Expressive Writing for Resilience in Adult Pediatric Oncology Survivors and Their Caregivers (2018-2019)


Despite successful treatment of childhood cancer, the emotional effects are lasting. Studies have shown that adult survivors of pediatric cancer are more likely to experience a myriad of physical and psychological late effects of their illness. The effects of childhood cancer are not limited to the children themselves: parents and caregivers report significant emotional distress.

Expressive writing is prompt-guided intervention designed to promote healing from trauma and emotional upheavals, to resolve life challenges, cultivate resilience and improve overall health and well-being. An accessible, low-cost intervention, writing to heal may improve quality of life and reduce the negative physical and psychosocial effects of cancer in adult oncology populations.

Project Description

This Bass Connections project aims to determine whether a pilot expressive writing intervention raises resilience scores as measured by the Connor-Davidson Resilience Scale for adult survivors of childhood cancer and their caregivers.

Phase 1 – Pilot Intervention

Through the Duke Supportive Care and Survivorship Clinic, the project team will recruit 8-10 dyads of adult survivors of pediatric cancer and their caregivers during the time of their cancer treatment. These participants will take part in a three-hour writing workshop at Duke Integrative Medicine. Expressive writing prompts will encourage them to reflect on what life was like before their (or their loved one’s) cancer diagnosis, their experiences during and after treatment and what they wish they could share with fellow cancer patients or caregivers who have just been diagnosed. Student team members will participate in an interactive training focused on expressive writing and narrative medicine.

Phase 2 – Integrating Lessons Learned

The second phase will integrate lessons from the first iteration of the intervention through a seminar hosted by the Trent Center for Bioethics. The seminar will allow students and collaborators to discuss real-life examples of the experiences of adult survivors of childhood cancer drawn from the intervention.

Anticipated Outcomes

Publication of outcomes; data for use in grant applications and for scaling the intervention to test in a variety of clinical settings


Fall 2018 – Fall 2019  

  • Fall 2018: September: seminar session 1; Medicine and Storytelling course begins; September–November: seminar session 2; students receive training in research methods; recruitment and consent at the Duke Supportive Care and Survivorship Clinic; December: administration of pre-intervention survey to research volunteers; Medicine and Storytelling course concludes, but student participation continues
  • Spring 2019: January: Writing workshop intervention for research volunteers at Duke Integrative Medicine; February: administration of post-intervention survey; seminar session 3; March–April: data analysis of research results; April: debriefing and review of intervention (session 4); May: planning for second intervention (session 5)
  • Summer 2019: July: closing session to review data and analysis (session 6); July–August: manuscript writing and preparation to present data
  • Fall 2019: September: integration seminar presenting lessons learned to undergraduate and graduate students, faculty, staff and representatives from Duke’s Adolescent and Young Adult cancer survivorship program

Team Outcomes to Date

Expressive Writing for Resilience: Writing to Heal (poster by Jill Jones, Dahlia Chacon, Arthi Kozhumam, Nicoly Santos, Jai Eun Huh, Katie Xu, Anna Savelyeva, Lucy Zheng, John Evans, Oliver Glass, Ray Barfield, Elizabeth Matteson Bechard, presented at Bass Connections Showcase, Duke University, April 17, 2019)

Oliver Glass, Mark Dreusicke, John Evans, Elizabeth Bechard, Ruth Q. Wolever. 2019. “Expressive writing to improve resilience to trauma: A clinical feasibility trial.” Complementary Therapies in Clinical Practice 34:240-246


Expressive Writing for Resilience: Writing to Heal

Expressive Writing for Resilience in Adult Pediatric Oncology Survivors and Their Caregivers


Sydney Grob

This Team in the News

Four Duke Juniors Named Goldwater Scholars

Class of 2019: Biology Student Learns the Value of Expressive Writing in Healing

Bass Connections: Expressive Writing as Therapy for Pediatric Cancer Survivors

New Blogger: Victoria Priester Loves Animals and Books

Meet the Members of the 2018-19 Student Advisory Council

fountain pen and paper

Team Leaders

  • Raymond Barfield, School of Medicine-Pediatrics
  • John Evans, Wellness & Writing Connections
  • Oliver Glass, School of Medicine-Medicine: General Internal Medicine

/graduate Team Members

  • Eunji Cho, Nursing-PHD
  • Yufen Lin, Nursing-PHD

/undergraduate Team Members

  • Dorothy Adu-Amankwah, English (AB)
  • Grace Cai, Psychology (AB), Global Health (AB2)
  • Dahlia Chacon, English (AB)
  • Thea Dowrich
  • Lydia Goff, English (AB), Biology (BS2)
  • Sydney Grob, Biology (BS)
  • Charles Huang, Biology (BS)
  • Jai Eun Huh, Chemistry (AB)
  • Jill Jones, Neuroscience (BS), Linguistics (AB2)
  • Arthi Kozhumam, Biology (BS), Global Health (AB2)
  • Sydny Long
  • Lindsay Maggioncalda
  • Caitlyn Martinez, Biology (BS)
  • Teresa Meng, Biology (BS)
  • Victoria Priester
  • Holly Ren, Public Policy Studies (AB)
  • Nicoly Santos, Psychology (BS)
  • Sabina Savelyeva, Biology (BS)
  • Dorothy Smith, Neuroscience (BS)
  • Ayesha Syed
  • Katie Xu, Cultural Anthropology (AB)
  • Megan Zhao, Russian (AB)
  • Lucy Zheng

/yfaculty/staff Team Members

  • Elizabeth Matteson Bechard, Duke Center for Integrative Medicine