Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes and health-related quality of life. Anxiety and depression are the most prevalent mental health symptoms impacting one-third of AYA cancer survivors. In addition, up to 85% of AYAs experience cancer-related anxiety and fear of cancer recurrence. Unfortunately, mental health care access barriers are common. Moreover, many AYAs who do receive treatment have a suboptimal response to traditional psychotherapy or pharmacologic treatment. Digital mental health solutions appeal to AYAs who are accustomed to smartphones, engage in text-messaging as a daily mode of communication, and prefer online self-help. Recent digital intervention initiatives have translated positive psychological interventions into scalable digital health solutions using text messaging and conversational chatbots. Mindfulness-to-Meaning Theory describes a process in which mindful positive self-regulation decreases stress, promotes psychological well-being, and improves health-related quality of life in the face of adversity. Mindfulness-based interventions are associated with small to moderate effect sizes and have a beneficial long-term impact on mental health, quality of life, and functional outcomes. We aim to create a SMS text-messaging chatbot prototype to guide AYAs through a positive psychological intervention with conversational prompts to elicit, extend, and promote mindful attention towards positive emotions. The chatbot prototype research design process will utilize the Discover, Design/Build and Test framework in partnership with a community advisory board. Results of this proposal and future studies have the potential to transform mental health care delivery models in a format that is universally accessible and appeals to AYAs. 

Digital interventions for pediatric and AYA cancer survivors have been shown to improve sleep and psychological well-being. However, there are no existing efficacious digital interventions for anxiety and depression in AYA cancer survivors. In addition, despite their broad appeal among young people, digitally deployed interventions are commonly associated with high levels of attrition and low adherence. We propose to design a chatbot mental health intervention that is tailored to the AYA cancer journey. Grounded in Mindfulness-to-Meaning Theory, we aim to develop and incorporate established mindfulness strategies and emerging serious illness meaning-making strategies (e.g., savoring, gratitude). These psychosocial intervention components will be packaged in an entertaining and engaging conversational chatbot that does not feel like self-therapy. The current study aims to promote psychosocial interventions that improve quality of life, and portable low-cost digital interventions to expand access to care.