Original Research Cocreating Meaning Through Expressive Writing and Reading for Cancer Caregivers Yvonne W. Leung, PhD 1,2 , Marta M. Maslej, PhD 3 , Clara Ho, MSW 2,4 , Shima Razavi, BSc, BA 2 , Paul Uy, MD, FRCPC 1 , Mehr-Afarin Hosseini, MD, FRCPC 1 , Jonathan Avery, PhD 2 , Gary Rodin, MD, FRCPC 1,2 , and Allan Peterkin, MD, FRCPC 1,5 Abstract Purpose: Caregivers of patients with cancer cope with socioemotional challenges, which can adversely affect their well-being. We developed an intervention, expressive writing and reading (EWR), to promote emotional processing and social con- nectedness among caregivers. In a single-arm pilot study, we assessed its feasibility and perceived usefulness. Methods: Care- givers participated in weekly 1.5-hour EWR workshops offered over 20 weeks. After 4 sessions, they completed semistructured interviews, which were analyzed using qualitative descriptive analysis. Findings: Of 65 caregivers approached, 25 were eligible, 18 consented, and 9 (50%) caregivers completed at least 4 workshops and the interview. Their responses revealed 3 themes: ‘‘inner processing,’’ ‘‘interpersonal learning,’’ and ‘‘enhanced processing and preparedness.’’ Perceived benefits of EWR included emotional and cognitive processing (individual and collaborative), learning from the emotions and experiences of other caregivers, and preparing for upcoming challenges. Conclusions: Expressive writing and reading can be a safe and cost-effective supportive intervention for caregivers of patients with cancer. Keywords expressive writing, caregiving, interventions, social support, emotional processing Introduction In 2012, there were 14 million new cancer diagnoses world- wide. 1 With the rate of survival increasing, significant car- egiving responsibilities are being transferred to informal caregivers who are usually spouses, adult children, friends, and relatives of the patients. 2 These caregivers are tasked with managing medications, symptoms, and distress. 3 They often face social, physical, and psychological challenges, which can take a significant toll on their health. 4-6 Up to 35% of family caregivers experience depression and anxiety 7 and feelings of helplessness, hopelessness, and anticipated loss and grief. 4,8 For this reason, caregivers have been recog- nized as ‘‘second-order patients,’’ who should be receiving supportive care. 9 The distress experienced by caregivers may be in part related to isolation and inadequate social support. 10,11 Lone- liness is common to patients with cancer and their caregivers, but as compared to patients, caregivers report feeling less socially and emotionally supported by their families and health-care professionals. 11,12 Caregivers express a desire for increased communication and support from their social net- works. 13 Social support may be particularly important in the final stages of illness, when the burden of caregiving is accom- panied by the stress of preparing for bereavement and antici- pating loss. 12 Unfortunately, few family care services have been incorporated into clinical oncology settings. 5 There is a need for safe and cost-effective interventions to support care- givers in their difficult journies. 14,15 One existing psychosocial intervention that may address this need is expressive writing (EW). Expressive writing involves sessions of solitary and unconstrained writing about personal experiences and life events. 16 Expressive writing promotes emotional and cognitive processing when writers articulate and explore their thoughts and feelings. 17-19 Despite small effect sizes, it has been associated with improved well-being and various health-related outcomes in different samples (for a meta-analysis, see the study by Frattaroli 20 ). Importantly, it is simple and implemented with minimal clinician intervention, making it a cost-effective strategy to enhance well-being. 21-24 1 Department of Psychiatry, University of Toronto, Ontario, Canada 2 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada 3 Centre for Addiction and Mental Health, Toronto, Ontario, Canada 4 Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada 5 Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada Corresponding Author: Yvonne W. Leung, The de Souza Institute, University Health Network, 700 Bay Street, Suite 1903, Toronto, Ontario, Canada M5G 2A1. Email: yvonne.leung@desouzainstitute.com Journal of Palliative Care 1-9 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0825859719871538 journals.sagepub.com/home/pal