CesiKids Trial: Enhancing Psychological Resilience in Adolescents With Cancer

This study aims to develop an innovative mobile-based co-design intervention program to strengthen psychosocial resilience among adolescents aged 12-18 diagnosed with cancer. The program will be structured based on Bronfenbrenner's Ecological Systems Theory, addressing adolescents' individual characteristics, family and close-social environment, and broader ecological interactions in a holistic manner. To date, no study has implemented a theoretically grounded, mobile psychosocial intervention designed specifically to enhance resilience in adolescents with cancer through a co-design process involving nurses, recovered adolescents, and parents. This project aims to fill this gap by presenting a model that can be integrated into both clinical practice and educational settings.

The research will be conducted using a randomized controlled experimental design with intervention and control groups. The intervention group will participate in the newly developed mobile CesiKids program and engage in structured sessions for four weeks to enhance psychosocial resilience skills. The control group will receive standard clinical care. Participants' coping and psychosocial resilience levels will be measured using the Pediatric Cancer Coping Scale (PCCS) and the Child and Youth Resilience Measure (CYRM-R). Data collection will take place at baseline (T0), post-intervention (T1) and during follow-up assessments (T2 and T3). Quantitative data will be analyzed statistically, and the feasibility and usability of the program will also be monitored.

The CesiKids application will be developed by the project leader and research team. Data collection will be carried out by a nurse researcher experienced in pediatric oncology. All intervention, data collection, and analysis procedures will be carefully planned and monitored. All study data will be anonymized and accessible only to the research team. Data will be securely stored on protected servers and maintained throughout the project. All research processes will be conducted in accordance with ethical standards, and participant rights will be fully respected.

The project is expected to generate an evidence-based model that enhances psychosocial resilience among adolescents with cancer. The developed program will be applicable and scalable in both clinical and educational environments. Findings will be disseminated through academic publications, conference presentations, and among relevant healthcare institutions to ensure sustainability and maximize societal impact. Ultimately, this study intends to provide a practical contribution to the field of adolescent psychosocial resilience and to support the adaptation of similar interventions for other chronic illness groups.

• CesiKids Mobile-Based Psychological Resilience Program (Other), also known as CesiKids Psychological Resilience Intervention, CesiKids Mobile Application, CesiKids Program: The CesiKids Program will be a nurse-led, AI-supported mobile intervention to enhance psychological resilience in adolescents diagnosed with cancer. Grounded in Bronfenbrenner's Bioecological Theory, it will address interactions between adolescents and their family, peers, and clinical environments. Developed through a co-design process with nurses, recovered adolescents, and parents, the program will include AI-driven adaptive feedback and emotional support features. Delivered over four weeks with structured digital sessions, CesiKids will promote emotional regulation, coping, and resilience through interactive storytelling, reflection, and personalized guidance. This integrative model will combine ecological principles, AI personalization, and participatory design to create an innovative psychosocial care approach for hospitalized adolescents with cancer.

Primary outcomes

• Child and Youth Resilience Measure (CYRM-R) [Baseline (prior to intervention), immediately post-intervention (within 1 week after completion), 3 months post-intervention, and 6 months post-intervention]: The Child and Youth Resilience Measure-Revised (CYRM-R) is a multidimensional scale based on the socio-ecological model to assess resilience. The 28-item original version was developed by Liebenberg, Ungar, and Van de Vijver through the International Resilience Project. Later, Liebenberg, Ungar, and LeBlanc created a 12-item short form with three subscales: individual, relational, and contextual resilience. Factor loadings ranged from .39-.88, and Cronbach's alpha was .84. Items are rated on a five-point Likert scale (1-5), with higher scores indicating greater resilience. The Turkish adaptation by Arslan showed strong reliability (α = .91; item-total correlations = .45-.79). In this study, the CYRM-R will assess changes in adolescents' resilience after the CesiKids program.

Secondary outcomes

• Pediatric Cancer Coping Scale (PCCS) [Baseline (prior to intervention), immediately post-intervention (within 1 week after completion), 3 months post-intervention, and 6 months post-intervention]: The scale was developed by Wu et al. to assess coping strategies among adolescents aged 7-18 diagnosed with cancer. The Turkish validity and reliability study was conducted by Şengül and Törüner with children in the same age range. The scale includes 33 items across three dimensions: cognitive coping, problem-focused coping, and defensive coping. Items are rated on a 0-3 scale, with total scores ranging from 0 to 99. Higher scores indicate stronger coping strategies. The original version showed a Cronbach's alpha of 0.91, while the Turkish version reported 0.77. The scale has been used to assess coping levels in pediatric oncology populations. In this study, it will be used to evaluate the effectiveness of the CesiKids program in enhancing adolescents' coping skills with cancer.

Sex: All, ages: 12 Years to 18 Years

Inclusion Criteria:

* Parents have provided informed consent after receiving information,
* The child has given assent to participate after being informed,
* The child is between 12 and 18 years of age,
* The child has been diagnosed with cancer and is currently receiving inpatient treatment,
* The child is undergoing chemotherapy and/or radiotherapy,
* The child is able to use a computer and/or smartphone,
* The child can understand and speak Turkish.

Exclusion Criteria:

* Receiving hematopoietic stem cell transplantation treatment,
* Having developed a relapse after remission,
* Experiencing communication difficulties (e.g., intellectual disability, visual impairment, etc.),
* Having a psychiatric diagnosis made by a psychiatrist,
* Having experienced a significant life event affecting psychological well-being within the past four weeks (e.g., death, divorce, etc.).

• Ayfer AÇIKGÖZ, PhD, Study director, Eskişehir Osmangazi University Faculty of Health Sciences