Mental Health CPR for Cancer Survivors

This outcome reflects the successful design, adaptation, and completion of the Community Toolbox - a culturally and linguistically tailored set of multimedia and printed resources developed to support the implementation of the Mental Health CPR intervention by Community Mental Health Workers (CMHWs). The Toolbox integrates educational modules, testimonial videos, infographics, and text message templates addressing distress screening, stigma reduction, communication enhancement, and linkage to psycho-oncology services. Completion is defined as finalization of all Toolbox modules validated through expert and community stakeholder review under Specific Aim 1.

The Distress Thermometer (DT) is a validated single-item visual analog screening tool developed by the National Comprehensive Cancer Network (NCCN) to measure psychological distress in cancer patients. Participants rate their distress over the past week on a scale from 0 (no distress) to 10 (extreme distress). Higher scores indicate greater emotional distress. Mean DT score (0-10 scale)

The percentage of participants who, after being screened for psychological distress, accept and complete at least one referral to psycho-oncology or behavioral health services. Uptake will be defined as documented attendance at one or more sessions with a licensed mental health or psycho-oncology provider. Data will be collected through Community Mental Health Worker (CMHW) tracking logs and verified by participant follow-up. Higher percentages indicate greater engagement in mental health services following the intervention.

The Communication and Caregiving Assessment Tool - Patient Form (CCAT-PF) is a validated self-report scale that assesses the quality and effectiveness of communication between patients and their primary caregivers. The scale includes items rated on a Likert-type format to evaluate understanding, emotional support, and problem-solving aspects of the patient-caregiver relationship. Higher scores indicate better communication quality. Mean score on the CCAT-PF (range 1-5)

The Communication and Caregiving Assessment Tool - Patient Form (CCAT-PF) is a validated self-report instrument that measures the patient's perception of communication quality with their primary caregiver. Items are rated on a Likert-type scale assessing emotional support, understanding, and collaborative problem solving. Higher scores indicate better communication quality. Mean CCAT-PF total score (range 1-5)

The Self-Stigma of Mental Illness Scale (SSMIS), developed by Corrigan et al. (2006), is a validated 40-item self-report instrument that measures internalized stigma toward mental illness and help-seeking. The SSMIS assesses four sequential components of self-stigma: awareness of stereotypes, agreement with stereotypes, application of stereotypes to oneself, and harm to self-esteem. Items are rated on a 9-point Likert scale (1 = strongly disagree to 9 = strongly agree). Higher scores indicate greater self-stigma. Mean SSMIS total score (range 1-9)

The Hospital Anxiety and Depression Scale (HADS), is a validated 14-item self-report questionnaire designed to assess symptoms of anxiety and depression in medical and community populations. It consists of two subscales-HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D)-each containing 7 items scored from 0 to 3. Subscale scores range from 0 to 21, with higher scores indicating greater anxiety or depression symptom severity. Mean HADS-A and HADS-D subscale scores (range 0-21)

The Functional Assessment of Cancer Therapy - General (FACT-G, Version 4) is a validated 27-item questionnaire developed by Cella et al. (1993) that measures health-related quality of life in cancer patients across four domains: Physical, Social/Family, Emotional, and Functional Well-Being. Each item is rated on a 5-point Likert-type scale (0-4). Higher scores indicate better quality of life.

Population: Adult cancer survivors enrolled in the Mental Health CPR study. Unit of Measure: Mean FACT-G total score (range 0-108)

The Multidimensional Scale of Perceived Social Support (MSPSS), developed by Zimet et al. (1988), is a validated 12-item self-report questionnaire that measures perceived social support from three sources: family, friends, and significant others. Each item is rated on a 7-point Likert scale (1 = very strongly disagree to 7 = very strongly agree). Higher total scores indicate greater perceived social support. Mean MSPSS total score (range 1-7)

The Brief Resilience Scale (BRS), developed by Smith et al. (2008), is a 6-item self-report questionnaire designed to assess the ability to recover from stress. Items are rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Higher scores reflect greater resilience. Mean BRS total score (range 1-5)

Salivary cortisol and alpha-amylase levels will be measured as biomarkers of physiological stress response. Saliva samples will be collected from participants at baseline and post-intervention following standardized collection procedures (e.g., morning fasting samples). Samples will be stored and analyzed in a blinded laboratory setting using enzyme-linked immunosorbent assay (ELISA) and kinetic enzyme assays. Higher cortisol and alpha-amylase concentrations indicate higher physiological stress activation. Laboratory personnel conducting assays are blinded to participants' group assignments. Mean salivary cortisol (µg/dL); mean salivary alpha-amylase (U/mL)

Salivary cytokine and chemokine concentrations will be analyzed as biomarkers of inflammation and immune activation associated with stress response. Samples will be collected using standardized saliva collection procedures and stored at -80°C until analysis. Laboratory assays will be performed using multiplex immunoassay or enzyme-linked immunosorbent assay (ELISA) methods to quantify cytokines (e.g., IL-6, IL-10, TNF-α) and chemokines (e.g., MCP-1, IL-8). All laboratory personnel conducting the analyses are blinded to participants' group assignments to ensure unbiased outcome assessment. Higher concentrations reflect greater inflammatory response. Mean concentration (pg/mL)