Efficacy of artificial intelligence‑integrated emotional granularity growth at improving resilience and quality of life in young and middle aged colorectal cancer survivors: protocol for a pilot randomised controlled trial

Authors

  • Jiyin Zhang School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
  • Joyce Oi Kwan Chung School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
  • Junjie Li Department of Electrical and Eletronic Engineering, Faculty of Engineering, and Research Centre for Data Science and Artificial Intelligence (RC-DSAI), The Hong Kong Polytechnic University, Hong Kong, China
  • Weilin Chen School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
  • Yan Li School of Nursing, China Medical University, Shenyang, Liaoning, China
  • Janelle Yorke School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom

DOI:

https://doi.org/10.18203/2349-3259.ijct20263276

Keywords:

Colorectal cancer, Emotional granularity, Resilience, Artificial intelligence, Randomized controlled trial, Protocol

Abstract

Background: Young and middle-aged colorectal cancer survivors frequently experience emotional distress and difficulties adapting during the cancer trajectory. Emotional granularity, the ability to identify and differentiate emotional experiences, may represent a modifiable target for improving emotion regulation and resilience. However, interventions targeting emotional granularity among colorectal cancer survivors remain limited. The artificial intelligence-integrated emotional granularity growth program (AI-EGG), delivered via a WeChat mini program, was developed to enhance resilience and quality of life.

Methods: A two-arm pilot randomised controlled trial will evaluate the feasibility, acceptability, and preliminary efficacy of AI-EGG among young and middle-aged colorectal cancer survivors. Fifty-four participants will be randomly assigned (1:1) to either the intervention group or usual care across three teaching hospitals in Suzhou, China. The intervention group will receive a four-week AI-EGG intervention consisting of emotion identification and differentiation, selection of regulation strategies, implementation of regulation strategies, and maintenance and adaptation. Primary outcomes include recruitment, retention, adherence, ecological momentary assessment completion, and system usability. Secondary outcomes will include resilience, emotional granularity, emotion regulation, and quality of life. Assessments will occur at baseline, post-intervention, and one-month follow-up. Semi-structured interviews with a purposive subsample will explore acceptability and implementation experiences. Ethical approval has been obtained from the Human Subjects Ethics Sub-Committee of The Hong Kong Polytechnic University and participating hospitals.

Conclusions: This study will evaluate the feasibility, acceptability, and preliminary efficacy of AI-EGG for young and middle-aged colorectal cancer survivors and inform intervention refinement and a future definitive trial.

Trial Registration: The trial is registered at ClinicalTrials.gov (NCT07611071).

 

References

Ratjen I, Schafmayer C, Enderle J, di Giuseppe R, Waniek S, Koch M, et al. Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a german cohort study. BMC Cancer. 2018;18(1):1156.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin. 2024;74(3):229-63.

Xia C, Dong X, Li H, Cao M, Sun D, He S, et al. Cancer statistics in China and united states, 2022: profiles, trends, and determinants. Chinese Med J-peking. 2022;135(5):584-90.

Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, et al. Progress in cancer mortality, incidence, and survival: a global overview. Eur J Cancer Prev. 2020;29(5):367.

Medeiros M, Oshima CTF, Forones NM. Depression and anxiety in colorectal cancer patients. J Gastrointest Cancer. 2010;41(3):179-84.

Tamura S. Factors related to resilience, anxiety/depression, and quality of life in patients with colorectal cancer undergoing chemotherapy in Japan. Asia-Pac J Oncol Nurs. 2021;8(4):393-402.

Li X, Xiao X, Wu Z, Li A, Wang W, Lin R. Global, regional, and national burden of early-onset colorectal cancer and projection to 2050: an analysis based on the global burden of disease study 2021. Public Health. 2025;238:245-53.

Ong SS, Xu L, Deng X, Lu H, Xu T. Trends, global comparisons, and projections of early onset colorectal cancer burden in China based on GBD study 2021. Sci Rep. 2025;15:2969.

Jeon S, Sikorskii A, Given BA, Given CW, Redeker NS. Latent transition analysis of the symptom experience of cancer patients undergoing chemotherapy. Nurs Res. 2019;68(2):91-8.

Fletcher KM, Revette A, Enzinger A, Biller L, MacDougall K, Brown MB, et al. Experience and needs of patients with young-onset colorectal cancer and their caregivers: a qualitative study. JCO Oncol Pract. 2024;OP2400002.

Ghazal LV, Abrahamse P, Ward KC, Morris AM, Hawley ST, Veenstra CM. Financial toxicity and its association with health-related quality of life among partners of colorectal cancer survivors. JAMA Netw Open. 2023;6(4):e235897.

Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatology. 2014;5.

