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A randomized factorial trial could allow for evaluation of the unique contribution of treatment components to overall treatment effects. The IN-FACT-0 trial assessed the feasibility of such an approach for building an online support program for reducing long-term psychiatric symptoms in cancer survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a full factorial experiment, 40 survivors of breast, testicular, or thyroid cancer with clinically significant depressive symptoms, anxiety, or fear of recurrence were randomized to combinations of three treatment components: (i) behavioral activation, (ii) systematic exposure, and (iii) healthy lifestyle promotion. All groups, including a control group, received rudimentary support and kept a symptom diary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      On average, therapists rated the feasibility of the study design 9 on a scale from 0 (\u201cnot feasible at all\u201d) to 10 (\u201cfully feasible\u201d). The Credibility\/Expectancy Scale mean was 36.6 (SD\u2009=\u20098.2). Participants initiated a mean of 6.1 (SD\u2009=\u20092.2, median\u2009=\u20097) out of 8 modules, and 90% (36\/40) completed the post-treatment assessment. The mean Client Satisfaction Questionnaire score was 24.3 (SD\u2009=\u20095.7). One adverse event each was reported by 2\/36 (6%) participants. No event was serious. The mean reduction was large in depressive symptoms (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.83) and moderate in general anxiety (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.55) and fear of recurrence (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.54).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This randomized factorial trial design was feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Cancer Survivors<\/jats:title>\n                    <jats:p>This trial design may be used to develop effective, evidence-based interventions for cancer survivors with psychiatric symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06046573 (registered 2023\u201309-21).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11764-025-01905-2","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T01:23:52Z","timestamp":1761355432000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proof-of-concept for a randomized factorial design strategy to build a complex online support program for cancer survivors with psychiatric symptoms: the IN-FACT-0 feasibility trial"],"prefix":"10.1007","author":[{"given":"Julia","family":"Winter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Gasslander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustaf","family":"Rane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia","family":"Sundstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Bj\u00f6rkhem-Bergman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christel","family":"Hedman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erland","family":"Axelsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"1905_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-023-00776-9","author":"MB Lustberg","year":"2023","unstructured":"Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. 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