Effects of participant preferences in unblinded randomized controlled trials.

Little research has deliberately investigated the effects of participant preferences for treatment condition in unblinded randomized controlled trials. We designed a study with a non-patient sample comparing a randomized arm to a preference arm of the same trial to investigate: (1) whether having a choice to select one's preference affects feelings about participation, belief in treatment effectiveness, treatment contamination, intervention adherence and engagement, and trial attrition; and (2) the interaction of preferences and treatment assignment on these variables. Contamination and attrition were rare and excluded from analyses. There was no effect of choice. Participants mismatched to preference felt less positive about their experience, but this did not affect belief in treatment, adherence, or engagement. Stronger effects may occur for patient populations.

Self-expansion and smoking abstinence.

Helping smokers quit is important as smoking is the number one preventable cause of death in the U.S. Smoking activates the mesolimbic dopamine reward system which is also responsible for pleasure associated with other behaviors, including engaging in novel, exciting and/or challenging (i.e., self-expanding) events. We hypothesized that the reward activation achieved by experiencing self-expanding events can supplant the reinforcement normally provided by smoking and can thus facilitate quitting. We investigated this hypothesis among 74 current and 66 former smokers who reported the self-expanding events they experienced for the 2 months prior to their most successful or final, quit attempt, respectively. Former smokers, compared to current smokers, reported significantly more self-expanding events and that the events were more helpful to their quitting. For current smokers, there was a significant moderate-to-large positive correlation between number of self-expanding events and number of days subsequently abstained from smoking. The results support the proposition that experiencing self-expanding activities or events can be beneficial for smoking abstinence.

Lessons to be learned from 25 years of research investigating psychosocial interventions for cancer patients.

Conducting rigorous psychosocial intervention research with cancer patients has many challenges including encouraging them to join studies, asking them to engage in interventions or be part of control conditions, and to provide data over follow-up assessments. Here, we highlight valuable insights regarding such challenges provided by investigators studying psychosocial interventions for cancer patients. Handling these skillfully has important implications for the internal and external validity of this research and the ethical treatment of participants. Challenges noted in research reports included in a systematic review of 25 years of research (comprising 488 unique projects) investigating interventions designed to enhance cancer patients' quality of life were compiled. Among the difficulties mentioned was the fact that patients may not feel the need for psychosocial interventions and thus may not be interested in joining an intervention study. Patients who do feel the need for such interventions may be deterred from joining trials by the prospect of being randomized to a nonpreferred group; if they do join a trial, participants may be disappointed, drop out, or seek compensatory additional assistance when they are assigned to a control group. Apart from randomization, other aspects of research may be off-putting to participants or potential participants, such as the language of consent forms or the intrusiveness of questions being asked. Potential remedies, such as research awareness interventions, monetary incentives, partnering with cancer support organizations, and using designs that take preferences into account merit consideration and further research inquiry.

Depressive symptoms and smokers' perceptions of lung cancer risk: moderating effects of tobacco dependence.

Smokers who acknowledge the personal health risks of smoking are more likely to attempt quitting. Unfortunately, many smokers are unrealistically optimistic about their health risks. Depressed smokers, however, may be more realistic about their risks. These studies examined the relationship between depressive symptoms and risk perceptions among two groups: college-age smokers (N = 128) and smokers from the nationally representative HINTS database (N = 1,246). In the college sample, among highly tobacco dependent smokers, more depressed smokers believed more strongly that quitting eliminates lung cancer risk (b = - .27, p = .01), and they estimated a faster reversal of risk after quitting (b = - .70, p = .03). In the HINTS sample, among highly tobacco dependent women, the more depressed they were, the higher their perceived risk of developing lung cancer (b = .23, p = .05). In sum, depressive symptoms among some smokers may lead to heightened risk perceptions. However the belief that quitting can reduce risk quickly might encourage smokers to postpone quitting. Cessation programs could benefit from tailoring their programs accordingly.