Deshields TL, Heiland MF, Kracen AC, Dua P. Resilience in adults with cancer: development of a conceptual model. Psychooncology. 2016;25(1):11-8.

Troy AS, Willroth EC, Shallcross AJ, Giuliani NR, Gross JJ, Mauss IB. Psychological resilience: an affect-regulation framework. Annu Rev Psychol. 2023;74(1):547-76.

Ding X, Zhao F, Wang Q, Zhu M, Kan H, Fu E, et al. Effects of interventions for enhancing resilience in cancer patients: A systematic review and network meta-analysis. Clin Psychol Rev. 2024;108:102381.

Lin C, Diao Y, Dong Z, Song J, Bao C. The effect of attention and interpretation therapy on psychological resilience, cancer-related fatigue, and negative emotions of patients after colon cancer surgery. Ann Palliat Med. 2020;9(5):3261-70.

Barrett LF. Solving the emotion paradox: categorization and the experience of emotion. Personality Soc Psychol Rev. 2006;10:20-46.

Tan TY, Wachsmuth L, Tugade MM. Emotional nuance: examining positive emotional granularity and well-being. Front Psychol. 2022;13:715966.

Kalokerinos EK, Erbas Y, Ceulemans E, Kuppens P. Differentiate to Regulate: Low Negative Emotion Differentiation Is Associated With Ineffective Use but Not Selection of Emotion-Regulation Strategies. Psychol Sci. 2019;30(6):863-79.

Erbas Y, Gendron M, Fugate JMB. Editorial: the role of emotional granularity in emotional regulation, mental disorders, and well-being. Front Psychol. 2022;13:1080713.

Gross JJ. Emotion Regulation: Current Status and Future Prospects. Psychological Inquiry. 2015;26(1):1-26.

Mosher CE, Winger JG, Given BA, Shahda S, Helft PR. A systematic review of psychosocial interventions for colorectal cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer. 2017;25(7):2349-62.

World Health Organization (WHO). World mental health report: Transforming mental health for all. 2022. Available at: https://iris.who.int/bitstream/ handle/10665/356119/9789240049338-chi.pdf. Accessed on 15 May 2026.

Chen Z, Wang Q, Sun Y, Cai H, Lu X. Chat-ePRO: development and pilot study of an electronic patient-reported outcomes system based on ChatGPT. J Biomed Inf. 2024;154:104651.

Elyoseph Z, Hadar-Shoval D, Asraf K, Lvovsky M. ChatGPT outperforms humans in emotional awareness evaluations. Front Psychol. 2023;26:14.

Wolff J, Seidel S, Wuelfing P, Lux MP, Eulenburg C zu, Smollich M, et al. App-based support for breast cancer patients to reduce psychological distress during therapy and survivorship – a multicentric randomized controlled trial. Front Oncol. 2024;18:14.

Zhang Y, Flannery M, Zhang Z, Underhill-Blazey M, Bobry M, Leblanc N, et al. Digital health psychosocial intervention in adult patients with cancer and their families: systematic review and meta-analysis. JMIR Cancer. 2024;10(1):e46116.

Willcox G. The feeling wheel: a tool for expanding awareness of emotions and increasing spontaneity and intimacy. Trans Anal J. 1982;12(4):274-6.

Wang Y, Lei T, Liu X. Chinese system usability scale: translation, revision, psychological measurement. Int J Hum Comp Interact. 2020;36(10):953-63.

Campbell-Sills L, Cohan SL, Stein MB. Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behav Res Ther. 2006;44(4):585-99.

Connor KM, Davidson JRT, Lee LC. Spirituality, resilience, and anger in survivors of violent trauma: a community survey. J Trauma Stress. 2003;16(5):487-94.

Ye ZJ, Qiu HZ, Li PF, Chen P, Liang MZ, Liu ML, et al. Validation and application of the chinese version of the 10-item connor-davidson resilience scale (CD-RISC-10) among parents of children with cancer diagnosis. Eur J Oncol Nurs. 2017;27:36-44.

Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the functional assessment of cancer therapy-colorectal (FACT-C) quality of life instrument. Qual Life Res. 1999;8(3):181-95.

Liu M, Wu H. Validation of Chinese Version of the Functional Assessment of Cancer Therapy-Colorectal in Patients with Colorectal Cancer. Chin Med Rec. 2020;21(3):90-2.

Kang S, Shaver PR. Individual differences in emotional complexity: their psychological implications. J Pers. 2004;72(4):687-726.

Wang H, Zhang J, Liu T, Yao B, Zhu Y. Validity and Reliability of the Chinese Version of the Range and Differentiation of Emotional Experiences Scale in Medical Undergraduates. Chinese Ment Health J. 2015;29(7):549-50.

Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assessment. 2004;26(1):41-54.

Wang L. Test of Difficulties in Emotion Regulation Scale in Chinese People. China J Health Psychol. 2007;15(4):336-9.

Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25(3):1057-73.

Alsakarneh S, Jaber F, Beran A, Aldiabat M, Abboud Y, Hassan N, et al. The national burden of colorectal cancer in the United States from 1990 to 2019. Cancers. 2024;16(1):205.

Baronas VA, Arif AA, Bhang E, Ladua GK, Brown CJ, Donnellan F, et al. Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer: a multicenter retrospective analysis. Curr Oncol. 2024;31(4):2133-44.

Patel SG, Ahnen DJ. Colorectal cancer in the young. Curr Gastroenterol Rep. 2018;20(4):15.

Burgoyne MJ, Bingen K, Leuck J, Dasgupta M, Ryan P, Hoffmann RG. Cancer-related distress in young adults compared to middle-aged and senior adults. J Adolesc Young Adult Oncol. 2015;4(2):56-63.

Gruß I, Hanson G, Bradley C, McMullen C, Ritzwoller D, Hodge S, et al. Colorectal cancer survivors’ challenges to returning to work: a qualitative study. Eur J Cancer Care. 2019;28(4).

Yoon S, Chua TB, Tan IB, Matchar D, Ong MEH, Tan E. Living with long‐term consequences: experience of follow‐up care and support needs among asian long‐term colorectal cancer survivors. Psychooncology. 2020;29(10):1557-63.

Zheng Z, Hu X, Banegas MP, Han X, Zhao J, Shi KS, et al. Health‐related social needs, medical financial hardship, and mortality risk among cancer survivors. Cancer. 2024;130(17):2938-47.

Sihvola SP, Kiwanuka F, Kvist TA. Promoting resilience among adult cancer patients: An integrative review of patient education methods. Eur J Oncol Nurs. 2023;64:102342.

Ding X, Fang Z, Wang Q, Zhu M, Kan H, Fu E, et al. Effects of interventions for enhancing resilience in cancer patients: A systematic review and network meta-analysis. Clin Psychol Rev. 2024;108:102381.

Axelsson E, Hedman-Lagerlöf E. Unwanted outcomes in cognitive behavior therapy for pathological health anxiety: a systematic review and a secondary original study of two randomized controlled trials. Expert Rev Pharmacoeconomics Outcomes Res. 2023;23(9):1001-15.

Zhang J, Chung JOK, Taylor S, Yorke J. Emotional strategies to enhance resilience in patients with cancer: a scoping review. Asia-Pac J Oncol Nurs. 2025;12:100777.

Kashdan TB, Barrett LF, McKnight PE. Unpacking Emotion Differentiation: Transforming Unpleasant Experience by Perceiving Distinctions in Negativity. Curr Dir Psychol Sci. 2015;24(1):10-6.

Ozomaro B, Wein PY, Miller S, Ospina LH, Goodman M, Torous J, et al. Emotional granularity in health and psychopathology: A scoping review. J Psychiatr Res. 2025;190:277-95.

Smidt KE, Suvak MK. A brief, but nuanced, review of emotional granularity and emotion differentiation research. Curr Opin Psychol. 2015;3:48-51.

Hoemann K, Barrett LF, Quigley KS. Emotional granularity increases with intensive ambulatory assessment: methodological and individual factors influence how much. Front Psychol. 2021;12:704125.

Vedernikova E, Kuppens P, Erbas Y. From knowledge to differentiation: increasing emotion knowledge through an intervention increases negative emotion differentiation. Front Psychol. 2021;12:703757.

Beck AT. Cognitive Therapy: Nature and Relation to Behavior Therapy – Republished Article. Behav Ther. 2016;47(6):776-84.

Thakkar A, Gupta A, De Sousa A. Artificial intelligence in positive mental health: a narrative review. Front Digital Health. 2024;6:1280235.

Zhong W, Luo J, Zhang H. The therapeutic effectiveness of artificial intelligence-based chatbots in alleviation of depressive and anxiety symptoms in short-course treatments: a systematic review and meta-analysis. J Affect Disord. 2024;356:459-69.

Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.

Downloads

Published

2026-09-16

How to Cite

Zhang, J., Chung, J. O. K., Li, J., Chen, W., Li, Y., & Yorke, J. (2026). Efficacy of artificial intelligence‑integrated emotional granularity growth at improving resilience and quality of life in young and middle aged colorectal cancer survivors: protocol for a pilot randomised controlled trial. International Journal of Clinical Trials. https://doi.org/10.18203/2349-3259.ijct20263276

Issue

Section

Protocols