Lu, Q., Zheng, D., Young, L., Kagawa-Singer, M., & Loh, A. (2012). A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychology, 31, 548–551.

To test the feasibility, cultural sensitivity, and effect of an expressive writing intervention.

Patients completed baseline assessments by mail and received three envelopes that were to be opened according to labels for study week. They were asked to write about their deepest feelings about having cancer and about the strategies they used for coping. They were to write for 20 minutes each week. After the last writing assignment and three and six months later they completed study questionnaires by mail. Focus group interviews were also conducted.

• The sample was comprised of 19 women.   
• Mean age was 54 years (range 31–83).
• Patients had stage I and II breast cancer. 
• Mean time since diagnosis was two years.
• Patients has been in the United States an average of 19 years.
• Most patients had a household income of less than $15,000, and more than 90% had a high school education.

 The study used a quasiexperimental, pre-/post repeated measures design.

• Functional Assessment of Cancer Therapy–Breast (FACT-B)
• Physical symptoms checklist
• Positive and Negative Affect Score (PANAS)
• Posttraumatic Growth Inventory (PTGI)
   

At three months, the change in fatigue showed a partial eta² of 0.066, and eta² for posttraumatic stress was 0.208. There was 100% compliance in completing writing assignments. Patients commented that the activity was meaningful for Chinese women.

 Findings suggested that expressive writing is a feasible and acceptable intervention for Chinese American women.

• The study had a small sample size, with less than 30 patients.
• The study had risks of bias due to no control group, no blinding, no random assignment, and the sample characteristics.*
• Unintended interventions or applicable interventions not described would have influenced the results.
• Outcomes reporting was selective.
• Patient withdrawals were 10% or greater.
• * The activity may not be acceptable to other cultural groups or to men. There was a 15% drop-out rate, suggesting that not all women appreciated the approach. The authors provided no confidence intervals for the statistics reported. Repeated measures may have given testing threat to validity.

Expressive writing appeared to be an acceptable intervention for these women. The study design and sample size did not allow for any firm conclusions about effects to be drawn.