Enhancing Hope Among Patients With Poor-Prognosis Breast Cancer and Oncologists

The aim of the proposed research is to study the impact of hope interventions on the coping
behavior of women with advanced breast cancer and physicians who provide care to patients
with cancer.

It is the investigator's contention, that improved hopefulness among cancer patients can be
manifest in improved Quality of Life (QOL). The challenge is to find specific interventions
that can optimize hopefulness and thereby direct individuals to adopt behavior styles that
contribute to a positive effect on QOL.

Two separate single-day interventions and hope applications will be developed for patients
and oncologists, respectively. What will be common for each workshop is that there will be an
experienced counselor designated as "coordinator" who will be in charge of implementing the
program and monitoring group dynamics. The interventions will be structured with the program
advancing from the identification of goals to the development of directions reasonable
pathways for achieving the delineated goals. In addition to goal-directed exercises, the
workshop will employ narrative techniques which utilize literary triggers as a springboard
for reflective writing.

The smartphone-based application will prompt study participants on a daily basis to engage in
additional, short activities designed to augment hopefulness, assess progress in achieving
goals, and identifying challenges. In addition, the application will allow sustained
interaction of workshop participants through social media exchange.

Course materials will be sent to study participants one week prior to the conduct of the
workshop.

Baseline assessment of hopefulness will be carried out via the aforementioned validated
scales on the day of the workshop.

Re-assessment of hopefulness will occur at the end of the day and at the 3- month interval
visits.

Inclusion Criteria:

Inclusion Criteria (patient component of study)

- Diagnosis of invasive breast cancer that is Stage IV.

- Female, 18 years of age or older.

- Able to proficiently speak, read, write English.

- ECOG performance status between 0 and 3.

- Subjects must have a smartphone with at least "3rd generation" mobile technology, and
willingness to download and utilize specialized application

- Expected to continue cancer care at the institution where cancer was begun for the
duration of the study.

Inclusion Criteria (physician component of study)

- Board certification or board eligibility in any of the 3 oncologic disciplines:

- Medical Oncology

- Surgical Oncology

- Radiation Oncology

- Able to proficiently speak, read, write English.

- Subjects must have a smartphone with at least "3rd generation" mobile technology, and
willingness to download and utilize specialized application

- NB: There will not be active recruitment of physicians who are subordinate to the
respective investigators. In the event that such a physician desires to enroll on the
study, formal application will be made to the institutional ethics committees to
verify that coercion has not taken place.

Exclusion Criteria:

Exclusion Criteria (applies to both patients and physicians)

- Participant actively undergoing psychotherapy for depression.

- Documented history of Alzheimer's disease or other forms of dementia.

- Participants practicing mindfulness meditation for an average of more than 1
hour/week.