Principal Investigator

Joyce P
Awardee Organization

Seattle Children'S Hospital
United States

Fiscal Year
Activity Code
Early Stage Investigator Grants (ESI)
Not Applicable
Project End Date

The Promoting Resilience in Stress Management (PRISM) Intervention: a multi-site randomized controlled trial for Adolescents and Young Adults receiving Hematopoietic Cell Transplantation

The experience of hematopoietic cell transplantation (HCT) for hematologic malignancy among Adolescents and Young Adults (AYAs) is particularly difficult because age-related developmental challenges of identity, relationships, and vocation may add to the burden of cancer. Compared to other age-groups, AYAs have poorer psychosocial outcomes including increased anxiety and depression and poorer adherence to oral immunosuppressive medications. These outcomes may, in turn, predispose AYAs to disease-related morbidity and mortality such as graft-versus-host disease (GVHD) and/or cancer-relapse. A potential barrier to improving these experiences may be that AYAs have few opportunities to develop the personal resources needed to handle adversity. We have previously developed the “Promoting Resilience in Stress Management” (PRISM) intervention for AYAs with serious illness. This manualized, brief intervention is delivered in 4, 30-60 minute, one-on-one sessions, followed by a family meeting. It targets skills in stress-management and mindfulness, goal-setting, positive reframing, and meaning-making. All of these skills are associated with improved patient wellbeing in other populations, and preliminary findings from a recently closed pilot randomized controlled trial among AYAs with newly diagnosed cancer suggest PRISM is associated with improved health-related quality of life. This application proposes to build on our prior experience and fill a critical knowledge gap regarding PRISM’s impact among AYAs receiving HCT. Thus, we propose a multi-site randomized controlled trial among N=70 AYAs (n=35 PRISM and n=35 usual care; ages 12-24 years), with the primary trial outcome of patientreported symptoms of anxiety and depression. Secondary outcomes will include patient adherence to oral GVHD prophylaxis and the cost-effectiveness of the intervention in this population. We hypothesize that AYAs who receive PRISM will report fewer mixed affective symptoms and demonstrate better adherence. We also anticipate the intervention will be costeffective. In sum, this application offers an opportunity to expand the body of knowledge regarding methodologically rigorous and evidence-based psychosocial interventions and standards of care for AYAs with hematologic malignancies. Ultimately, this research has the potential to reduce the burden of cancer in these vulnerable populations.


