exercise intervention or health education control. Constructs of interest included social support, exercise self‐efficacy, activity engagement, sense of coherence, and inflammatory biomarkers. Tai chi was associated with increased everyday activity engagement compared with the health education group (P

Background Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support in Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. Methods Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. Discussion Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.

BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (PPPbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.

Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system during the COVID-19 pandemic to inform the development of tailored supportive services.Methods: From March – June 2020, frontline clinicians across the Mass General Brigham healthcare system were invited to register for an adapted mind-body resiliency group program. Clinicians completed pre- and post-program assessments asking them to report their COVID-19-related concerns. Qualitative data were analyzed in aggregate and by clinical role using content analysis to identify overarching domains.Results: Frontline clinicians’ concerns fall within seven domains: concerns for self, patients, family members, staff, existential concerns, systems-level concerns, and job-level concerns. Concerns for self and existential concerns were most commonly reported across clinical roles. Long-term care clinicians were highly concerned about patients’ wellbeing while rehabilitation therapists were highly concerned about their family members’ health. Across groups, nurse practitioners and physician assistants more often reported job-level concerns. Concerns for staff and systems level concerns were less frequently reported across clinical roles.Conclusions: Frontline clinicians share common pandemic-related concerns, but nuances exist among the concerns most frequently reported across clinical roles. Interventions that offer stress management and resiliency training may be helpful for addressing pandemic-related concerns overall. Future research should determine if tailored support services by clinical role may be warranted.

e19062 Background: Ethnic/racial minorities and socioeconomically disadvantaged patients remain underrepresented in cancer clinical trials (CCT), challenging the accuracy and generalizability of findings. While oncologists’ recommendations influence trial participation, we know little about their perspectives on recommending CCT to underrepresented patients. Methods: From 9/16-5/19 we conducted a sequential mixed methods study to assess oncologists’ attitudes toward recommending underrepresented patients for CCT. We performed individual interviews with 17 oncologists, developed a survey instrument, and surveyed a randomly selected sample of 98 oncologists (from ASCO, NCORP, MGH; RR = 31.2%). Descriptive statistics summarized attitudes, practices and challenges with trial enrollment of underrepresented patients. Results: Content analysis of interviews (age = 46.9, female = 37.5%, white = 75.0%) revealed overall support for CCT. Indeed, 84.4% of survey respondents (age = 53.3, female = 31.3%, white = 78.6%) considered CCT as central to their professional identity. Yet, 37.5% agreed CCT placed undue burden on oncologists. Oncologists’ concerns around informed consent and perceived lack of clinical/personal equipoise discouraged recommending CCT participation to vulnerable patients. Interviews revealed that nearly all believed that patients with certain vulnerabilities (e.g., literacy, social, financial barriers) had needs that conflicted with CCT demands, increasing the potential for harm. Oncologists were less likely to recommend CCT to patients who do not reliably report side effects (91.2%), demonstrate difficulty comprehending the costs/benefits of CCT (88.7%), lack support (87.6%), live far away (76.3%), or face insurance obstacles (73.2%). Notably, 67.7% affirmed they presented trials with varying enthusiasm based on perceived patient challenges; 32.4% deemed it hard to justify enrolling patients if efficacious standard treatment options exist outside of trials. Oncologists desired navigation support (63.3%) to offset concerns and facilitate trial discussion/enrollment. Conclusions: Findings confirm that oncologists value CCT; however, they experience conflict when considering CCT for patients with pre-existing hardships. Time constraints interfere with oncologists’ ability to adequately address and overcome perceived challenges to participation. Our findings underscore the need for programs that integrate informational support with patient navigation to increase enrollment of underrepresented patients into CCT.