Digital Life Coaching for Myeloma Patients Undergoing Transplantation

BACKGROUND: Patients undergoing autologous stem cell transplantation (ASCT) for multiple myeloma (MM) face sudden exacerbations of anxiety, insomnia, and other symptoms within the initial weeks following ASCT. Even as these symptoms abate in subsequent months, long-term consequences include post-traumatic stress disorder (Griffith 2020), quality of life (QOL) impairments (El-Jawahri 2016), and chronic reliance on higher-risk medications such as benzodiazepines (Banerjee 2020). These findings are particularly relevant to MM patients given their older age at diagnosis, longer expected post-ASCT survival, and poorer QOL at baseline compared with other cancer patients (Kent 2015). Compared to other integrative interventions in the peri-ASCT setting, life coaching transcends a symptomatic focus while directly addressing the root determinants of impaired QOL. Life coaches work with patients using structured frameworks (Figure 1A) to provide longitudinal support, education, and accountability to meet patient-identified wellness goals. Digital life coaching (DLC) combines the strengths of life coaching with the capabilities of digital health by channeling patient-coach communication through patients' personal phones. Compared to in-person coaching, DLC is location-agnostic and allows patients to work their coaches more conveniently and frequently. DLC is feasible among ASCT survivors (Chen 2016) but has not yet been studied in the active peri-ASCT setting. We are conducting a pilot study of a 16-week DLC subscription to assess its feasibility and effects on QOL during an intensive period spanning from pre-ASCT hospitalization through Day +100 after ASCT. If successful, we plan to then pursue a randomized Phase II study comparing DLC versus usual care in the peri-ASCT setting. METHODS: Our study is registered at clinicaltrials.gov as NCT04432818. We plan to enroll 27 adult patients with MM undergoing first ASCT at our institution. Inclusion criteria include English language proficiency and ownership of a personal cellphone. Notably, neither ownership of a smartphone nor installation of a specific mobile app is required for patient enrollment. Enrolled patients will receive unlimited access to a certified life coach beginning at Day -5 before ASCT; bidirectional communication is encouraged via phone, text, or email. The life coaches will reach out at least once per week to help patients accomplish self-identified goals such as symptom management, stress reduction, and physical activity. Our study's primary endpoint is ongoing patient engagement, defined as least one patient-initiated outreach to their coach during each of four 4-week study subperiods. Our study's secondary endpoints include patient-reported outcome (PRO) assessments of QOL, distress, and sleep disturbances (to be collected using electronic surveys every 1-2 weeks as shown in Figure 1B). Exploratory endpoints include benzodiazepine usage and rates of electronic/phone communication with patients' treatment teams. We will analyze endpoints using descriptive methods, including stratification of secondary & exploratory endpoints by DLC usage and specific 4-week study subperiod. PROGRESS TO DATE: Of 18 approached patients as of the data cutoff (8/1/20), 15 (83%) have expressed interest. Reasons for non-enrollment include skepticism about the value of interactions with coaches who do not themselves have MM. Of the 15 patients who have expressed interest in the study, the median age is 65 (range: 50-81) and all but one patient report owning a personal smartphone. All 6 patients with finalized ASCT hospitalization dates have been enrolled and paired with life coaches. Adherence to weekly electronic PRO assessments has been 100% (n = 9 timepoints) to date, consistent with previous studies (Wood 2013). CONCLUSIONS: Our pilot study is ongoing. Our findings to date suggest that certain MM patients are phone-savvy and would be interested in digital health tools, which will continue to gain prominence in light of the ongoing COVID-19 pandemic. Strengths of DLC include its scalability across institutional lines and its ability to reach patients at home in an integrative manner. Results of this study will inform innovative approaches to support the wellbeing of patients with hematologic malignancies, both in the peri-transplantation setting and beyond. Disclosures Brassil: Pack Health: Current Employment. Patel:Pack Health: Current Employment. Jackson:Pack Health: Current Employment. Wong:Janssen: Research Funding; Roche: Research Funding; Amgen: Consultancy; Sanofi: Membership on an entity's Board of Directors or advisory committees; GSK: Research Funding; Bristol Myers Squibb: Research Funding; Fortis: Research Funding. Wolf:Adaptive: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Martin:Seattle Genetics: Research Funding; AMGEN: Research Funding; GSK: Consultancy; Sanofi: Research Funding; Janssen: Research Funding. Shah:BMS, Janssen, Bluebird Bio, Sutro Biopharma, Teneobio, Poseida, Nektar: Research Funding; GSK, Amgen, Indapta Therapeutics, Sanofi, BMS, CareDx, Kite, Karyopharm: Consultancy.

The Treatment of Doubt

This chapter follows Jews whose life-changing doubt was discovered by or confessed to a spouse. It talks about therapeutic professionals who tried to help double lifers such as Jewish life coaches, outreach rabbis, and religious therapists. It also explains the profession of religious therapy that are in the midst of a moral struggle as to which authorities they owed their allegiance: their own religious orthodoxy or their clients' individual autonomy. The chapter explains how most therapeutic professionals rejected the common rabbinic explanation in circulation for the contemporary crisis of faith, the Internet. It also points out how therapeutic professionals drew on the authority of therapeutic discourse in order to argue that it was emotional and interpersonal dynamics that obstructed emuna or faith.

Kategoria inwestycji w języku life coachingu.

This paper is a part of the research on the language of life coaching. The text describes the infl uence of the language of business on the way of speaking of a man. In the examined text corpus containing, among others, business cards on websites and blogs of Polish life coaches, press articles, and training offers, a man is presented as capital to invest in to achieve an undefi ned success. A part of the study is the examination of the lexemes inwestycja (investment) and inwestować (to invest) and their collocations. The whole discussion is consistent with a broader refl ection on the expansion of the language of business, the language of economics, and the language of neoliberalism over the domains of life which had not been associated with the world of entrepreneurship before.

Determination of mothers’ depression levels by the type of special educational services they get for their autistic children

The purpose of this study is to determine the depression levels of mothers by the type of special educational services they got for their autistic children. Mothers of 20 male autistics and 5 female autistics participated in the study as volunteers. %24 of families got educational services from life coaches, %48 from O.Ç.E.M (Autistic Children Education Centers) and %28 from rehabilitation centers. Beck depression scale applied to volunteers to determine the depression levels (SCORES, Life Coach =16±7,05, O.Ç.E.M =13,83±7,05, Rehabilitation Center =25,57±9,28). Data were presented as mean, SD, frequency for description purpose. Variables were analyzed and were calculated by using Kruskal Wallis Test and Mann Whitney U tests. There is a significance difference at level of P<0.05 (p=0,035) between parents which get different types of special educational services. As a result; significant difference has found in the depression levels of parents which get special educational services from rehabilitation centers found more depressive then O.Ç.E.M and life coach services.