  • Lee BM, Jecker NS, Marron JM, Rosenberg AR. Striving for equity: Patient prioritization during a critical cancer drug shortage. Pediatric blood & cancer. 2021 Nov;68(11):e29280. Epub 2021 Aug 6. PMID: 34357696
  • Dionne-Odom JN, Wells RD, Guastaferro K, Azuero A, Hendricks BA, Currie ER, Bechthold A, Dosse C, Taylor R, Reed RD, Harrell ER, Gazaway S, Engler S, McKie P, Williams GR, Sudore R, Rini C, Rosenberg AR, Bakitas MA. An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial. Journal of pain and symptom management. 2022 Jan;63(1):11-22. Epub 2021 Jul 31. PMID: 34343621
  • Yu JA, Cook S, Imming C, Knezevich L, Ray K, Houtrow A, Rosenberg AR, Schenker Y. A Qualitative Study of Family Caregiver Perceptions of High-Quality Care at a Pediatric Complex Care Center. Academic pediatrics. 2022 Jan-Feb;22(1):107-115. Epub 2021 May 19. PMID: 34020106
  • Bogetz JF, Trowbridge A, Lewis H, Shipman KJ, Jonas D, Hauer J, Rosenberg AR. Parents Are the Experts: A Qualitative Study of the Experiences of Parents of Children With Severe Neurological Impairment During Decision-Making. Journal of pain and symptom management. 2021 Dec;62(6):1117-1125. Epub 2021 Jun 17. PMID: 34147578
  • Lau N, Bona K, Steineck A, Rosenberg AR. What we did not learn from an exploratory analysis of economic hardship in newly diagnosed adolescents and young adults with cancer. Pediatric blood & cancer. 2018 Dec;65(12):e27411. Epub 2018 Aug 28. PMID: 30155981
  • Barton KS, Steineck A, Walsh CA, Lau N, O'Donnell MB, Rosenberg AR. "I won't get to live my life the way I planned it": A qualitative analysis of the experiences of adolescents and young adults with advanced cancer. Pediatric blood & cancer. 2023 Oct;70(10):e30554. Epub 2023 Jul 12. PMID: 37438862
  • Rosenberg AR, Steiner J, Lau N, Fladeboe K, Toprak D, Gmuca S, O'Donnell MB, Smith K, Brown CE, Yi-Frazier JP. From Theory to Patient Care: A Model for the Development, Adaptation, and Testing of Psychosocial Interventions for Patients With Serious Illness. Journal of pain and symptom management. 2021 Sep;62(3):637-646. Epub 2021 Mar 5. PMID: 33677072
  • Coats H, Downey L, Sharma RK, Curtis JR, Engelberg RA. Quality of Communication and Trust in Patients With Serious Illness: An Exploratory Study of the Relationships of Race/Ethnicity, Socioeconomic Status, and Religiosity. Journal of pain and symptom management. 2018 Oct;56(4):530-540.e6. Epub 2018 Jul 17. PMID: 30025937
  • Steiner JM, Kirkpatrick JN, Heckbert SR, Sibley J, Fausto JA, Engelberg RA, Randall Curtis J. Hospital resource utilization and presence of advance directives at the end of life for adults with congenital heart disease. Congenital heart disease. 2018 Sep;13(5):721-727. Epub 2018 Sep 19. PMID: 30230232
  • Wells RD, Guastaferro K, Azuero A, Rini C, Hendricks BA, Dosse C, Taylor R, Williams GR, Engler S, Smith C, Sudore R, Rosenberg AR, Bakitas MA, Dionne-Odom JN. Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care. Journal of pain and symptom management. 2021 Jul;62(1):174-182. Epub 2020 Nov 28. PMID: 33253787
  • Barton KS, Tate T, Lau N, Taliesin KB, Waldman ED, Rosenberg AR. "I'm Not a Spiritual Person." How Hope Might Facilitate Conversations About Spirituality Among Teens and Young Adults With Cancer. Journal of pain and symptom management. 2018 Jun;55(6):1599-1608. Epub 2018 Feb 9. PMID: 29428188
  • Bogetz JF, Rosenberg AR. Adults are just big children: What we can learn about quality end-of-life care from pediatrics. Cancer. 2021 Jul 15;127(14):2393-2396. Epub 2021 Mar 30. PMID: 33784414
  • McDermott CL, Bansal A, Ramsey SD, Lyman GH, Sullivan SD. Depression and Health Care Utilization at End of Life Among Older Adults With Advanced Non-Small-Cell Lung Cancer. Journal of pain and symptom management. 2018 Nov;56(5):699-708.e1. Epub 2018 Aug 17. PMID: 30121375
  • Rosenberg AR, Weaver MS, Fry A, Wiener L. Exploring the Impact of the Coronavirus Pandemic on Pediatric Palliative Care Clinician Personal and Professional Well-Being: A Qualitative Analysis of U.S. Survey Data. Journal of pain and symptom management. 2021 Apr;61(4):805-811. Epub 2020 Sep 30. PMID: 33010337
  • Murphy KM, Chen E, Ip EH, Rosenberg AR, Snyder MA, Salsman JM. Properties of the Shift and Persist Questionnaire in adolescent and young adult cancer patients and survivors: Validity, consistency, and interpretability. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2023 Jan;32(1):273-283. Epub 2022 Aug 13. PMID: 35962916
  • Fousek K, Watanabe J, Joseph SK, George A, An X, Byrd TT, Morris JS, Luong A, Martínez-Paniagua MA, Sanber K, Navai SA, Gad AZ, Salsman VS, Mathew PR, Kim HN, Wagner DL, Brunetti L, Jang A, Baker ML, Varadarajan N, Hegde M, Kim YM, Heisterkamp N, Abdel-Azim H, Ahmed N. CAR T-cells that target acute B-lineage leukemia irrespective of CD19 expression. Leukemia. 2021 Jan;35(1):75-89. Epub 2020 Mar 24. PMID: 32205861
  • Wiener L, Rosenberg AR, Pennarola B, Fry A, Weaver M. Navigating the terrain of moral distress: Experiences of pediatric end-of-life care and bereavement during COVID-19. Palliative & supportive care. 2021 Apr;19(2):129-134. PMID: 33648612
  • Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Seminars in oncology nursing. 2019 Dec;35(6):150954. Epub 2019 Nov 18. PMID: 31753704
  • Steineck A, Rosenberg AR. Why performance status? A case for alternative functional assessments in pediatric oncology clinical trials. Cancer. 2021 Oct 1;127(19):3511-3513. Epub 2021 Jul 1. PMID: 34196972
  • Taylor MR, Scott SR, Steineck A, Rosenberg AR. Objectifying the Subjective: The Use of Heart Rate Variability as a Psychosocial Symptom Biomarker in Hospice and Palliative Care Research. Journal of pain and symptom management. 2021 Sep;62(3):e315-e321. Epub 2021 Apr 29. PMID: 33933615
  • Fladeboe KM, Scott S, Comiskey L, Zhou C, Yi-Frazier JP, Rosenberg AR. The Promoting Resilience in Stress Management (PRISM) intervention for adolescents and young adults receiving hematopoietic cell transplantation: a randomized controlled trial protocol. BMC palliative care. 2022 May 19;21(1):82. PMID: 35585525
  • Walsh CA, Rosenberg AR, Lau N, Syrjala KL. Key considerations for advancing the development and testing of mHealth interventions in adolescent and young adult oncology. Psycho-oncology. 2020 Jan;29(1):220-223. Epub 2019 Oct 9. PMID: 31475768
  • Fladeboe KM, Siembida EJ, Ip E, Rosenberg AR, Snyder MA, Salsman JM. Indicators of developmental status among adolescents and young adults with cancer: Perceived adult status, social milestones, and health-related quality of life. Psycho-oncology. 2023 Sep;32(9):1363-1371. Epub 2023 Jun 28. PMID: 37381114
  • Luong A, Cerignoli F, Abassi Y, Heisterkamp N, Abdel-Azim H. Analysis of acute lymphoblastic leukemia drug sensitivity by changes in impedance via stromal cell adherence. PloS one. 2021 Sep 30;16(9):e0258140. doi: 10.1371/journal.pone.0258140. eCollection 2021. PMID: 34591931
  • Bogetz JF, Trowbridge A, Lewis H, Jonas D, Hauer J, Rosenberg AR. Forming Clinician-Parent Therapeutic Alliance for Children With Severe Neurologic Impairment. Hospital pediatrics. 2022 Mar 1;12(3):282-292. PMID: 35141756
  • Rosenberg AR, Barton K, Junkins C, Scott S, Bradford MC, Steineck A, Lau N, Comiskey L, Yi-Frazier JP. Creating a Resilient Research Program-Lessons Learned From a Palliative Care Research Laboratory. Journal of pain and symptom management. 2020 Oct;60(4):857-865. Epub 2020 Jul 1. PMID: 32621950