PreCharge: An Innovative Digital Program to Increase Coping, Resilience, and Health Care Engagement Among Cancer Previvors

Pro-Change Behavior Systems, Inc., West Kingston RI

Investigators

Abstract

Hereditary Cancer Syndromes (HCS) account for approximately 5-10% of all diagnosed cancers. Inherited genetic mutations resulting in HCS significantly increase the likelihood of developing cancer and pose risks across generations. Previvors—individuals who test positive for HCS mutations—carry up to an 80% lifetime cancer risk, face increased risks of developing multiple primary cancers, and often develop cancer at an early age. Previvors confront distinct challenges, such as intensive surveillance that leads to “scanxiety,” health uncertainties, and dual roles of managing their own health while also caring for relatives who have the same mutation. Epidemiologic models estimate that 1 in 279 people may carry one of the most common HCS: Lynch Syndrome. Advances in genetic testing have identified more inherited mutations and have made testing more accessible, increasing the number of individuals diagnosed with HCS and raising concerns about programs and services available to support previvors. Existing solutions are limited, underscoring the urgent need for effective, scalable interventions designed to promote previvors’ mental health and emotional well-being. Pro-Change has developed a digital intervention prototype, PreCharge, that is informed by the extensive formative work completed in Phase I. The program includes assessments, tailored feedback and text message communications, interactive activities and tools, and just-in-time assistance to enhance resilience and coping, both of which are critical to previvor well-being. It does this using tailored communications created by a rule- based AI engine and provide activities to assist previvors in: 1) getting informed; 2) navigating healthcare; 3) processing difficult emotions; 4) getting social support; and 5) engaging in self-care. It proactively offers tools to address "scanxiety" before medical appointments and users can text trigger words anytime for immediate assistance or additional support. In a 1-month pilot test involving 134 previvors with low to moderate levels of resilience, PreCharge was well received, demonstrating: statistically significant pre-post improvements in confidence to cope; notable pre-post improvements in resilience and psychological flexibility; and decreases in symptoms of anxiety and depression among participants. The proposed Phase II work aims to fully develop the PreCharge program, incorporating what was learned in the pilot, which will provide a more personalized, interactive, and integrated program experience. In the proposed Phase II work, the fully developed PreCharge program will be evaluated for its efficacy, engagement, and acceptability in a 6-month trial involving 574 previvors. Participants will be randomly assigned to a treatment or assessment-only control condition. Efficacy will be assessed by comparing changes in confidence to cope at 3- and 6-month follow-ups, as well as changes in secondary outcomes including anxiety, depression and resilience. Successful completion of Phase II will position PreCharge as an evidence-based previvor well-being intervention to be disseminated to genetic testing providers, genetic counselors, wellness platform providers, and other organizations.